The Non-Metal vs Metal Fistula Needles Used in Haemodialysis - Literature review Example

Literature Review on non metal vs. metal fistula needles Name Institution Instructor Date Abstract This paper provides a literature review of the non metal vs. metal fistula needles used in haemodialysis. In Australia, there is introduction of cannulas, which are needless, unlike the conventional dialysis metal needle, a transformation that provides the challenge of period of transition with respect to the relabeling of how fistulae is accessed to explain between cannulation and needling. Even though primarily the methods are similar there are various differences involving fistula cannulation with the latest needling and cannula with the conventional needle of dialysis that need to be discussed. One issue experienced in units of dialysis is that despite of the reinforcement and education patients and nurses still move the arms and certainly end up infiltrating vessels. In this situation cannulas are thought to be better choice over metallic dialysis needles because the cannula does not have the needle to infiltrate the vessel in the course of dialysis session. Haematomas’ presence around the external luminal walls is another issue with vessels that are traumatized. In conclusion, it is right to state that dialysis cannulas need a place in the nurse’s haemodialysis cannulating arsenal and even though there are various positives there are some points to be considered by the nurse prior to getting a dialysis cannula. For instance, with cannulas’ use there can be a raise of over-tenting or tamponading of the upper wall of the vessel. 5 Keywords: Hemodialysis, arteriovenous fistula (AVF), metal fistula needles, Cannulation, Infiltration, Literature Review on non metal vs. metal fistula needles Introduction Hemodialysis is considered a mechanism of routing blood via a machine of dialysis that filters it for waste removal. For most of the patients that have renal failure, this is regarded a support action. It can be done through an access circuit (graft or fistula) or central venous catheter. A dialysis fistula is surgically created in the arm through connection of an artery straight to a vein with no use of any plastic graft substance (Yevzlin et al, 2013). The vein close to the artery’s connection will expand over a month prior to becoming large enough to access with needles during dialysis. Whereas the fistula is enlarging (maturing), patients will classically require a catheter of dialysis to get dialysis. In a number of cases the vein fails to expand by its own and ought to be opened by balloon angioplasty (Harber, 2014). Even though fistulas are very hard to develop, they can survive for around 10 years. That is why, a dialysis fistula is chosen over a tunneled dialysis catheter or a dialysis graft. This paper provides a literature review comparing metal and non metal fistula needles for dialysis. Literature Review According to Davies & Gibbons (2007) vascular access that is functional is essential for hemodialysis. The intention of cannulation is to access entry into the vascular access of a patient without bringing about damage to the lifeline of the patient. A couple of the frequent issues linked to cannulation can result in serious complications of vascular access (Brouwer et al, 2009).There is introduction of needleless ‘cannula’ in Australia, as opposed to conventional dialysis steel ‘needle’, a transformation that offers people with the transition period challenge with regards to the relabeling of how fistulae is accessed to explain between cannulation and needling (Clatworthy, 2010). Even though primarily the techniques are related there are a couple of differences involving fistula cannulation with the new needling and cannula with the conventional dialysis needle that needs to be discussed (Figuerido, et al 2008). Du Toit (2013) opinion piece regarding dialysis cannulas would make one not to entirely shift from metal needle cannulation toward the needleless plastic cannulas. An experiment of Covidien’s Argyle Fistula cannulas, protective fistula cannula with silicone fastener and protective fistula cannula with a valve that is anti-reflux was carried out in Queensland at a leading referral hospital, with not less than 120 cannulations finished in the clinical set up, basically under the guidance of ultrasound. Generating from this experiment, a number of major points were brought out and need to be considered prior to using dialysis cannulas (Grainer, 2014). Grainer (2014) contends that one of the problems experienced in units of dialysis is a couple of the confused and new patients that despite of reinforcement and education still succeed in moving their arms and certainly their vessels end up getting infiltrated (Lai, 2009). In this case cannulas are the preferred choice over metal dialysis needles because the cannula does not have the needle to infiltrate the vessel in the course of dialysis session. Additionally, on the instance where an arteriovenous fistula (AVF) needs to be accessed for infusion that is intravenous the dialysis cannulas that have the anti-reflux valve or silicone valve cannulas offer an insertion that is much safer compared to the standard intravenous cannulas, and their bore size is larger. This is because of the fact that it is complete occlusion flow is very difficult via the fistula as a result of the high pressures, hence the clamps and valves on the cannulas are able to stop refluxing of blood back up the cannula once the stylette is removed (Grainer, 2014). Another concern with vessels that are traumatized is haematomas’ presence within the exterior luminal walls. Frequently nurses dealing with vascular access are called to troubleshoot the fistula that has clots in it. Even though internal vessel thrombosis can take place, it normally leads in fistulas that are completely occluded (McCall & Tankersley, 2012). The clots identified in the fistula are regularly taken extravascularly and centered and transferred into the fistula through the needle of dialysis, forming a plug over the needle’s end that frequently leads to failure of the fistula being flushed with saline. Whilst normally this region would be left alone, there have been circumstances when a vessel that is heavily haematosed from earlier treatments has needed access for dialysis because of excessive gain of fluid and/or biochemical grounds (Henry, 2005). 