Use of plastic cannulae in haemodialysis: A scoping review

BACKGROUND: Metal needles have traditionally been used for cannulation of arteriovenous fistula and grafts in haemodialysis. Plastic cannulae have emerged as a potential alternative, particularly for patients with newly formed arteriovenous fistula or graft, or those that require more arm mobility during dialysis. Despite the potential for improved clinical outcomes, the introduction of plastic cannula into haemodialysis units globally has been variable. Empirical evidence related to the clinical advantages of plastic cannula in haemodialysis remains limited. AIM: To map the existing literature to gain an understanding of global trends in the use of plastic cannula for arteriovenous fistula and arteriovenous grafts in patients with end-stage renal disease requiring haemodialysis. METHODS: A review of literature from published 1990 to May 2025 is reported. MEDLINE Complete, CINAHL Complete, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials, ProQuest, Trove, and Google Scholar were searched. English language articles describing the use of plastic cannula in adults for haemodialysis in any setting were eligible for inclusion. Two reviewers independently assessed title, abstract relevant full text papers. Data were analysed using narrative synthesis. RESULTS: Papers (N = 45) reporting randomised controlled trials, non-randomised experimental, cohort and cross-sectional studies, case reports, cost analyses, or literature reviews from Australia, Europe, the United States, Canada, New Zealand, and Asia met the inclusion criteria. Findings indicate increasing adoption of plastic cannulae in haemodialysis practice worldwide. Key barriers included the higher initial unit cost, and procedural complexities associated with implementing a new technique. Despite this, long-term cost-effectiveness was demonstrated, due to reductions in clinical interventions resulting from adverse outcomes. Plastic cannulae were linked to improved clinical outcomes such as less catastrophic tissue damage due to failed cannulations, lack of aborted haemodialysis sessions, and higher levels of patient comfort. CONCLUSION: There is a growing global interest in plastic cannulae for haemodialysis vascular access. Although emerging evidence points to potential clinical and economic advantages, widespread adoption remains limited due to logistical challenges and higher initial costs. Robust, high-quality trials comparing metal needles versus plastic cannulae are required to accurately determine relative effectiveness. Trial design must accommodate an appropriate period of plastic cannulae practice integration.