Cannulation of the arteriovenous fistula in haemodialysis: a systematic review and narrative synthesis.

BACKGROUND: Arteriovenous fistulas (AVF) and arteriovenous grafts (AVG) are the preferred options for establishing vascular access in adult patients undergoing haemodialysis treatment. Although various official recommendations exist for AVF and AVG cannulation, a comprehensive, personalised approach to cannulation has yet to be proposed. This systematic review highlights existing knowledge gaps and identifies best practices by synthesising quality evidence on all components involved in AVF and AVG cannulation for haemodialysis. METHODS: A search was conducted across the PubMed, CINAHL, Cochrane, Scopus and Web of Science databases for studies published between January 2016 and January 2023. This review followed the PRISMA statement and was registered with PROSPERO (CRD42024293288). RESULTS: Twenty-four studies met the inclusion criteria and reported outcomes for 11,687 patients and 801 ward staff in 14 countries. Collectively, their results emphasized a person-centred approach, the importance of nurses' and patients' skills, and the need for continuous learning to enhance patient care. While recommendations varied, the implementation of the button-hole technique and innovative nurse-led devices such as plastic cannulas and point-of-care ultrasound guided cannulation were highly recommended. CONCLUSION: This systematic review highlights the importance of adopting a person-centred approach to managing patients undergoing haemodialysis. It also recommends the systematic assessment of vascular access and the continuous training for nurses and patients. Further research is needed to evaluate the cost-effectiveness of innovative, nurse-led tools in haemodialysis units.