2 or 3 needles can often be required on these patients for successful vascular access. Fortunately trauma and haematoma can regularly be noticed under ultrasound. Location is normally established under ultrasound and the moment there is removal of the stylette tha haematoma’s core will habitually be removed, leaving a cannula that is functional and no need for access re-puncturing (Grainer, 2014). According to Grainer (2014) nurses have had some technique failures not putting in the needle extreme enough into the blood vessel prior to advancing the cannula leading to concertinaing of the cannula that is external to the luminal wall and terminating the attempt. In a study, this happened on first insertion or early cannula exposure. This was noted on 4 of 8 failed insertions. Even though cannulation together with needling share related concepts, the technique of insertion is not similar (Grainer, 2014). The cannula posses a much longer focal point and held further back unlike a dialysis needle. Hence any vertical or horizontal movement is repeatedly exaggerated at the stylette’s end in the vessel. A reasonable recommendation is using the cannulas on vessels, which someone is primarily more confident with in case he or she has not performed any cannulation lately. This allows someone to be more at ease with technique changes like different angles of insertion, longer cannula as well as threading the covering off the stylette’s end (Grainer, 2014). As a result of the cost alert characteristic of health it is most likely important to discuss the elephant at hand. Definitely there is a variation of price across services of health and needles being used (Grainer, 2014). The Argyle cannulas might have a primary increase in unit expense. The question narrows down to expense verses risk analysis for the unit. The Argyle cannulas, in saying this, have been utilized severally for accessing fistulas, which were not reached out via traditional dialysis needling as well as preventing hospital admissions since the patient had the ability to get full treatments of dialysis, avoiding surgical processes and permanent vascular catheters’ insertions; by now improving cost effectiveness (Grainer, 2014). According to Du Toit (2013) sharp metallic needle left in an AVF/AVG puts the patient at infiltration risk if the tip of the needle is moved. The infiltration risk linked to using a sharp metallic needle is reduced through adoption of practices that prevent pushing of the needle through the AVG/AVF wall. A number of these practices entail: patient and staff education about maintaining the arm still; carefully taping and removing the tape; avoiding tortuous segments’ cannulation; and avoiding joint regions’ cannulation, such as the elbow crease. At the same time as these practices definitely reduce the infiltration risk; there is always the risk of infiltration (Du Toit, 2013). Du Toit (2013) contends that in units of dialysis, fistula cannulation’s infiltrations are frequent, although likely, under-reported incidence. An infiltration takes place when end of the sharp metallic dialysis needle comes out of the AVG/AVF and in to nearby tissue bringing about bleeding into those tissues and leading to bruising. In heamodialysis units, a lot of infiltrations happen either; in the course of dialysis when the patient moves his or her arm and the tip of the needle is pressed outside from the AVG/AVF (Harris, 2005). Replacement of the sharp metallic needle with a dialysis cannula that is blunt would decrease the infiltration risk since once inserted; the blunt cannula of haemodialysis is not likely to penetrate out via the AVG/AVF wall (Du Toit, 2013). In the literature, there exists little powerful evidence to lead people with respect to needles of dialysis and infiltrations however, anecdotally; most dialysis patients and nurses have faced infiltrations with major and minor complications (Du Toit, 2013). There is need for further research including an association between cannula and metal needles. A number of valuable associations between blunt cannulae and sharp metal needles would be; infiltrations and its impacts; time taken for cannulation; pain perception; rates of blood flow; need for dialysis single needle; misshed cannulation; incapacity to cannulate an AVG/AVF (Du Toit, 2013). For patients having haemodialysis, it is argued that good access of the vessels is fundamental in getting good dialysis (LeMone, 2008). Damage to the AVG/AVF brought about by metal needles is considered a major issue in longevity of the site access. Non metal needles such as Supercath CLS can decrease these risks, and provides other benefits. Other benefits of using plastic dialysis needles is that: they are highly biocompatible and hence an effective substitute for patients that are allergic to AVF needles that are metallic; they are optimum alternative for AV fistulae and grafts, since they create the site of puncture two sizes smaller unlike the metal AVF needles; in AV fistulae that are poorly sited, like around the elbows, there is no damage risk if the patient’s arm is bent; if there is movement of the catheter in the course of dialysis, there is damage risk to the entry site or the internal wall of the AVG or AVF; and they are very comfortable unlike the metal AVF needles. On the other hand, the National Kidney Foundation (2006) recommends that high-tech technology and years of manufacturing experience warranty of high quality standards. The perfection and sharpness of the bevel in the metal dialysis needle reduce traumatization as well as scar formation’s risk. The vent that is slit shaped in the arterial fistula needles prevents suctioning as well, even under blood flow with high rates (The National Kidney Foundation, 2006). The group of vascular access nurses in Australia has started discussing about the