Indicating Direction and Angle for Cannulating of AV-fistula in Hemodialysis Patients

Study Overview
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Brief Summary
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Arteriovenous fistula is the preferred access for hemodialysis, and cannulation using a button-hole technique is increasingly recommended. By using the same two sites for cannulation there are reports of less risk of complications and less pain for the patient. However, button-hole cannulation can be difficult for the dialysis nurse, and failing cannulations can damage the AV fistula and increase patient discomfort. The investigators therefore will test whether a simple marking on the skin of the direction and angle of cannulation used in each specific patient could improve the probability of a successful and painfree cannulation.

Official Title
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Indicating Direction and Angle for Button-hole Cannulating of AV-fistula in Hemodialysis Patients - a Randomized Controlled Study

Conditions
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Chronic Kidney Disease, Kidney Failure

Intervention / Treatment
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* Procedure: Skin drawing
* Procedure: No skin drawing


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: chronic kidney disease hemodialysis arteriovenous fistula established buttonhole technique informed consent signed Exclusion Criteria: child minor not speaking Norwegian not willing to sign informed consent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Skin drawing<br> | Procedure: Skin drawing<br>* Mark direction and angle for cannulation with a pencil on the skin<br>|
| Active Comparator: No skin drawing<br> | Procedure: No skin drawing<br>* Standard practice; i.e. no marks on skin to help find correct direction and angle for introducing needles<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of successful cannulations | A successful cannulation is defined as being able to insert a blunt needle in both canals at the first attempt. | 8 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Difficulty of cannulation | Nurse and patients describe on a Verbal Rating Scale (1-6) how difficult the cannulation was experienced. All dialysis sessions are scored. | 8 weeks | 
| Fear of cannulation | Patients describe on a Verbal Rating Scale (0-10) how strongly they fear the cannulation. Assessed once a week. | 8 weeks | 
| Pain at cannulation | Patients describe on a VAS scale (0-10) how painful the cannulation was experienced. Assessed once a week. | 8 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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hemodialysis, cannulation, AV-fistula, buttonhole technique