Plastic cannula use in hemodialysis access

INTRODUCTION: Successful cannulation of arteriovenous fistula (AVF) or arteriovenous graft (AVG) is an important concept in hemodialysis. Metal needles have been used for cannulation in dialysis for over 50 years. Plastic cannula for dialysis is currently being introduced into Australia. AIMS: To identify if the implementation of plastic cannula could decrease the amount of miscannulations and adverse events in AVFs at first cannulation. METHODS: Train all staff in the Barwon Health renal department in the new technique of plastic cannula insertion and implement a new protocol for cannulation of AVFs in the first two weeks of dialysis. RESULTS: The training process took 12 months longer than anticipated due to issues with 'expert' to 'novice' reservations from staff, but initial results are positive with the statewide key performance indicator of new patients using AVF at first dialysis rising from 50% in 2013 to 78% in 2015. Staff were significantly more successful cannulating with plastic cannula in patients who had AVF only (67% success) than those who had a CVC alternative (24% success). CONCLUSIONS: Plastic cannulas offer a new and innovative way to cannulate AVFs and with time, expertise and training can be utilized to provide a successful cannulation program for patients starting hemodialysis with AVFs.