Peralta Ricardo, Sousa Luís, Cristovão António Filipe
Lisbon School of Nursing, University of Lisbon, 1600-096 Lisbon, Portugal.
NephroCare Portugal, Fresenius Medical Care Portugal, 1750-233 Lisbon, Portugal.
J Clin Med. 2023 Sep 13;12(18):5946. doi: 10.3390/jcm12185946.
Adequate cannulation technique (CT) methods and successful puncture are essential for hemodialysis (HD) and arteriovenous fistula (AVF) maintenance. This systematic review and meta-analysis was designed to identify which CT allows better AVF primary patency and lower rates of complications in HD patients. The search was carried out on the CINAHL, MEDLINE, Cochrane Library, and Joanna Briggs Institute Library databases to identify all randomized controlled trials (RCTs) and observational studies comparing clinical outcomes of buttonhole (BH) versus rope ladder cannulation (RL) from 2010 to 2022. The Risk-of-Bias (Rob 2) tool was used for RCTs and the ROBINS-I was used for non-randomized studies. RevMan 5.4 was used for the meta-analysis. A total of five RCTs, one quasi-randomized controlled trial, and six observational studies were included. When compared with RL cannulation, BH cannulation significantly increased bacteremia (RR, 2.76, 95% CI (1.14, 6.67), = 0.02) but showed no differences in AVF primary patency (HR, 1.06, 95% CI (0.45, 4.21), = 0.90). There was no thrombosis reduction (RR, 0.51, 95% CI (0.23, 1.14), = 0.10) or intervention number reduction (RR, 0.93, 95% CI (0.49, 1.80), = 0.84) with BH. Outcomes like pain, hematoma, and aneurism could not be merged due to a lack of data, reported as medians, as well as due to different definitions. The quality in general was poor and the heterogeneity among the studies prevented us from merging the outcomes.
充分的插管技术（CT）方法和成功穿刺对于血液透析（HD）和动静脉内瘘（AVF）维护至关重要。本系统评价和荟萃分析旨在确定哪种CT能使HD患者的AVF初始通畅率更高且并发症发生率更低。在CINAHL、MEDLINE、Cochrane图书馆和乔安娜·布里格斯研究所图书馆数据库中进行检索，以识别2010年至2022年期间比较纽扣式穿刺（BH）与绳梯式插管（RL）临床结局的所有随机对照试验（RCT）和观察性研究。随机对照试验使用偏倚风险（Rob 2）工具，非随机研究使用ROBINS - I。使用RevMan 5.4进行荟萃分析。共纳入5项随机对照试验、1项半随机对照试验和6项观察性研究。与RL插管相比，BH插管显著增加了菌血症（RR，2.76，95%CI（1.14，6.67），P = 0.02），但在AVF初始通畅率方面无差异（HR，1.06，95%CI（0.45，4.21），P = 0.90）。BH插管在减少血栓形成（RR，0.51，95%CI（0.23，1.14），P = 0.10）或减少干预次数（RR，0.93，95%CI（0.49，1.80），P = 0.84）方面并无效果。由于缺乏数据（以中位数报告）以及定义不同，疼痛、血肿和动脉瘤等结局无法合并。总体质量较差，研究间的异质性使我们无法合并这些结局。
