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Kidney Week

Abstract: PO1331

Impact of Ultrasound Guidance in Assessment of the Maturity and Cannulation of New Arteriovenous Fistula (AVF): A Quality Improvement Initiative

Session Information

  • Vascular Access
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Karki, Niraj, Emory University, Atlanta, Georgia, United States
  • Niyyar, Vandana Dua, Emory University, Atlanta, Georgia, United States
Background

A common complication during cannulation, particularly in new AVF, is needle infiltration. AVF infiltration is associated with major morbidity, including additional interventions, prolongation of catheter dependence and access failure. Judicious use of ultrasound guidance has been successfully used in difficult peripheral as well as central venous access to reduce iatrogenic injury. We hypothesized that the use of portable ultrasound for cannulation of hemodialysis (HD) access would minimize infiltration during cannulation of new AVF in HD patients at Emory Dialysis over a 6-month period as compared to a control period without the use of ultrasound guidance for cannulation.

Methods

We implemented an educational protocol to train 18 members of our dialysis staff in the use of portable ultrasound for evaluation of dialysis access. 2 dedicated vascular access coordinators were trained as ''access champions'' and led the initiative. Each of the 4 HD units were equipped with a portable ultrasound machine. All new AVF were evaluated by ultrasound 4-6 weeks post-operatively. Immature AVF were sent for further evaluation/interventions. Mature AVF were cannulated under real-time ultrasound guidance. All data, including AVF infiltrations, were recorded prospectively.

Results

Infiltration data of new AVF for the control period was obtained from a retrospective database. The infiltration rate was 14% in our dialysis (calculated by dividing the number of new AVF infiltrations by the total number of new AVF cannulated). During the study period (8/15/2019 to 2/14/2020), 39 new AVF were evaluated for cannulation using a combination of physical examination and ultrasound guidance. There were only 4 infiltrations of new AVF. The rate of infiltration was thus 10.2% in our patients, a decrease of 3.8% from baseline.

Conclusion

The use of portable US devices for assessment of maturity and cannulation guidance is feasible even in busy HD units. We were able to reduce the infiltration rate with the use of US guidance for cannulation in combination with physical examination. We plan to expand ultrasound education to include all members of the dialysis staff involved with cannulation within our dialysis units. Regular competency checks are essential to identify and supplement gaps in knowledge.