Hill Kathleen, Sharp Rebecca, Childs Jessie, Esterman Adrian, Le Leu Richard, Juneja Rajiv, Jesudason Shilpa
University of South Australia, Adelaide, SA, Australia.
Central and Northern Adelaide Renal and Transplantation Service, Adelaide, SA, Australia.
J Vasc Access. 2020 Sep;21(5):573-581. doi: 10.1177/1129729819869093. Epub 2019 Aug 18.
A functioning long-term vascular access is required for haemodialysis therapy; however, establishing this can be challenging in the setting of advanced age and vessels damaged by diabetes. Complications include the inability to insert two needles for the treatment resulting in miscannulation trauma and in some cases insertion of a temporary central venous access device. The broad objective of this review is to define the evidence base regarding cannulation practices in the initiation of haemodialysis via an arteriovenous fistula or an arteriovenous graft.
This review uses the framework recommended by the Joanna Briggs Institute and the process by which papers were included or excluded followed the standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses group approach. A total of 20 primary research studies met the inclusion criteria.
Cannulation in the 10- to 15-week period rather than delaying past this time frame is associated with the best outcomes. New vascular access given time to mature through single-needle haemodialysis treatments may improve long-term patency. Duplex ultrasound mapping prior to initiation of cannulation supports the clinical decision-making process on timing of and selection of cannulation sites.
Cannulation trauma at the initiation of haemodialysis could potentially be reduced with a strategy of incremental haemodialysis using single-needle treatment supported with duplex ultrasonography assessment to 'map' the vascular access as a guide for clinicians prior to cannulation initiation.
血液透析治疗需要一个功能良好的长期血管通路；然而，在高龄和因糖尿病而受损的血管情况下建立这种通路可能具有挑战性。并发症包括无法插入两根用于治疗的针，从而导致误穿刺创伤，在某些情况下还需要插入临时中心静脉通路装置。本综述的广泛目标是确定关于通过动静脉内瘘或动静脉移植物开始血液透析时穿刺操作的证据基础。
本综述采用乔安娜·布里格斯研究所推荐的框架，纳入或排除论文的过程遵循系统评价和荟萃分析的首选报告项目组方法。共有20项原发性研究符合纳入标准。
在10至15周期间进行穿刺而非延迟超过这个时间段与最佳结果相关。通过单针血液透析治疗让新的血管通路有时间成熟，可能会提高长期通畅率。在开始穿刺前进行双功超声测绘有助于临床医生就穿刺时间和穿刺部位的选择做出决策。
通过采用渐进式血液透析策略，即使用单针治疗并辅以双功超声检查评估，以在穿刺开始前“测绘”血管通路作为临床医生的指导，有可能减少血液透析开始时的穿刺创伤。
