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Abstract
Introduction: Polytetrafluoroethylene prosthetic fistulas are an alternative when native vascular accesses are not viable. Their use is associated with more complications and lower survival related to repetitive punctures.
Objectives: To describe the technique and puncture
characteristics of prosthetic fistulas, and analyze the practical utility after the implementation of a scheduled puncture map.
Material and Method: We conducted a 6-week prospective,
single-center study, with patients with prosthetic fistulas.
We analyzed clinical and sociodemographic characteristics,
puncture technique, ultrasound parameters, degree of
clinical and ultrasound destructuring, dialysis characteristics, and vascular access-related complications, after the implementation of a scheduled puncture map.
Results: A total of 6 hemodialysis patients with prosthetic
fistulas were studied (50% women, 80% humeroaxillary). The mean prosthesis usage time was: 47.1±46.1 months and they had a mean of 2.6±3.4 previous vascular accesses. All patients were punctured in an antegrade direction and with 16G gauge needles. At the end of the 3 study, we increased the percentage of patients with ladder puncture (60 vs 100%) as well as the distance between needles (9.3±1.3 vs 12.3±1.4 cm; p < 0.05), withoutchanges to the analyzed parameters. Throughout the study, 2 patients presented hematomas and extravasations, without other complications.
Conclusions: The implementation of a scheduled puncture map allowed us to improve the technique and optimize the puncture of prosthetic fistulas without any associated complications. We consider the implementation of our scheduled puncture map important in our routine clinical practice.
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Copyright (c) 2025 Ariadna Morera Mas, Javier Gutiérrez de la Iglesia, Vicent Esteve Simó, Jorge Alfonzo Juliá, Irati Tapia González, Sandra Rubio Paez, Sara Ibáñez Pallarés, Manel Ramírez de Arellano Serna
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References
- Ibeas J, Roca-Tey R, Vallespín J, Moreno T, Moñux G, Martí-Monrós A, et al. Spanish Clinical Guidelines on Vascular Access for Haemodialysis. Nefrología. 2017;37 Suppl 1:1-191. DOI: https://doi.org/10.1016/S2013-2514(19)30100-2
- Smith A, Johnson B, Brown C. The role of vascular access in hemodialysis. J Nephrol. 2019;32(4):547-56.
- Williams E, Jones R, Johnson K. Hemodialysis vascular access: current challenges and future directions. Clin J Am Soc Nephrol. 2021;16(3):487-99.
- García D, Martínez R, Rodríguez M. Complications and survival of PTFE prosthetic arteriovenous fistulae versus native arteriovenous fistulae for hemodialysis access: A systematic review and meta-analysis. J Vasc Surg. 2020;72(6):2215-25.
- Tordoir JH, Herman JM, Kwan TS, Diderich PM. Long-term follow-up of the polytetrafluoroethylene (PTFE) prosthesis as an arteriovenous fistula for hemodialysis. Eur J Vasc Surg. 1988;2(1):3-7. DOI: https://doi.org/10.1016/S0950-821X(88)80099-9
- Martínez de Merlo MT. Manual de accesos Vasculares para hemodiálisis: Fístulas arteriovenosas y catéter central. Cuidados de enfermería. 1ª ed 2012. Madrid, España. SEDEN 2012.
- Parisotto, M. T., & Pancirova, J. (2016). Acceso vascular. Punción y cuidados. Guía de buenas prácticas de enfermería para el manejo de la fístula arteriovenosa (1ª ed.). Lucerne, Switzerland: European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA).
- Ota K, Ara R, Takahashi K, Toma H, Agishi T. Clinical experience with circumferentially reinforced expanded polytetrafluoroenthylene (E-PTFE) graft as a vascular access for haemodialysis. Proc Eur Dial Transplant Assoc. 1977;14:222-8.
- Rapaport A, Noon GP, McCollum CH. Polytetrafluoroethylene (PTFE) grafts for hemodialysis in chronic renal failure: assessment of durability and function at three years. Aust N Z J Surg. 1981;51(6):562-6. DOI: https://doi.org/10.1111/j.1445-2197.1981.tb05255.x
- Schanzer H, Martinelli G, Chiang K, Burrows L, Peirce EC. Clinical trials of a new polytetrafluoroethylene-silicone graft. Am J Surg. 1989; 158(2):117-20. DOI: https://doi.org/10.1016/0002-9610(89)90358-9
- Ball LK. Improving arteriovenous fistula cannulation skills. Nephrol Nurs J. 2005;32:611-17.
