Post-General Anesthesia Ultrasound-Guided Venous Mapping Increases Autogenous Access Placement Rates

This study investigates the impact of introducing a post-general anesthesia ultrasound (PAUS) mapping on the type of vascular access chosen for hemodialysis in patients without previous accesses.

Two hundred three of 297 consecutive patients met inclusion criteria and were reviewed. Within-subjects analysis was performed on patients with both an outpatient ultrasound-guided vein mapping and a PAUS using sign tests and Wilcoxon signed rank tests. Furthermore, a between-subjects analysis added patients with only the outpatient vein mapping; demographic and comorbidity data were analyzed using t-tests and chi-squared tests. An ordinal logit regression was run for the type of access placed, while a bivariate logit regression was used to compare rates of autogenous access maturation.

One hundred sixty-five (81%) patients received both a standard outpatient vein mapping and a PAUS. At the outpatient vein mapping, 130 (79%) patients had suitable veins for an autogenous access, whereas 35 (21%) patients did not have suitable veins for an autogenous access and were planned for a prosthetic access. During PAUS, all 165 (100%) patients were found to have suitable veins for autogenous access formation (P < 0.001). When comparing specific autogenous access configurations, Wilcoxon signed rank testing showed significantly more preferable access configurations in the PAUS group than the outpatient mapping (P < 0.001); outpatient mapping resulted in 81 (47%) radiocephalic accesses, 10 (6%) radiobasilic accesses, 20 (12%) brachiocephalic accesses, 19 (12%) brachiobasilic accesses, and 35 (21%) prosthetic accesses planned, in contrast to 149 (90%) radiocephalic accesses, 3 (2%) radiobasilic accesses, 10 (6%) brachiocephalic accesses, 3 (2%) brachiobasilic accesses, and 0 prosthetic accesses when the same patients were analyzed using PAUS. With the analysis expanded to include the 38 (19%) patients with only the outpatient vein mapping (without-PAUS), the Wilcoxon-Mann-Whitney test showed no significant differences between the groups in terms of outpatient vein mapping plans (P = 0.10); however, when comparing the PAUS plans to the outpatient vein mapping plans, there was again a significantly increased proportion of preferred access types in the PAUS group compared with the outpatient group (P < 0.001). In the ordinal logit multivariate analysis, the only significant variable was the postanesthesia ultrasound, which positively correlated with more favorable access configurations (coefficient = 2.61, P < 0.001). The bivariate logit regression for autogenous access maturation rates found no significant difference between the without-PAUS group and the PAUS group (P = 0.13).

Introducing a postanesthesia ultrasound mapping to guide vein-finding significantly increases the quality and quantity of suitable veins found, subsequently leading to increased proportions preferred access placement (autogenous versus prosthetic and forearm versus upper extremity).