Cambio de técnica de punción de la fístula arteriovenosa nativa a partir de los hallazgos ecográficos

Abstract

Introduction: Most AVFs for hemodialysis (HD) should be punctured by the rope-ladder method. The area technique for AVF cannulation should be avoided whenever possible. On the other hand, cannulation guided by Doppler ultrasound (DU) can increase the success of difficult cannulation procedures.
Objective: Identify the patients dialyzed through an AVF using the area technique for cannulation that are susceptible for changing to the rope-ladder technique based on the DU findings.
Patients and methods:
• During January-2016 we have performed a crosssectional observational study in the prevalent HD patients dialyzed through an AVF with two needles using the area technique for cannulation.
• All patients were explorer by DU using GE Logic E(linear array 7.5 MHz) device. The following parameters were explored by DU: blood flow rate of the feeding artery (ml/min), diameter and depth of the arterialized vein segment that never was punctured (cm). All parameters by DU were measured in duplicated and the results were averaged. All determinations by DU were performed by the same explorer.
Results: From 63 prevalent HD patients, 39 patients had AVF (61.9%) and, of them, only 9 patients (14.3%) were dialyzed through an AVF using the area technique for cannulation (mean age 73.0±13.3 years, 11.1% diabetic nephropathy, time on HD 53.6±26.9 months). All AVF were brachial artery-based AVF (6 brachiobasilic and 3 braquioperforating). The ultrasongraphic findings were the following: mean diameter 0.7± 0.3 cm, mean depth 0.5± 0.3 cm and mean flow 1309.9± 966 ml/min. Only two cases had the arterialized vein in more than 0.6 cm of depth and, therefore, they will need will perform a vein transposition procedure for apply the rope-ladder technique for cannulation. In the remaining cases (n=7), is possible to perform the rope-ladder technique immediately using DU by increasing the puncture zone extension in the arterialized vein.
Conclusions:
1. It has been recorded a low incidence of area technique for AVF needling in our HD Unit.
2. It is feasible to change the needling AVF technique from area to rope-ladder technique in all cases by means of the morphological and functional parameters recorded in the AVF.
3. The portable DU used "in situ" in the HD Unit is a valuable tool that allows to change the technique for AVF cannulation.