Arteriovenous fistula cannulation in hemodialysis: A vascular access clinical practice guidelines narrative review

Area of Science:

• Nephrology
• Vascular Surgery
• Nursing Practice

Background:

• Cannulating arteriovenous fistulas (AVFs) for hemodialysis (HD) is a complex nursing procedure.
• AVF cannulation is a primary cause of vascular access (VA) damage and potential failure.
• Numerous clinical practice guidelines (CPGs) for VA management have been published globally.

Purpose of the Study:

• To comprehensively analyze existing CPGs on AVF cannulation for HD.
• To identify current recommendations and interpret potential future approaches to AVF cannulation.
• To assess the evidence base supporting CPG recommendations for AVF cannulation.

Main Methods:

• Systematic review of seven selected CPGs.
• Analysis of CPGs based on seven subthemes: initiation, preparation, technique, needle selection, surveillance, pain, and education.
• Coding table utilized for data organization and analysis.

Main Results:

• Current CPGs for HD VA cannulation are characterized by a lack of robust evidence for most recommendations.
• Significant variation exists in the quality and evidence grading across different CPGs.
• There is a clear need for enhanced international collaboration to generate high-quality evidence.

Conclusions:

• Future CPGs should prioritize recommendations with stronger evidence grading.
• Development of patient-centered care models and nurse decision-making frameworks is crucial.
• Improved evidence and guidelines can lead to better AVF cannulation outcomes and patient care.