Abstract: TH-PO292
Point-of-Care Ultrasound for Assessing Arteriovenous Fistula Maturity in Outpatient Hemodialysis
Session Information
- Vascular Access: From Biology to Managing Complications
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 703 Dialysis: Vascular Access
Authors
- Fullmer, Jessie C., Westchester Medical Center Health Network, Valhalla, New York, United States
- Weiss, Steven, Atlantic Dialysis Management Services, Queens, New York, United States
- Coritsidis, George N., Westchester Medical Center Health Network, Valhalla, New York, United States
Background
Point-of-care ultrasound (POCUS) in end-stage renal disease (ESRD) is on the rise. Presently the decision to cannulate an arteriovenous fistula (AVF) is based on its duration since surgery, surgeon clearance, and physical exam. This study examines the effects of POCUS on decreasing the time to AVF cannulation and reducing time spent with a central venous catheter (CVC).
Methods
Patients were prospectively recruited between January 2021 and May 2022 after new AVF placement in patients at 5 separate dialysis units, while in patients at 5 other units patients had POCUS within 3 weeks of AVF creation and were followed for a minimum of 3 months following fistula creation. Recommendation for cannulation was made once the following parameters were met: diameter > 6 mm (with no depreciable narrowing of more than 20% throughout), depth < 6 mm from skin surface, and length > 6 cm. Demographic data, as well as time to cannulation and CVC removal, number of infections, complications, and interventions were compared between POCUS and non- POCUS cohorts.A Kruskal-Wallis test was conducted to compare the effect of the POCUS use on the number of successful cannulation in weeks 1 through 6.
Results
The POCUS cohort had signifcantly less cannulating complications than seen in the control group p<0.02. There were no blood stream infections seen in the POCUS group, and one in the control. The average time to decannulation from AVF placement was 103 days in the POCUS group vs 145 days in the control.
Conclusion
Point-of-care ultrasound facilitates early and safe arteriovenous fistula cannulation leading to a reduction in central venous catheter time and risk of cannulation injury. These findings on a larger scale should result in decreased infections seen when using POCUS.