Handheld Ultrasound-guided Cannulation of Difficult Haemodialysis Arteriovenous Access by Renal Nurses

Not Applicable

Completed

• Conditions: Dialysis; Complications; Vascular Access Complication; Dialysis Access Malfunction; Graft Av; Hemodialysis Complication; Vascular Access Site Haematoma; Fistula
• Interventions: Device: Handheld US device

• Registration Number: NCT05410691
• Lead Sponsor: National Healthcare Group, Singapore

Brief Summary

Cannulation of complex arteriovenous fistula (AVF) or graft (AVG) is a challenge to renal nurses. Ultrasound (US) guidance on central and peripheral venous access visualisation has been widely adopted in nephrology and shown to reduce complications of vascular interventions. With broader adoption of handheld US devices in clinical services, renal nurses could acquire this point-of-care technique to increase the successful cannulation rate while facilitating confidence build-up during training and practice. We aim to evaluate the use of handheld US on difficult AVF/AVG cannulation in a hospital-based dialysis unit.

Detailed Description

We conducted a prospective randomised controlled study from January 2021 to January 2022. Ten renal nurses were trained by an interventional nephrologist before patient recruitment and had completed a pre- and post-training questionnaire on their confidence level. Fifty haemodialysis patients with complex AVF were randomised to US-guided or conventional cannulation. The total time spent on cannulation and patients' pain scores were also collected.

Study Timeline

• Study Start: 2021-01-01
• Primary Completion: 2022-01-31
• Study Completion: 2022-01-31
• Status Verified: 2022-06
• Study First Submitted: 2022-06-05
• Study First Submitted QC: 2022-06-05
• Last Update Submitted: 2022-06-05
• Study First Posted: 2022-06-08
• Last Update Posted: 2022-06-08

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 50

Inclusion Criteria

1. First-time cannulation, 2. Post-angioplasty or thrombectomy, 3. Partial stenosis confirmed with imaging or by vascular surgeons/interventional radiologists, 4. Failed cannulation by dialysis nurses at community centres, 5. Bruises or haematoma around AVF/AVG, 6. Presence of clots in AVF/AVG and 7. Deep-seated access by physical examination.

Exclusion Criteria

complex access with a high risk of complications (calibre ≤0.4cm or vessels ≥0.8cm in depth from skin)

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
ultrasound guided	Handheld US device	AVF/AVG cannulation by renal nurses by handheld US device

Primary Outcome Measures

Name	Time	Method
percentage of successful cannulation	from skin contact to actual start of dialysis

Secondary Outcome Measures

Name	Time	Method
complications	from skin contact to actual start of dialysis	need for a temporary central venous catheter, single-needle dialysis, or infiltration (e.g. haematoma) that hastened the use of AVF/AVG for the same dialysis session
pre-cannulation assessment time	from patient physical contact to the time before needling thru skin	time taken to assess the AVF/AVG with either US or clinical examination before cannulation
cannulation time	skin contact by needle to succesful aspiration of blood from needle
patients' pain score	needle to skin to end of dialysis session	10cm visual analogue scale

Trial Locations

Locations (1)

Allen Liu; 🇸🇬 Singapore, Singapore