- Baena L, Merino J. L, Bueno B, Martín B, Sánchez V, Caserta L, et al. Establishment of buttonhole technique as a puncture alternative for arteriovenous fistulas. Experience of a centre over 3 years. Nefrología. 2017;37(2):199-205. DOI: https://doi.org/10.1016/j.nefroe.2017.04.012
- Andrés Vázquez, M. del M., Gruss Vergara, E., Martínez Gómez, S., Piña Simón, M. D., Gálvez Serrano, M. C., Gago Gómez, M. C. et al. Comparison of two methods for monitoring incident prosthetic arteriovenous fistulas in a health area. Revista de la Sociedad Española de Enfermería Nefrológica, 2011;14(3):163-6. DOI: https://doi.org/10.4321/S1139-13752011000300003
- Molina Mejías P, Liebana Pamos B, Moreno Pérez Y, Arribas-Cobo P, Rodríguez Gayán P, & Díaz de Argote-Cervera P, et al. Aportación de la ecografía realizada por enfermería a la exploración del acceso vascular. Enfermería Nefrológica 2017;20(3)241-45. DOI: https://doi.org/10.4321/S2254-28842017000300007
- Carroll J, Colley E, Cartmill M, Thomas SD. Robotic tomographic ultrasound and artificial intelligence for management of haemodialysis arteriovenous fistulae. J Vasc Access. 2025;26(1):242-50. DOI: https://doi.org/10.1177/11297298231210019
- Rosique López F, Sánchez-Tocino ML, Hernán Gascueña D, Santos-Ascarza Bacariza JL, Andúgar Rocamora L, Gallego Zurro D, et al. Towards a reduction of patients' refusal to perform arteriovenous fistula: New tools and new actors in the interdisciplinary vascular access team. Presentation of the ERCAV project. Nefrología. 2025;45(Supl 1):2013-4. DOI: https://doi.org/10.1016/j.nefroe.2025.02.006
References
Ibeas J, Roca-Tey R, Vallespín J, Moreno T, Moñux G, Martí-Monrós A, et al. Spanish Clinical Guidelines on Vascular Access for Haemodialysis. Nefrología. 2017;37 Suppl 1:1-191. DOI: https://doi.org/10.1016/S2013-2514(19)30100-2
Smith A, Johnson B, Brown C. The role of vascular access in hemodialysis. J Nephrol. 2019;32(4):547-56.
Williams E, Jones R, Johnson K. Hemodialysis vascular access: current challenges and future directions. Clin J Am Soc Nephrol. 2021;16(3):487-99.
García D, Martínez R, Rodríguez M. Complications and survival of PTFE prosthetic arteriovenous fistulae versus native arteriovenous fistulae for hemodialysis access: A systematic review and meta-analysis. J Vasc Surg. 2020;72(6):2215-25.
Tordoir JH, Herman JM, Kwan TS, Diderich PM. Long-term follow-up of the polytetrafluoroethylene (PTFE) prosthesis as an arteriovenous fistula for hemodialysis. Eur J Vasc Surg. 1988;2(1):3-7. DOI: https://doi.org/10.1016/S0950-821X(88)80099-9
Martínez de Merlo MT. Manual de accesos Vasculares para hemodiálisis: Fístulas arteriovenosas y catéter central. Cuidados de enfermería. 1ª ed 2012. Madrid, España. SEDEN 2012.
Parisotto, M. T., & Pancirova, J. (2016). Acceso vascular. Punción y cuidados. Guía de buenas prácticas de enfermería para el manejo de la fístula arteriovenosa (1ª ed.). Lucerne, Switzerland: European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA).
Ota K, Ara R, Takahashi K, Toma H, Agishi T. Clinical experience with circumferentially reinforced expanded polytetrafluoroenthylene (E-PTFE) graft as a vascular access for haemodialysis. Proc Eur Dial Transplant Assoc. 1977;14:222-8.
Rapaport A, Noon GP, McCollum CH. Polytetrafluoroethylene (PTFE) grafts for hemodialysis in chronic renal failure: assessment of durability and function at three years. Aust N Z J Surg. 1981;51(6):562-6. DOI: https://doi.org/10.1111/j.1445-2197.1981.tb05255.x
Schanzer H, Martinelli G, Chiang K, Burrows L, Peirce EC. Clinical trials of a new polytetrafluoroethylene-silicone graft. Am J Surg. 1989; 158(2):117-20. DOI: https://doi.org/10.1016/0002-9610(89)90358-9
Ball LK. Improving arteriovenous fistula cannulation skills. Nephrol Nurs J. 2005;32:611-17.
Baena L, Merino J. L, Bueno B, Martín B, Sánchez V, Caserta L, et al. Establishment of buttonhole technique as a puncture alternative for arteriovenous fistulas. Experience of a centre over 3 years. Nefrología. 2017;37(2):199-205. DOI: https://doi.org/10.1016/j.nefroe.2017.04.012
Andrés Vázquez, M. del M., Gruss Vergara, E., Martínez Gómez, S., Piña Simón, M. D., Gálvez Serrano, M. C., Gago Gómez, M. C. et al. Comparison of two methods for monitoring incident prosthetic arteriovenous fistulas in a health area. Revista de la Sociedad Española de Enfermería Nefrológica, 2011;14(3):163-6. DOI: https://doi.org/10.4321/S1139-13752011000300003
Molina Mejías P, Liebana Pamos B, Moreno Pérez Y, Arribas-Cobo P, Rodríguez Gayán P, & Díaz de Argote-Cervera P, et al. Aportación de la ecografía realizada por enfermería a la exploración del acceso vascular. Enfermería Nefrológica 2017;20(3)241-45. DOI: https://doi.org/10.4321/S2254-28842017000300007
Carroll J, Colley E, Cartmill M, Thomas SD. Robotic tomographic ultrasound and artificial intelligence for management of haemodialysis arteriovenous fistulae. J Vasc Access. 2025;26(1):242-50. DOI: https://doi.org/10.1177/11297298231210019
Rosique López F, Sánchez-Tocino ML, Hernán Gascueña D, Santos-Ascarza Bacariza JL, Andúgar Rocamora L, Gallego Zurro D, et al. Towards a reduction of patients' refusal to perform arteriovenous fistula: New tools and new actors in the interdisciplinary vascular access team. Presentation of the ERCAV project. Nefrología. 2025;45(Supl 1):2013-4. DOI: https://doi.org/10.1016/j.nefroe.2025.02.006