Among end-stage renal disease patients dialyzing using arteriovenous fistula (AVF), does the use of the buttonhole cannulation technique compared to the standard rope-ladder technique increase the risk of access-related complications?
- editorials, opinion pieces, or any other articles not containing original data (except systematic reviews)
- abstracts
- gray literature
Condition or domain being studied
The domain of interest for this review is cannulation method in hemodialysis (HD) patients with AVF.
Participants/ population
Types of patients will include:
- adult patients (>= 18 years of age)
- on chronic HD (>= 90 days; no restriction to dialysis prescription)
- AVF as vascular access type
Intervention(s), exposure(s)
AVF cannulation using the buttonhole (or constant site) technique
Comparator(s)/ control
AVF cannulation using the rope-ladder technique
Outcome(s)
Primary outcomes
Primary outcomes:
- rate of local infection at AVF site
- access-related systemic infection rate
- access thrombosis/failure/intervention rate
- access-related hospitalization rate
- patient-perceived pain with needling
- access-related mortality rate
Secondary outcomes
Secondary outcomes:
- hematoma occurrence rate
- aneurysm formation rate
- unsuccessful cannulation rate
- time to hemostasis
- all-cause hospitalization rate
- all-cause mortality rate
Data extraction, (selection and coding)
The initial literature search will include search terms for the intervention of interest and the control intervention; we will not place restrictions on outcome.
Duplicate citations will be removed, and references will be imported into Refworks® for Macintosh or Windows. Four reviewers will independently perform title and abstract screening in duplicates and studies that are obviously irrelevant will be excluded at this stage. A title/abstract relevance form will be piloted with 5% of citations and revised as necessary.
Full-text articles will then be retrieved and further assessed for eligibility. Two reviewers will perform this task, with a third reviewer to resolve disagreements. One of the predefined reasons for exclusion will be documented for each of the excluded studies. A data extraction form will be piloted with 5% of the remaining citations and revised as necessary. Two reviewers will assess the included studies independently for methodological validity.
Risk of bias (quality) assessment
For randomized studies, risk of bias within studies will be evaluated using the criteria by Higgins et al.:
1) Was there adequate sequence generation?
2) Was allocation adequately concealed?
3) Was blinding maintained among study participants, attending nurses and physicians, data collectors, outcome adjudicators, and data analysts?
4) Were incomplete outcome data adequately addressed?
5) Were reports of the study free of suggestion of selective outcome reporting?
6) Was the study apparently free of other problems that could put it at a risk of bias?
For observational studies, we will use a risk of bias assessment tool based on the Ottawa-Newcastle criteria:
1) Was selection of exposed and non-exposed (group receiving intervention and control) cohorts drawn from the same population?
2) Representativeness of cases or group receiving intervention (Cases are consecutive).
3) Comparability (Did the study match exposed and unexposed for all variables that are associated with the outcome of interest.
4) Can we be confident in the assessment of the presence or absence of prognostic factors, or did the statistical analysis adjust for these prognostic variables?
5) Can we be confident that the outcome of interest was not present at start of study?
6) Can we be confident in the assessment of outcome?
7) Same method of assessing outcome apply to both groups.
8) Co-interventions similar between groups, length of follow up is adequate for outcome to occur, number lost to follow up does not affect our conclusion about the effect of the intervention on the outcome.
9) Were the reasons for drop out identified and similar across groups?
Strategy for data synthesis
No individual patient level data will be used. Where possible, we will pool treatment effect estimates using standard statistical techniques as appropriate. In the event that pooling is not feasible (due to inadequate information or excessive heterogeneity), we will use descriptive methods to present data by outcome.
Given the anticipated, limited number of randomized controlled trials on this topic, a meta-analysis will not be conducted. Narrative methods will be used to present data by outcome.
Analysis of subgroups or subsets
If sufficient data are available, we will present pooled estimates by subgroup as follows:
- subgroup for those who perform self-cannulation
- subgroup for those whose cannulation is performed by others
Contact details for further information
Ben Wong
Aberhart Centre One, Room 8133
11402 University Avenue
Edmonton, Alberta, Canada
T6G 2J3
bcw@ualberta.net
Organisational affiliation of the review
University of Alberta
Review team
Dr Ben Wong, University of Alberta Dr Robert Pauly, University of Alberta Dr Sabin Shurraw, University of Alberta Dr Gihad Nesrallah, University of Western Ontario Alexa Grudzinski, University of Western Ontario Dr Neesh Pannu, University of Alberta
Formal screening of search results against eligibility criteria
Data extraction
Risk of bias (quality) assessment
Data analysis
Prospective meta-analysis
PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites.
