Arteriovenous fistula is the lifeline of long-term hemodialysis patients. Protecting the arteriovenous fistula can ensure the smooth progress of dialysis, reduce the number of hospitalizations and reduce costs. Commonly used arteriovenous fistula puncture techniques in clinical practice include regional puncture, rope ladder puncture and buttonhole puncture. At present, many blood purification centers use safe dialysis indwelling needle puncture to establish buttonhole tunnels, which are compared with the method of using sharp needle puncture to establish fistula buttonhole tunnels, seeking a simpler, faster and less painful method for patients to establish arteriovenous fistula buttonhole tunnels.
Establishing fistula buttonhole tunnels
Safe dialysis indwelling needle puncture method
Criteria for judging the maturity of arteriovenous fistula:
The newly created arteriovenous fistula needs 4 to 6 weeks of maturation. The three important parameters of arteriovenous fistula maturity include: pulsation, tremor and murmur. The clinical manifestations of normal and stenotic parameters are shown in the table below. When the arteriovenous fistula is mature, the natural blood flow measured by ultrasound exceeds 500ml/min, the inner diameter is ≥5mm, and the depth from the skin is less than 5mm.
Before puncturing the arteriovenous fistula, the patient's skin condition should be observed, and a suitable vein should be selected (generally the cephalic vein, basilic vein or median vein), and an arteriovenous puncture plan map should be drawn. The arterial puncture point is at the proximal end, more than 5cm away from the fistula anastomosis, and the venous puncture point is at the proximal end, about 8cm away from the arterial puncture point.