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Cannulation techniques for an arteriovenous fistula

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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cannulation techniques for an arteriovenous fistula

Three different needling techniques are used during cannulation of an AVF:

  • localised cannulation (area puncture)

  • cannulation using the length of the fistula (rope ladder)
    • entire length of an arteriovenous fistula or graft is used for cannulation
    • changes the needle placement site each time the patient has dialysis

  • cannulation through a formed tract (buttonhole)
    • cannulates at the exact same spot at consecutive dialysis sessions creating a channel in the AVF
    • currently recommended by the UK Renal Association due to lower risk of haematoma and aneurysm formation when compared to the rope ladder technique
    • several studies have identified an increased risk of infective complications associated with buttonhole cannulation thus some haemodialysis units avoid using this technique (1,2)

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