S 32 Masterclass

Title: Masterclass – Vascular access

Monday, September 8, 16:00 – 17:30

Omega 2

Programme of the Session

GS: Professor Malik (Czech Republic)
Vascular access and the heart: haemodynamic and clinical relationships

O 62
Reinventing fistula cannulation – Initial results of a centre experience
Rui Sousa (Portugal)

O 63
Comparison of two puncture techniques: Buttonhole vs. Rope Ladder
Marcia Galvao (Portugal)

Abstracts:

GUEST SPEAKER
Abstract is not available

BIOGRAPHY OF THE GUEST SPEAKER

O 62
Reinventing fistula cannulation - Initial results of a centre experience
P. Sousa¹, P. Goncalves¹, M. Costa¹, S. Marinho¹, A. Marques¹, M. Marques¹, R. Peralta², J. Fazendeiro Matos²
¹NephroCare Dialysis Centre Viseu , Fresenius Medical Care, Viseu, Portugal; ²NephroCare Nursing Care Management, Fresenius Medical Care, Porto, Portugal

Background: Arteriovenous fistula (AVF) is the preferred vascular access for haemodialysis due to its low complication rate. To avoid potential complications, an optimal cannulation technique should be used. Area puncture and rope-ladder are the most common techniques. Moreover, the buttonhole technique can be used but are there other possibilities?
Objectives:To implement a new cannulation technique: Multi Single Puncture Technique (MSPT).
Methods: MSPT is a combination of the rope-ladder and buttonhole techniques. Ideally there are three arterial and three venous puncture sites, with rotation assigned to a specific treatment day.
The entire nursing staff was trained and in March 2013, MSPT was implemented for selected AVF. Complications were documented.
Results:Until December 2013, 20 AVFs were cannulated using MSPT for about 1,400 sessions.

Findings: Scrab in cannulation sites occurred in 30 to 70%; the most common complication was difficulty in cannulation (5.6/1,000 AVF days) leading to a change in puncture site in two cases; bruises were observed in few cases (2.8/1000 AVF days); haemostasis complications were observed in 14.2/1000 AVF days; bleeding in canulation sites 5/1,000 AVF days; least common complication was inflammation at cannulation site (0.5/1000 AVF days) without the need for medication; no aneurysms were observed.
Conclusion/Application to practice:Observing a large number of cannulations the most serious complications often associated with AVF puncturing seems to be avoided with MSTP. In 1,000 treatments we only observed 2 episodes of minor inflammatory signs and less serious complications. Therefore, MSPT has the potential to become a new puncturing technique which needs to be confirmed by future studies.

Disclosure: No conflict of interest declared

O 63
Comparison of two puncture techniques: Buttonhole vs. Rope Ladder
M. Galvão¹, F. Gomes¹, J. Fazendeiro Matos², M.T. Parisotto³
¹NephroCare Dialysis Centre VFXira, Fresenius Medical Care, Vila Franca de Xira, Portugal; ²NephroCare Nursing Care Management, Fresenius Medical Care, Porto, Portugal; ³NephroCare Coordination, Fresenius Medical Care, Bad Homburg, Germany

Background: The ideal Vascular Access (VA) for dialysis is the arteriovenous fistula (AVF) due to a higher greater durability and lower risk of infection and thrombosis. Studies show that the puncture technique is a variable that interferes with the mentioned aspects.
Objectives:To compare some VA related parameters when using buttonhole versus rope ladder technique.
Methods:
21 patients with AVF were followed in two different periods of six months each:
T1 - June to November 2012 (buttonhole)
T2 - March to August 2013 (rope ladder)
Results: Five of the 21 patients were female (average age 69 years). When comparing period T1 (buttonhole) vs. T2 (rope ladder) we observed aneurysms in 47.8% of patients vs. 76.2%. Mean VA flow was 1,027 vs. 1,161 ml/min. Bruising was observed in 7 vs. 34% and cannulation difficulties in 60 vs. 42% of cannulations.
During T2, inflammatory signs occurred in 8% and stenosis and thrombosis in 4% of AVF, whereas these events were not observed in T1. 33% of buttonhole cannulations and 8% of rope ladder cannulations were associated with extracorporeal circuit clotting. In T1, cannulation sites had to be changed in 3 cases.
Conclusion/Application to practice: Cannulation difficulties were higher in T1 which might be due to the use of buttonhole needles. Moreover, extracorporeal clotting occurred more often in this period. However, we observed less bruising, stenosis and thrombosis episodes, translated into less aneurysms formation. We can conclude from the results that better outcomes were achieved with the buttonhole technique.