Vascular access and nephrology nursing practice: existing views and rationales for change

No controlled studies investigating the effect of specific cannulation techniques on AV graft survival time and/or patency rates appear in the literature. These techniques include but are not limited to the following: skin preparation, rotation of cannulation sites, antegrade versus retrograde cannulation, rotating the axis of the needle, rerotating axis before removal, local injection versus topical application of anesthetics versus no anesthesia, and postdialysis site care and dressings. There have been no investigations published in the recent literature concerning the benefits of antegrade versus retrograde access cannulation. The difficulty validating the idea that antegrade cannulation may be more beneficial than retrograde, from a practical standpoint, is that few dialysis units use only one method. In addition, some clinicians change their method from one patient to the next. Does antegrade or retrograde cannulation create an incisional flap that is better approximated as the Qb passes over it after hemostasis occurs? Is there a difference in the incidence of stenosis in the arterial end of synthetic AV grafts exposed to antegrade cannulation versus those exposed to retrograde cannulation? No studies of blood recirculation at varying blood flow rates appear in the current literature. There is little mention of time required for hemostasis as an indication of patency of the AV graft. Are increases in time required to accomplish hemostasis after needle removal related to graft patency? Can one show distinct patterns in time to hemostasis at certain levels of patency?(ABSTRACT TRUNCATED AT 250 WORDS)