Study on the application and efficacy of multiple needle puncture techniques in the management of autologous arteriovenous fistulas in patients undergoing maintenance hemodialysis_West China Medical Journal

Authors：

ZHAO Wenfang ¹ , WU Huimin ¹ , ZHONG Lanyu ² , CAI Yan ¹ , YUAN Qian ¹ , WENG Fulan ¹ ,  LIU Gaolun ¹

1. Nephrology Department, West China Longquan Hospital Sichuan University / the First People’s Hospital of Longquanyi District Chengdu, Chengdu, Sichuan 610100, P. R. China;
2. Ultrasound Department , West China Longquan Hospital Sichuan University / the First People’s Hospital of Longquanyi District Chengdu, Chengdu, Sichuan 610100, P. R. China;

Corresponding?author：

LIU Gaolun, Email: 414181490@qq.com

Keywords：

Maintenance hemodialysis; autologous arteriovenous fistula; multiple needle puncture technique; application outcomes.

DOI：

10.7507/1002-0179.202606197

Video：

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Objective To explore the application of multiple needle puncture technique in maintenance hemodialysis (MHD). The clinical value of autologous arteriovenous fistula (AVF) puncture in patients with MHD, analyze the impact of this technique on vascular complications, puncture pain, and nursing effectiveness, and optimize the long-term standardized puncture management of AVF. Methods Patients with AVF who were enrolled in the Department of Nephrology of the First People’s Hospital of Longquanyi District Chengdu in November 2024 were selected. Patients were categorized into the multiple needle puncture group and the rope ladder puncture group according to puncture methods. All enrolled patients completed the 18-month follow-up period, with a follow-up deadline of May 2026. The incidence of AVF vascular complications (vascular stenosis, aneurysm, thrombus), puncture pain scores, and the one-time puncture success rate of junior nurses were analyzed between the two groups at 1, 6, 12 and 18 months after intervention. Results A total of 102 patients were included, with 51 in each group. The results of generalized estimating equations showed that there were time effects, inter-group effects, and time-group interaction effects on vascular access complications of fistula between the two groups (P<0.05). Compared with the rope ladder puncture group, the multiple needle puncture group exhibited a lower incidence of fistula vascular stenosis, aneurysm and thrombus, and puncture pain score (P<0.05). In addition, the one-time puncture success rate of junior nurses was higher (P<0.05). Conclusions Multiple needle puncture can protect the blood vessels of internal fistula, alleviate puncture-related pain, reduce the risk of vascular access-related complications, maintain the long-term smoothness of internal fista, and improve the effectiveness of clinical care. However, this technique has some shortcomings, so the clinical choice of a puncture regimen needs to be tailored to the patient’s vascular conditions.

Citation： ZHAO Wenfang, WU Huimin, ZHONG Lanyu, CAI Yan, YUAN Qian, WENG Fulan, LIU Gaolun. Study on the application and efficacy of multiple needle puncture techniques in the management of autologous arteriovenous fistulas in patients undergoing maintenance hemodialysis. West China Medical Journal, 2026, 41(7): 1101-1106. doi: 10.7507/1002-0179.202606197 Copy

1.	楊超, 張路霞, 趙明輝. 2024版KDIGO《慢性腎臟病評估與管理臨床實踐指南》更新要點及解讀[J]. 中國實用內科雜志, 2024, 44(6): 457-460.
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5.	趙微微, 金瑋藝, 楊春艷, 等. 維持性血液透析患者自體動靜脈內瘺功能的影響因素分析[J]. 中國護理管理, 2026, 26(2): 183-189.
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9.	肖光輝, 王玉柱, 詹申, 等. 血管通路護士分級授權管理對復雜動靜脈內瘺安全穿刺的效果觀察[J]. 河北醫藥, 2021, 43(4): 628-630, 634.
10.	中國醫院協會血液凈化中心分會血管通路工作組. 中國血液透析用血管通路專家共識(第 2 版)[J]. 中國血液凈化, 2019, 18(6): 365-381.
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12.	董永澤, 許秀君, 沈華娟, 等. 維持性血液透析患者動靜脈血管通路穿刺管理的最佳證據總結[J]. 中華護理雜志, 2023, 58(9): 1135-1141.
13.	Lok CE, Huber TS, Lee T, et al. KDOQI clinical practice guideline for vascular access: 2019 update[J]. Am J Kidney Dis, 2020, 75(4 Suppl 2): S1-S164.
14.	劉瑤, 李靜, 曹立云, 等. 506 所血液透析中心自體動靜脈內瘺功能監測現狀及障礙因素研究[J]. 中華護理雜志, 2024, 59(24): 2966-2972.
15.	鄧甲秀, 藍麗娟, 胡秀梅, 等. 不同穿刺方式對血液透析患者自體動靜脈內瘺影響的調查研究[J]. 軍事護理, 2025, 42(3): 44-47.
16.	Peralta R, Fazendeiro Matos J, Pinto B, et al. Multiple single cannulation technique of arteriovenous fistula: a randomized controlled trial[J]. Hemodial Int, 2022, 26(1): 4-12.
17.	史慧, 陳瑤, 王蕾, 等. 基于協同一體化護理模式的多單穿刺術在血液透析患者內瘺中的應用[J]. 醫藥高職教育與現代護理, 2024, 7(5): 420-423.
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19.	肖光輝, 張聞娣, 張麗紅, 等. 血液透析新型單針穿刺技術在復雜自體動靜脈內瘺中的應用[J]. 中國血液凈化, 2025, 24(4): 323-327.

