Centre Hospitalier Intercommunal De Poissy Saint Germain, Poissy, France.
Dpt Santé Publique U1018 UVSQ INSERM GIRCI IdF-UFR Médecine Paris-Ile-de-France-Ouest Université Versailles St-Quentin, Boulogne, France.
Hemodial Int. 2023 Oct;27(4):364-369. doi: 10.1111/hdi.13105. Epub 2023 Jul 6.
There are two techniques for puncturing an arteriovenous fistula: one where the needle is inserted bevel up and then rotated to a bevel down position, and another where the needle is inserted bevel down. The aim of this study was to compare these two methods of needle insertion on minimum compression time required for hemostasis after needle removal.
This was a prospective, randomized, cross-over, blinded, single-center, routine care study. Each patient's average post-dialysis puncture site compression time was determined during a 2-week baseline period while using bevel-up access puncture. Subsequently, minimum post-dialysis puncture-site compression time was determined during each of two sequential follow-up periods, during which fistula puncture was done with needles inserted bevel up or down, respectively. The order of treatments (bevel up or bevel down insertion) was randomized. During each follow-up period, the minimum compression time necessary to avoid bleeding on needle removal was determined by progressively shortening the compression time. Puncture-associated pain was also assessed as prepump and venous pressures and ability to achieve desired blood flow rate during the dialysis session.
Forty-two patients were recruited. The baseline compression time after needle removal averaged 9.99 ± 2.7 min During the intervention periods, the minimum compression time was on average 10.8 min (9.23-12.4) when the access needles had been inserted bevel down versus 11.1 min (9.61-12.5) when the access needles had been inserted bevel up (p = 0.72). There was no difference in puncture-associated pain between the two insertion techniques, and no difference in prepump or venous pressures or ability to achieve the desired blood flow rate during the dialysis session.
Bevel-up and bevel-down needle orientation during arteriovenous fistula puncture are equivalent techniques in terms of achieving hemostasis on needle removal, and puncture-associated pain.
动静脉瘘穿刺有两种技术：一种是针尖斜面向上插入，然后旋转至斜面朝下的位置，另一种是针尖斜面朝下插入。本研究旨在比较这两种针尖插入方法在拔针后止血所需的最小压迫时间。
这是一项前瞻性、随机、交叉、盲法、单中心、常规护理研究。在使用斜面朝上的动静脉瘘穿刺方法进行 2 周基线期时，确定每位患者的平均透析后穿刺部位压迫时间。随后，在两个连续的随访期内，分别使用斜面朝上和斜面朝下的针头进行穿刺，确定每个随访期的最低透析后穿刺部位压迫时间。治疗顺序（斜面朝上或斜面朝下插入）是随机的。在每个随访期内，通过逐渐缩短压迫时间来确定避免拔针后出血所需的最小压迫时间。还评估了穿刺相关疼痛，包括穿刺前泵压和静脉压以及在透析过程中达到所需血流速度的能力。
共招募了 42 名患者。拔针后平均压迫时间为 9.99±2.7 分钟。在干预期间，当使用斜面朝下的穿刺针时，平均最小压迫时间为 10.8 分钟（9.23-12.4），而当使用斜面朝上的穿刺针时，平均最小压迫时间为 11.1 分钟（9.61-12.5）（p=0.72）。两种插入技术的穿刺相关疼痛无差异，且在透析过程中，泵前压和静脉压或达到所需血流速度的能力也无差异。
在动静脉瘘穿刺时，针尖斜面朝上和朝下的方向在止血方面是等效的技术，与穿刺相关疼痛无关。
