A Randomized Control Trial of MuST for Vascular Access Cannulation in Hemodialysis Patients: Contributions for a Safe...

Preservation and maintenance of a complication-free arteriovenous fistula (AVF) remains significant challenge. An adequate cannulation technique and successful puncture are critical for preserving AVF and ensuring patient safety. The study investigated whether the multiple single cannulation technique (MuST) leads to improved AVF survival and a lower complication rate than the rope-ladder (RL) technique.

The MuST study was a multicenter, prospective, nonblinded, parallel group, randomized controlled trial.

A total of 101 patients received hemodialysis in 3 peripheral units; 49 patients were assigned to the MuST group and 52 to the control group.

The intervention group received MuST, whereas the control group underwent the RL technique, with both groups followed for period of 12 months.

The primary outcome was to evaluate the AVF survival rate at 12 months, defined as unassisted patency. The secondary outcome included the assessment of assisted primary patency, complication rates, and pain perception.

There were no statistically significant differences between the MuST and RL techniques in unassisted patency (HR, 1.02; 95% CI, 0.38-2.71; P = 0.98) or in assisted patency (HR, 0.74; 95% CI, 0.37-1.47; P = 0.39). There were no statistically significant differences in the incidence of hematoma or thrombosis, and no infections occurred during the study period. The MuST presented an advantage over the RL technique in the development and formation of new aneurysms. There were no significant differences observed in pain perception between the 2 cannulation techniques.

The sample size was smaller than expected due to limitations in the selection of patients during the SARS-CoV-2 pandemic phase.

We could not definitively demonstrate a difference in AVF survival between MuST and RL. The low incidence of AVF thrombosis in both techniques shows that MuST can be a choice for patient safety and well-being when nursing teams decide which cannulation technique to perform.

Registered at ClinicalTrials.gov with identifier NCT05081648.