The Comparison of Patient Clinical Outcomes between Antegrade and Retrograde Cannulation Methods Received Hemodialysis Machine Process at Arteriovenous Fistula
Keywords:
Arteriovenous fistula, Antegrade cannulation, Retrograde cannulationAbstract
Background: The arteriovenous fistula (AVF) is the most popular vascular access for hemodialysis (HD) procedures. Normally, it has two needle insertion methods at the arterial site, including the needle tip position has the parallel (antegrade) and the opposite (retrograde) directions to the arterial blood flow. However, the clinical outcomes of the patients receiving HD with both antegrade and retrograde cannulations need to be investigated. Objective: To compare the clinical outcomes of HD patients receiving between antegrade and retrograde cannulation methods. Method: We conducted a randomized crossover trial in HD patients with AVF. All patients were randomly assigned to either the antegrade (study) or the retrograde (control) group and then switched to the other group in the following HD session. Baseline patient characteristics, HD characteristics, the patient clinical outcomes (e.g., dialysis adequacy, clotting duration after needle removal, access recirculation, and pain scores) and staff satisfaction were collected. All data were presented in terms of number with its percentage or mean±standard deviation. We employed multivariable multilevel Gaussian regression to adjust prognostic variables. Result: A total of 246 HD sessions were included. The results showed no significant difference in any clinical outcomes. However, HD nurses significantly prefer antegrade to retrograde cannulation. Conclusion: HD nurse can design the needle position with either antegrade or retrograde cannulations depending on the patient’s condition and the suitable HD procedure without significant difference in patient clinical outcomes.
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