The objectives of our study were to evaluate the influence of the caliber of arteriovenous fistula (AVF) puncture needles on the total convective volume and other characteristics of OL-HDF, and to investigate possible adverse effects” Galán et al (2017).
Abstract:
INTRODUCTION AND OBJECTIVE: Higher infusion volumes (IV) in online hemodiafiltration (OL-HDF) are associated with better survival. The IV depends mainly on blood flow (Qb). The objectives of our study were to evaluate the influence of the caliber of arteriovenous fistula (AVF) puncture needles on the total convective volume and other characteristics of OL-HDF, and to investigate possible adverse effects.
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MATERIAL AND METHODS: Prospective intervention study analyzing six sessions of postdilution OL-HDF with 14G needles and six sessions with 15G needles in the same patients, to compare results of efficacy and safety. The monitor, the dialyser, the arterial and venous pressures, the conductivity and the flow of the dialysis fluid were kept equal in each patient. Efficacy through mean blood flow for maximal blood and venous pressures of -220mmHg and 220mmHg respectively, total convective volume, and percentages of creatinine, urea and β2-microglobulin reduction, were measured. Adverse effects such as measured pain with an analog scale, postdialysis coagulation times and complications were analyzed.
RESULTS: A total of 34 patients, 55±16 years old, 63% male, were studied. The use of 14G needles was associated with higher Qb (471.1±36.7ml/min vs 354.8±25.8ml/min, p<0.001) and higher total convective volume (29.7±5.7 liters with G14 vs 24.1±3.6 liters with G15, p<0.001) compared to 15G needles. The percentages of creatinine, urea and β2-microglobulin reduction were significantly higher in the 14G needles sessions (73.94±6.03%, 82.54±6.41% and 84.07±4.83%) than 15G needles sessions (70.31±6.67%, 78.80±6.52% and 81.45±5.16%), p=0.031, 0.029 and 0.047 respectively. On the analog pain scale, no significant differences were found between both needles (4.03±2.09 with 14G and 3.57±2.04 with 15G, p=0.386). No significant differences between the coagulation times of arterial and venous punctures with the two types of needles were found. As complications, only two punctured bleedings that required new coagulation were recorded, one with a 14G needle and one with a 15G needle.
CONCLUSION: The use of 14G needles improves the efficacy of OL-HDF without increasing the associated adverse effects. In light of the results, widespread use of 14G needles in OL-HDF whenever possible can be recommended.
Reference:
Galán, I., Cedeño, S., Vega, A., Abad, S., Macías, N., López-Gómez, J.M. and Luño, J. (2017) Influence of the vascular access punction needle caliber in the efficacy of online hemodiafiltration. August 28th. [epub ahead of print]. [Article in English, Spanish].
doi: 10.1016/j.nefro.2017.04.006.
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