Using a plastic cannula prevents arteriovenous fistula failure in early cannulation

AIM: To study the effect of early arteriovenous fistula (AVF) cannulation and the usage of plastic cannulas on short- and long-term AVF primary patency. METHODS: A database of 1,127 access operations from 1 November 2009 to 1 January 2011 was retrospectively analyzed. In total, 765 AVFs used for dialysis with follow-up until 1 December 2015 were included in the study. The period between operation and the initial cannulation, termed first cannulation time (FCT), was classified into intervals of 1-2 weeks, 3-4 weeks, 5-6 weeks, and 7-12 weeks. Primary patency was the interval between AVF creation and the first re-intervention for access dysfunction or thrombosis, the time of measurement of patency or the of its abandonment. RESULTS: The AVF primary patency was 98.1% after 1 year and decreased to 80.1% after 2 years. Among patients using metal needles for the first puncture, those with an FCT of 1-2 weeks experienced significantly decreased AVF primary patency compared to other groups. Conversely, in patients using plastic cannulas at the first puncture, no significant differences were observed among groups with AVF primary patency in 6, 12, and 24 months. FCT and the application of plastic cannulas were significantly associated with primary patency at 12 and 24 months after adjusting for age, sex, hemodialysis (HD) frequency, and HD duration per session. Combination of six variables including age, sex, FCT, application of plastic cannulas, hemodialysis (HD) frequency, and HD duration per session could accurately predict 6-month primary patency with area under ROC curve of 0.89, 95% CI: 0.80-0.99. CONCLUSIONS: Early AVF cannulation, within 1-2 weeks of creation, using plastic cannulas, does not increase the risk of access failure and offers an alternative to reduce reliance on catheters.