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Cannulation Guidelines

The Vascutek cannulation guidelines are provided to assist dialysis units with their in-house training. The guidelines are intended for individuals to use as a reference document. Vascutek appreciates that different facilities will have their own protocol for the initiation of dialysis.

This information serves only as guidance in technique and in no way constitutes a prescriptive instruction for use for any Vascutek ePTFE vascular prosthesis used for the purpose of vascular access.

The guidelines are also available in presentation format for larger audiences.

Selection of Cannulation Site

Guiding Principles

  • Venous and arterial bevels should be at least 5 cm apart
  • Do not cannulate within 2.5 cm of an anastomosis or reinforcement
  • Selected sites should be between 0.6 and 1.25 cm from previous sites
  • Rotate sites at each session

There are specific areas that must NOT be cannulated. These are different for each graft configuration.

Guidelines to cannulation and needle rotation are outlined below.

Straight graft

  • Do NOT cannulate within 2.5 cm of anastomosis
  • Start in central position and rotate sites outward
  • When stick point is within 2.5 cm of anastomosis, return to central position

Cannulation Area - straight graftFigure 1. Cannulation Area - Straight Graft

 

Loop Graft

  • Do NOT cannulate within 2.5 cm of anastomosis
  • Mark the central position of the graft loop
  • Do not cannulate on curved tight-looped section
  • Note: Rapidax™ can be cannulated in this section
  • Allocate one side exclusively for arterial sites
  • Allocate one side exclusively for venous sites
  • When stick point is within 2.5 cm of anastomosis, return to central position

Figure 2. Cannulation Area - Loop GraftFigure 2. Cannulation Area - Loop Graft (No Central Reinforcements)

Loop Graft (with Central Reinforcement)

 

  • Do NOT cannulate within 2.5 cm of anastomosis
  • Mark the central position of the graft loop
  • Do not cannulate on curved tight-looped section or within 2.5 cm of reinforcement
  • Allocate one side exclusively for arterial sites
  • Allocate one side exclusively for venous sites
  • When stick point is within 2.5 cm of anastomosis, return to central position

Figure 3. Cannulation Area - Loop GraftFigure 3. Cannulation Area - Loop Graft (Central Reinforcement)

 

Tapered Graft Loop Configuration

  • Do NOT cannulate within 2.5 cm of anastomosis
  • Cannulate only on wide bore section of graft
  • Mark the central position of the graft loop
  • Do not cannulate on curved tight-looped section
  • Allocate one side exclusively for arterial sites
  • Allocate one side exclusively for venous sites
  • When stick point is within 2.5 cm of anastomosis, return to central position

Figure 4. Cannulation Area - Tapered Loop Graft ConfigurationFigure 4. Cannulation Area - Tapered Loop Graft Configuration (No Central Reinforcements)

Tapered Graft Loop Configuration (with Central Reinforcement)

 

  • Do NOT cannulate within 2.5 cm of anastomosis
  • Cannulate only on wide bore section of graft
  • Mark the central position of the graft loop
  • Do not cannulate on curved tight-looped section or within 2.5 cm of reinforcement
  • Allocate one side exclusively for arterial sites
  • Allocate one side exclusively for venous sites
  • When stick point is within 2.5 cm of anastomosis, return to central position

Figure 5. Cannulation Area - Tapered Loop Graft Configuration (Central Reinforcements)Figure 5. Cannulation Area - Tapered Loop Graft Configuration (Central Reinforcements)

Initial Cannulation

Initial Cannulation

  • As per instructions for use, best results are achieved by leaving the graft in place for approximately 2 weeks prior to use
  • Immediate use may increase the risk of haematoma formation

Note: The Rapidax™ vascular access graft may be punctured for vascular access within 24 hours after implant*

*= Providing no contraindications are present i.e. if there are any signs of infection, bleeding. swelling, oedema, haematoma, or in the absence of a strong “thrill”

Site Preparation

The access area should be thoroughly cleaned prior to cannulation, for example, a 2 - 3 minutes povidone-iodine scrub.

Ensure sufficient time is allowed for antiseptic to dry prior to needle insertion. This will ensure full bacteriostatic action occurs.

Figure 1. Scrub using povidone-iodineFigure 1. Scrub using povidone-iodine

Access Procedure

The access should be conducted on a firm base.

The cannulation site should be immobilised by pulling the skin near the stick site in the opposite direction to needle placement.

Figure 2. Pull skin near the stick site in opposite direction to needle placementFigure 2. Pull skin near the stick site in opposite direction to needle placement

Needle Insertion

First cannulation should be with a 16 gauge dialysis needle and inserted bevel-up and at an angle of 45°.

Figure 3. Insert needle bevel-up and at an angle of 45 degreesFigure 3. Insert needle bevel-up and at an angle of 45°

It is important to ensure cannulation in the bevel-up position. This will ensure a crescent shape is formed for the access.

Bevel sideways would create a slit and bevel down will leave a circular hole (as shown below).

Figure 4. Insert needle bevel-upFigure 4. Insert needle bevel-up

Needle Placement

Needle Placement

Venous Needle

Always direct venous needle with the direction of blood flow.

Antegrade flow will minimise re-circulation of blood.

Figure 5. Venous needle placed in Antegrade PositionFigure 5. Venous needle placed in Antegrade Position

Arterial Needle

The arterial needle can be placed either with the flow (antegrade) or against the flow (retrograde).

Figure 6. Arterial needle placed in Antegrade PositionFigure 6. Arterial needle placed in Antegrade Position

 

Figure 7. Arterial needle placed in Retrograde PositionFigure 7. Arterial needle placed in Retrograde Position

Removal of Needle & Compression of Site

Needle removal and compression of the site should take place simultaneously.

Sufficient pressure should be applied over the VESSEL entry site.

Pressure should be sufficient to control bleeding while maintaining pulse/thrill.

Figure 8. Compression should be applied to the vessel entry siteFigure 8. Compression should be applied to the vessel entry site

4x4x4 technique

A 4 x 4 gauze pad should be used for a minimum of 4 minutes.

Site Rotation

It is imperative to vary needle sites at each session to preserve the integrity of the graft wall as shown below:

Figure 9. Vary needle sites at each session to preserve the integrity of the graft wallFigure 9. Vary needle sites at each session to preserve the integrity of the graft wall

 

Literature

Literature

Click the appropriate flag to download a printable version of the Cannulation Guidelines. (PDF format)

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