1. 楊超, 張路霞, 趙明輝. 2024版KDIGO《慢性腎臟病評估與管理臨床實踐指南》更新要點及解讀[J]. 中國實用內科雜志, 2024, 44(6): 457-460.
2. 中華醫學會腎臟病學分會專家組.透析通路中國指南(2024年版)[J]. 中華腎臟病雜志, 2024, 40 (12): 990-1070.
3. Engels N, de Graav GN, van der Nat P, et al. Shared decision making in advanced kidney disease: a scoping review[J]. BMJ Open, 2022, 12(9): e055248.
4. Mohamed I, Kamarizan MFA, Da Silva A. Medical adjuvant treatment to increase patency of arteriovenous fistulae and grafts[J]. Cochrane Database Syst Rev, 2021, 7(7): CD002786.
5. 趙微微, 金瑋藝, 楊春艷, 等. 維持性血液透析患者自體動靜脈內瘺功能的影響因素分析[J]. 中國護理管理, 2026, 26(2): 183-189.
6. 孫琳, 牛洪艷, 胡璐璐, 等. 多單穿刺技術在維持性血液透析患者自體動靜脈內瘺穿刺中的應用[J]. 中華護理雜志, 2025, 60(18): 2210-2215.
7. Peralta R, Sousa R, Pinto B, et al. Commentary on: multiple single cannulation technique of arteriovenous fistula: a randomised controlled trial[J]. Arch Nephrol Ren Stud, 2021, 1(1): 28-33.
8. 王瑞敏, 王思妍, 薛小玲, 等. 多單點穿刺技術改善血液透析患者動靜脈移植物內瘺結局的回顧性研究[J]. 四川大學學報 (醫學版), 2024, 55(4): 1001-1006.
9. 肖光輝, 王玉柱, 詹申, 等. 血管通路護士分級授權管理對復雜動靜脈內瘺安全穿刺的效果觀察[J]. 河北醫藥, 2021, 43(4): 628-630, 634.
10. 中國醫院協會血液凈化中心分會血管通路工作組. 中國血液透析用血管通路專家共識(第 2 版)[J]. 中國血液凈化, 2019, 18(6): 365-381.
11. 彭飛, 張小勝, 張韡, 等. 多排螺旋 CT 全景影像在動靜脈內瘺中的應用價值[J]. 中國衛生標準管理, 2016, 7(22): 163-165.
12. 董永澤, 許秀君, 沈華娟, 等. 維持性血液透析患者動靜脈血管通路穿刺管理的最佳證據總結[J]. 中華護理雜志, 2023, 58(9): 1135-1141.
13. Lok CE, Huber TS, Lee T, et al. KDOQI clinical practice guideline for vascular access: 2019 update[J]. Am J Kidney Dis, 2020, 75(4 Suppl 2): S1-S164.
14. 劉瑤, 李靜, 曹立云, 等. 506 所血液透析中心自體動靜脈內瘺功能監測現狀及障礙因素研究[J]. 中華護理雜志, 2024, 59(24): 2966-2972.
15. 鄧甲秀, 藍麗娟, 胡秀梅, 等. 不同穿刺方式對血液透析患者自體動靜脈內瘺影響的調查研究[J]. 軍事護理, 2025, 42(3): 44-47.
16. Peralta R, Fazendeiro Matos J, Pinto B, et al. Multiple single cannulation technique of arteriovenous fistula: a randomized controlled trial[J]. Hemodial Int, 2022, 26(1): 4-12.
17. 史慧, 陳瑤, 王蕾, 等. 基于協同一體化護理模式的多單穿刺術在血液透析患者內瘺中的應用[J]. 醫藥高職教育與現代護理, 2024, 7(5): 420-423.
18. Kosmadakis G, Amara I, Costel G. Pain on arteriovenous fistula cannulation: a narrative review[J]. Semin Dial, 2021, 34(4): 275-284.
19. 肖光輝, 張聞娣, 張麗紅, 等. 血液透析新型單針穿刺技術在復雜自體動靜脈內瘺中的應用[J]. 中國血液凈化, 2025, 24(4): 323-327.

West China Medical Journal

Study on the application and efficacy of multiple needle puncture techniques in the management of autologous arteriovenous fistulas in patients undergoing maintenance hemodialysis

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