Kimura Go, Matsuyama Takuya, Mizuno Yuki
Dialysis Center, Shiroishi Memorial Hospital, Sapporo, Hokkaido, Japan.
Medical Products Division, W. L. Gore & Associates G.K., Minato City, Tokyo, Japan.
J Vasc Access. 2023 Nov;24(6):1299-1304. doi: 10.1177/11297298221081650. Epub 2022 Mar 18.
Posterior wall puncture of the AVG causes serious vascular access complications, but there is no concrete technical recommendation for AVG cannulation with plastic cannula. The purpose of this study is to identify cannulation techniques to reduce posterior wall puncture of the AVG using plastic cannula.
Sixty-three hemodialysis nurses' cannulations on experimental models were recorded and included in this study. Cannulations were conducted on AVG and AVF models with a plastic cannulation needle. We analyzed the angle of the needle, the motion of the needle, and the location of the needle in the graft lumen.
The occurrence of posterior wall puncture of the AVG model was 22.2%. The cannulation angles in the AVG model were greater than those in the AVF model ( < 0.05). In the posterior wall puncture group of the AVG model, after the tip of the needle had reached into the graft lumen, the angle of the needle was not flattened ( < 0.05) and the outer sleeve of the needle was not inserted into the graft ( < 0.05). Furthermore, posterior wall puncture of the AVG model were observed in the group with less than 5 years of dialysis nursing experience ( < 0.05).
From this study, after the tip of the needle had reached into the graft lumen, flattening the angle of the needle and inserting the outer sleeve of the needle into the graft were suggested as specific cannulation techniques to reduce posterior wall puncture of the AVG. Furthermore, this study also suggests the importance of cannulation technique education for new dialysis nurses to reduce cannulation-caused complications.
动静脉内瘘（AVG）后壁穿刺会导致严重的血管通路并发症，但对于使用塑料套管进行AVG插管尚无具体的技术建议。本研究的目的是确定使用塑料套管减少AVG后壁穿刺的插管技术。
记录并纳入63名血液透析护士在实验模型上的插管情况。使用塑料插管针在AVG和自体动静脉内瘘（AVF）模型上进行插管。我们分析了针的角度、针的运动以及针在移植物管腔内的位置。
AVG模型后壁穿刺的发生率为22.2%。AVG模型中的插管角度大于AVF模型中的插管角度（<0.05）。在AVG模型的后壁穿刺组中，针尖端进入移植物管腔后，针的角度未变平（<0.05）且针的外套管未插入移植物（<0.05）。此外，透析护理经验少于5年的组中观察到AVG模型的后壁穿刺（<0.05）。
从本研究来看，在针尖端进入移植物管腔后，建议将针的角度变平并将针的外套管插入移植物作为减少AVG后壁穿刺的具体插管技术。此外，本研究还表明了对新透析护士进行插管技术教育以减少插管引起的并发症的重要性。
