Multiple Single Cannulation Technique of Arteriovenous Fistula a randomized controlled study in a tertiary care centre

Arteriovenous fistula (AVF) is called as “Achilles heel of dialysis”. Without a good AVF, a chronic kidney disease (CKD5D) patient’s dialysis adequacy decreases and morbidity and mortality greatly increases. Cannulation technique (CT) is key factor in maintaining a good AVF. A new approach to AVF cannulation with noticeable benefits to patients is the Multiple Single cannulation technique (MuST). MuST is a new modified CT combining the techniques of traditional Rope ladder and button hole techniques. This CT consists of rotating the same six specific cannulation sites, three arterial and three venous puncture sites through two or three treatment days each week. Though this technique has been there since 2013, the technique’s efficacy hasn’t been well explored and its efficacy hasn’t been properly compared with traditional CT in literature. This is a non-randomized open label comparative study comparing MuST cannulation and conventional cannulation technique in terms of AVF survival and complications resulting in missed cannulation. AVF survival is measured by doppler ultrasonogram of AVF to determine the flow volume in AVF. Study will be conducted at hemodialysis unit at Department of Nephrology, Stanley Medical College, Chennai. Inclusion criteria is CKD5D on Maintainence hemodialysis with a Arteriovenous Fistula (AVF) previously cannulated within 3 months or new AVF without any vascular access complications with good flow rate of > 600 ml/min and good segment length of 6 cm for cannulation for interventional group. For control group, patients who don’t fit into interventional group criteria and who are already on dialysis and cannulated by conventional method. Exclusion criteria is CKD5D patients on arteriovenous grafts, AVF with thrombus, infections, immature AVF or central venous stenosis. Outcomes are comparison of AVF survival in both groups and access the AVF complications in interventional group.