Work

A Randomized Control Trial of MuST for Vascular Access Cannulation in Hemodialysis Patients: Contributions for a Safe Nursing Intervention

Year: 2026

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: Rationale & Objective Preservation and maintenance of a complication-free arteriovenous fistula (AVF) remains significant challenge. An adequate cannulation technique and successful puncture are critical for preserving AVF and ensuring patient safety. The study investigated whether the multiple single cannulation technique (MuST) leads to improved AVF survival and a lower complication rate than the rope-ladder (RL) technique. Study Design The MuST study was a multicenter, prospective, nonblinded, parallel group, randomized controlled trial. Setting & Participants A total of 101 patients received hemodialysis in 3 peripheral units; 49 patients were assigned to the MuST group and 52 to the control group. Intervention The intervention group received MuST, whereas the control group underwent the RL technique, with both groups followed for period of 12 months. Outcomes The primary outcome was to evaluate the AVF survival rate at 12 months, defined as unassisted patency. The secondary outcome included the assessment of assisted primary patency, complication rates, and pain perception. Results There were no statistically significant differences between the MuST and RL techniques in unassisted patency (HR, 1.02; 95% CI, 0.38-2.71; P = 0.98) or in assisted patency (HR, 0.74; 95% CI, 0.37-1.47; P = 0.39). There were no statistically significant differences in the incidence of hematoma or thrombosis, and no infections occurred during the study period. The MuST presented an advantage over the RL technique in the development and formation of new aneurysms. There were no significant differences observed in pain perception between the 2 cannulation techniques. Limitations The sample size was smaller than expected due to limitations in the selection of patients during the SARS-CoV-2 pandemic phase. Conclusions We could not definitively demonstrate a difference in AVF survival between MuST and RL. The low incidence of AVF thrombosis in both techniques shows that MuST can be a choice for patient safety and well-being when nursing teams decide which cannulation technique to perform. Trial Registration Registered at ClinicalTrials.gov with identifier NCT05081648. Plain-language Summary Functioning vascular access (VA) is crucial to patients with chronic kidney disease undergoing hemodialysis. Repeated cannulation of the VA increases the risk of complications, thereby compromising its survival. Although VA is not free of complications, guidelines recommend the rope-ladder (RL) cannulation technique. We conducted a randomized controlled trial of 101 renal patients receiving hemodialysis who required an arteriovenous fistula comparing the multiple single cannulation Technique (MuST) with the RL technique, to assess their survival and complications for 12 months. We found a low incidence in the development of aneurysms in the MuST group, but we were unable to demonstrate a difference in arteriovenous fistula survival between MuST and RL. Further studies are required to determine the benefits and patient safety of MuST.

Source: Kidney Medicine

DOI: 10.1016/j.xkme.2026.101305