Comparison of the effect among three kinds of internal fistula puncture in patients with hemodialysis

Zou Lihua; Yang Liu

doi:10.3969/j.issn.1006-7256.2015.14.010

Abstract：Objective:To compare the application effect among three Kinds of internal fistula puncture(conventional puncture,blunt needle puncture and improved buttonhole blunt needle puncture)in patients with hemodialysis. Methods:60 patients(taKing arteriovenous fistula as a vascular access for hemodialysis)were randomly divided into group A(conventional puncture,n = 20),group B(blunt needle puncture,n = 20)and group C(improved buttonhole blunt needle puncture,n = 20). After 6 months,the puncture - related complications, the biochemical indicators and dialysis adequacy were compared among the three groups. And the related factors affecting the complications of puncture were analyzed by multivariate COX regression model. Results:The incidence of severe pain at the puncture point and fistula stenosis was lower in group C than that in group A and B(P < 0. 05);the incidence of fistula hematoma and pseudoaneurysm was lower in group C than group A(P < 0. 05);After 6 months,the levels of CRP of the patients in group C were lower than group A and B(P < 0. 05);the levels of HGB were higher in group C than group A and B(P < 0. 05);the differences of URR and Kt / V were not statistically significant between the groups(P > 0. 05). The multivariable Cox regression model analysis showed that the main factors affecting the com-plications of internal fistula puncture were the duration of dialysis,HGB and CRP levels. Conclusion:The improved buttonhole blunt needle puncture method can significantly reduce the incidence of hematoma around puncture site,pseudoaneurysm and vascular stenosis and alle-viate the microinflammation state in dialysis patients,which does not affect the dialysis adequacy. The complications of internal fistula puncture may be related to duration of dialysis,HGB and CRP levels.