Cannulation techniques for an arteriovenous fistula

cannulation techniques for an arteriovenous fistula

Three different needling techniques are used during cannulation of an AVF:

• localised cannulation (area puncture)
  
  
• cannulation using the length of the fistula (rope ladder)
  • entire length of an arteriovenous fistula or graft is used for cannulation
  • changes the needle placement site each time the patient has dialysis
    
    
• cannulation through a formed tract (buttonhole)
  • cannulates at the exact same spot at consecutive dialysis sessions creating a channel in the AVF
  • currently recommended by the UK Renal Association due to lower risk of haematoma and aneurysm formation when compared to the rope ladder technique
  • several studies have identified an increased risk of infective complications associated with buttonhole cannulation thus some haemodialysis units avoid using this technique (1,2)

Reference:

• (1) Siddiky A et al. Management of arteriovenous fistulas. BMJ. 2014;349:g6262
• (2) Verhallen AM, Kooistra MP, van Jaarsveld BC.  Cannulating in haemodialysis: rope-ladder or buttonhole technique? Nephrol Dial Transplant. 2007;22(9):2601-4