Objective To explore the application of novel single-needle puncture technique for safe puncture in the maintenance hemodialysis (MHD) patients with complex autologous arteriovenous fistulas (AVF). Methods A total of 42 MHD patients undergoing regular hemodialysis in the Department of Nephrology, Beijing Haidian Hospital (Peking University Third Hospital Haidian District Section) between May 2023 and May 2024 were enrolled in this study. They were divided by random table method into observation group (using single-needle technique for hemodialysis) and control group (using traditional puncture method for hemodialysis). Puncture related data were compared between the two groups. Results There were no statistical differences in baseline data, including age, gender, primary disease, the status of complex AVF (initial fistula, acute thrombosis secondary to stenosis, and difficulties in puncture) and central venous indwelling catheter, between the two groups at the time of enrollment (P >0.05). The total number of punctures was 43 in observation group, lower than that of 81 times in control group, with the average number of punctures statistically lower in observation group than in control group (t =8.446, P >0.001). The incidence of puncture injury was statistically lower in observation group than in control group (c2=9.860, P=0.007). The rate of indwelling catheter usage was statistically lower in observation group than in control group (c2=16.800, P <0.001). The average value of online real-time Kt/V monitoring was statistically lower in observation group than in control group (t =-3.594, P=0.001). Conclusion The novel single-needle puncture technique can effectively reduce the number of punctures, the complications caused by multiple needle punctures, and the rate of central venous catheter usage, and ensure safe puncture to the complex AVF during its difficult puncture period. Therefore, this method is worthy of clinical promotion.
[1]金其庄,王玉柱,叶朝阳,施雅雪. 中国血液透析用血管通路专家共识(第2版)[J]. 中国血液净化,2019,18(6):365-381.
[2]陈香美.血液净化标准操作规程[M].北京:人民卫生出版社,2021.
[3]肖光辉,王玉柱,詹申等.血管通路护士分级授权管理对复杂动静脉内瘘安全穿刺的效果观察[J].河北医药,2021,43(4):628~630,634.
[4]Parisotto Maria Teresa,Schoder Volker U,Miriunis Cristina,et al.Cannulation technique influences arteriovenous fistula and graft survival[J].KIDNEY INTERNATIONAL,2014,86 (4):790-797.
[5] Wilson Barbara,Harwood Lori,Thompson Bonita.Impact of single-needle therapy in new chronic hemodialysis starts for individuals with arteriovenous fistulae[J].CANNT journal = Journal ACITN,2009,19 (2):23-28.
[6]王玉柱,肖光辉主编.血液净化通路一体化管理手册.北京:北京航空航天大学出版,2018.46.
[7]Lee T,Barker J,Allon M.Needle infiltration of arteriovenous fistulae in hemodialysiS:Risk factors andconsequences[J].Am J Kidney Dis,2006,47(6):1020-1026.
[8]张丽红,王玉柱.北美血管通路协会血液透析血管通路标准化定义解读[J].中国血液净化,2013,12(3):167-169.
[9] Van Loon MM, Kessels AG, Van der Sande FM, et al. Cannulation practice patterns in haemodialysis vascular access: predictors for unsuccessful cannulation[J]. J Ren Care2009,35(2): 82–89.
[10] Schmidli J,Widmer MK,Basile C,et al. VascularAccess:2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS) [J]. Eur J Vasc Endovasc ,2018, 55 (6): 757-818.
[11] Hill, K, Sharp, R, Childs, J, et al. Cannulation practices at haemodialysis initiation via an arteriovenous fistula or arteriovenous graft[J]. J VASC ACCESS. 2019, 21 (5): 573-581.
[12] Vanholder, R. Single needle hemodialysis: is the past the future? [J] .J NEPHROL,2019, 33 (1): 49-58.
[13]Vlassopoulos, DA, Hadjiyannakos, DK, Koutala, KG, et al. Hemoglobin normalization results in lower dialysis dose, despite high dialysate flow. Single needle offers inadequate dialysis[J]. INT J ARTIF ORGANS,2004,27 (6): 467-72.
[14] Wilson B., Harwood L. and Thompson B. Impact of single-needle therapy in new chronic hemodialysis starts for individuals with arteriovenous fistulae[J].CANNT Journal, 2009,19(2) 23-8.
[15] Allon M, Depner TA, Radeva M, et al. Impact of dialysis dose and membrane on infection-related hospitalization and death: results of the HEMO Study[J]. J Am Soc Nephrol, 2003,14 (7): 1863-70.
[16] Rayner HC, Pisoni RL, Gillespie BW, Goodkin DA, Akiba T,Akizawa T, et al. Creation, cannulation and survival of arte-riovenous fistulae: data from the Dialysis Outcomes andPractice Patterns Study[J]. Kidney Int ,2003,63(1):323-330.
[17] Thomson PC, Stirling C, Traynor J, Morris S, Mactier R.A prospective study of catheter-related bacteraemia andthrombosis in a haemodialysis cohort: univariate and multi-variate analyses of risk association[J]. Nephrol Dial Transplant,2010,25(5):1595-1604.
[18] Bray BD, Boyd J, Daly C, et al.Vascular access type and risk of mortality in a national pro-spective cohort of haemodialysis patients[J]. QJM-INT J MED ,2012,105(11):1097-103.
[19] Taylor G, Gravel D, Johnston L, et al. Incidence of bloodstream infection in multicenter inception cohorts of hemodialysis patients[J]. Am J Infect Control, 2004,32(3):155-60.
[20]Maurizio Gallieni, Markus Hollenbeck, Nicholas Inston, et al. Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults[J].Nephrol Dial Transplant,2019,34,( 2):1-42.
[21]Trakarnvanich, T, Chirananthavat, T, Maneerat, P, et al. Is single-needle hemodialysis still a good treatment in end-stage renal disease? [J]. BLOOD PURIFICAT,2008, 25 (6): 490-6.
[22]Rostoker, G, Griuncelli, M, Loridon, C, et al. Improving the efficiency of short-term single-needle hemodialysis. RENAL FAILURE. 2009; 31 (4): 261-6
[23] Bieser, W, Welsch, M, Jakob, M, et al. Effectiveness of a New Single-Needle Single-Pump Dialysis System with Simultaneous Monitoring of Dialysis Dose[J]. ARTIF ORGANS, 2018, 42 (8): 814-823.
[24] Lena,Axelsson,Eva,Benzein, et al.End-of-life and palliative care of patients on maintenance hemodialysis treatment: a focus group study.[J].BMC palliative care,2019,18(1):89.