dialysis cannulas use compared to the needles of dialysis. The most common of those is on pressures of dialysis and what rates of blood flow they can accept. The experience in Cairns with more than 120 cannulations has a standard pressure with 140mmHG cannulas on both venous and arterial insertions. A large number of these effective flows of blood have had 300ml/minute extra with both haemodialysis and haemodiafiltration. It is not easy to practically compare against the Japanese counterparts since it is not common for patients to achieve more than 300ml/minute flow of blood with more than 80% of patients on not more than 250ml/minute flow rates (Arbor Research Collaborative for Health, 2014). According to Grainer (2014) even though data on standard vascular pressures is kept in each treatment in majority of centers of dialysis, there are several subjective factors that influence these pressures, technique of cannulation, needle angle, and puncture zone, that comparing between dialysis cannula and needle would be tricky in a patient trial and hence this may possibly be better performed in a laboratory setting. Additionally, physics’ nature demands that the longer the cannula’s lumen then the pressures will be higher. Grainer (2014), states that the idea is that Japan has been utilizing these cannulas or their variations for the past forty years whereas other countries in the world have continued using metal needle cannulation. Thomas (2014) states that with the current information flow and technology it is surprising why the non metal cannulas have not been previously accepted. This could be due to an opposing culture to change as a result of the comfort of what people know. There is less evidence within a hospital setting where various subspecialties have removed several needles, yet haemodialysis is still resistant despite of the options and has continued using dialysis needles (European best practice guidelines on haemodialysis, 2007). With the regularity as well as success of use all over Japan and with current experience the cannula is an effective product that raises access versatility. As the popularity of a product rises, so will the variety to adjust to the dialysis culture that is evolving (Grainer, 2014). In another study to find evident differences between practices of haemodialysis in Japan to describe why they were frequently using cannula needles, nothing much was established, other than the staff in Japan not willing to accept the associated risks with cannulating with metal needles that are sharp. The cannula needle is not cheap compared to the sharp needle even though the staff in Japan did not take into consideration this reason enough to rationalize swapping to metallic needles that are sharp. On the other hand, there were various differences identified in haemodialysis practices in Japan (Du Toit, 2013). On average, their pump speeds is run at 200ml per minute unlike their Australians counterparts that run theirs at 300ml per minute on average. Another difference is the site of cannulation. In Japan, a lot of patients were cannulated near or in the elbow crease as well as near the bends in the AVF. With a sharp metallic needle, this practice would pose a great infiltration risk. The capacity to cannulate in tortuous sections or at the elbow crease, permitted for a greater zone of cannulation in AVFs. Increased regions for site rotation of cannulation may assist reduce formations of aneurysm (Du Toit, 2013). Du Toit (2013) argues that taping requires care to be practiced during its placement and removal around sharp metallic needles. Removal of tape or taping may result in the placing of the tip of needle in to the wall of vessel leading to infiltration or abnormal pressures (Molzahn et al, 2006). The cannulas that are blunt are not able to pierce into the AVG/AVF wall if angled toward or pressed on the AVF/AVG wall in the process of taping or removing the tape (Brouwer & LaMendola, 2006). Sharp metal needle’s removal from an AVG/AVF calls for some extra training to ensure that the needle is not pressed on by the patients or staff during its removal (Murray et al, 2014). Timing needle removal takes skill and practice (Longe, 2006). Untimely pressing can bring out pain as well as injury to the AVG/AVF or adjacent tissue (Lee et al, 2006). Delayed pressing can cause spurting of blood from the site of puncture. The blunt dialysis cannula is considered safer because it is able to be pressed on while it is being removed. In addition, there are no sharps for disposal during the removal time (Du Toit, 2013). Conclusion In conclusion, vascular accesses in dialysis are important and are cannulated regularly. When poorly carried out, cannulations can result in complications, particularly stenosis and aneurysm/pseudoaneurysm that affect the access life. Nurses, patients and doctors all have a responsibility of preserving the vessel during dialysis. This paper has discussed both the metal and non metal fistula needles. Metal needles pose a high risk of infiltration to patients in most units of haemodialysis. Hence, it is argued that since the cannula needle is available in Australia, patients would gain from cannulation using the cannula needle that is blunt. More research is needed to show financial, psychological and physical advantage for using non metal cannula needles for every haemodialysis patient. Reference Arbor Research Collaborative for Health, 2012b, Prescribed blood flow rate (mL/min), by DOPPS country and cross-section. Retrieved from www.dopps.org: http://www.dopps.org/annualreport/html/bfr_TAB2011.htm Brouwer, D & LaMendola, B, 2006, Optimizing Hemodialysis Cannulation Methods, Endovascular Today, Feb., 58-64. Clatworthy, M, 2010, Nephrology, Chichester, West Sussex, UK: Wiley-Blackwell, 100-250. Du Toit, D, 2013, Why do we use metal fistula needles? Renal Society of Australasia Journal, 9(3), 138–140. Davies, AH & Gibbons CP, 2007, Vascular access simplified, Philadelphia: Wolters Kluwer, 50-300. European best practice guidelines on haemodialysis, 2007, London [u.a.: Oxford Univ. 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