Vascular access cannulation in hemodialysis patients - A survey of current practice and its relation to dialysis dose

Purpose: The appropriate use of vascular access is of fundamental importance in the treatment of hemodialysis (HD) patients. This survey entailed collecting data on current practice of vascular access cannulation to assess its relation to dialysis dose. Methods: This international, multicenter, observational, cross-sectional survey was performed in 171 dialysis centers of the European dialysis network of Fresenius Medical Care in Europe and South Africa during April 2009. Practice patterns of vascular access cannulations were documented by means of a 24-item questionnaire. Dialysis dose from the documented hemodialysis treatments was derived from the clinical database EuCliD (R). Results: In total, 10,807 cannulations in hemodialysis patients with either arteriovenous fistula (91%) or arteriovenous graft (9%) were documented. For the puncture, the area technique was applied most frequently using 15G and 16G needles. Blood flow rates were mostly between 300 and 400 mL/min and adjusted to the needle size used. In two-thirds of cases the arterial needle was placed first, mostly in an antegrade direction, with an average distance to the venous needle of 7.0 +/- 3.7 cm. More than two-thirds of the cannulations were performed by nurses with more than 5 years of experience in dialysis. A logistic regression model revealed a significantly higher odds ratio to attain Kt/V >= 1.2 for retrograde placement of the arterial needle, and for using needles with bigger diameter. Conclusions: This survey covered a broad number of countries and centers and provides information on current practice of vascular access cannulation, their effect on dialysis dose, and serves as feedback to the dialysis centers for their quality management process.