A randomized controlled study on the safety and efficacy of ultrasound-guided cannula needle for puncturing difficult autogenous arteriovenous fistulas

Objective To investigate the application effect of ultrasound-guided puncture technique combined with plastic cannula needle in treating difficult autogenous arteriovenous fistula (AVF).

Methods A total of 120 patients with difficult AVF were randomly divided into Group A (blind puncture with metal needle), Group B (ultrasound-guided puncture with metal needle), Group C (blind puncture with cannula needle), and Group D (ultrasound-guided puncture with cannula needle), with 30 cases in each group. The success rate of first-attempt puncture, time of hemostasis, incidence rate of hematoma, dialysis blood flow, urea clearance index (Kt/V) value, and the incidence of fistula complications (stenosis, thrombosis) within 6 months were compared among the four groups.

Results There were no significant differences in baseline characteristics such as age, gender, body mass index (BMI), prevalence rates of diabetes and hypertension, dialysis vintage, AVF usage time, and laboratory indicators (hemoglobin, serum creatinine, etc.) among the four groups (P>0.05). Significant differences were observed among the four groups in puncture success rate, time of hemostasis, incidence rate of hematoma, dialysis blood flow, Kt/V value, shear stress, and the incidence of complications (fistula stenosis, thrombosis) within 6 months (P < 0.05). Pairwise comparisons of various indicators among the four groups, after Bonferroni correction, revealed that there were significant differences between Group D and Group A in multiple indicators such as success rate of puncture, time of hemostasis, and blood flow (P_corrected < 0.01). Some indicators showed significant differences between Group D and Group B, as well as between Group D and Group C before correction, but these differences did not reach the significance threshold after correction. Only the Kt/V value between Group B and Group D showed a significant difference after correction (P_corrected < 0.01).

Conclusion The ultrasound-guided puncture technique combined with cannula needle can significantly improve the success rate of puncture for difficult AVF, reduce complications, optimize hemodynamic indicators, and improve dialysis adequacy, demonstrating clinical promotion value.