P54
DOES FREQUENT CANNULATION OF ARTERIO-VENOUS FISTULAE RESULT IN AN
INCREASED REQUIREMENT FOR VASCULAR INTERVENTIONS?
Barnett, J, Breen, C, Vincent, D, Hickling, K
Guy’s and St Thomas’ NHS Foundation Trust
Problem: Home haemodialysis (HHD) is considered to be the optimum treatment for patients
requiring haemodialysis treatment for end stage kidney disease, with increased clinical benefit seen in
patients undertaking more dialysis sessions per week. These benefits include improved well-being and
reduced hospitalisation, reduced medication requirements and dietary restrictions, and improved
dialysis adequacy. However it is not clear if the increased frequency of accessing the circulation has
an adverse effect on vascular access. Some recent studies appear to suggest that frequent
haemodialysis scheduling increases the risk of venous access complications. This did not seem to
correlate with our local experience.
Patients on the HHD programme self-record HD parameters and are requested to report falling blood
flow rate and/or rising venous pressure to the nursing team for evaluation. The fistula also undergoes
routine assessment at review appointments. Any deterioration triggers a referral to the surgical access
review clinic, and access occlusion generates an urgent surgical referral.
Purpose: The aim was to compare the number incidence of vascular access interventions in those
patients dialysing five times a week or more with those dialysing three times a week within our HHD
population (n = 50).
Design: We undertook a retrospective analysis of access interventions required by HHD patients
using an arteriovenous fistula over the preceding five years. We included incident and prevalent
patients on both daytime and nocturnal regimes. Patients were allocated into two groups:
1. those who cannulate their fistula five times a week or more
2. those who cannulate their fistula 4 times a week or less
To obtain meaningful comparative results within the small patient group each patient’s time on
dialysis was converted into patient months. These were 970 and 745 patient months respectively.
Findings: There was no significant difference between the intervention rate between the groups; high
frequency cannulation group had 1.88% of interventions while the lower frequency cannulation
group recorded 1.96% of interventions.
Conclusion: Within our patient group frequency of access needling appears to have little impact on
the frequency of required interventions. These findings appear to support our belief that increasing
dialysis frequency does not present a risk to fistula survival. This retrospective study has not sought to
identify how particular elements of practice, such as patient education or active surveillance, have
contributed to the findings. This would be potentially amenable to further investigation.
Relevance : This study suggests that frequent cannulation of fistulae does not result in a higher
requirement for intervention. Regular surveillance of vascular access, timely referral to a surgical
access clinic and patient education remain the key factors in maintaining vascular access.