{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T21:30:28Z","timestamp":1790631028379,"version":"4.1.0"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,7,6]],"date-time":"2021-07-06T00:00:00Z","timestamp":1625529600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Hemodialysis International"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Despite the impact needling has had on vascular access survival and patient outcome, there is no universal or standardized method proposed for proper cannulation. Rigorous studies are needed, examining cannulation practices, and challenges to achieving complication\u2010free cannulation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This randomized, open\u2010label trial was conducted at 18 dialysis units owned by a large private dialysis provider operating in Portugal. Eligible patients were adults on chronic hemodialysis, with a new arteriovenous fistula (AVF); cannulated for at least 4\u2009weeks complication\u2010free. Patients were randomly assigned in a 1:1 ratio to one of three cannulation techniques (CT): Multiple Single cannulation Technique (MuST), rope\u2010ladder (RLC), and buttonhole (BHC). The primary endpoint was AVF primary patency at 1\u2009year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>One hundred seventy\u2010two patients were enrolled between March 2014 and March 2017. Fifty\u2010nine patients were allocated to MuST, 56 to RLC, and 57 to BHC.<\/jats:p><jats:p>MuST and RLC were associated with a better AVF primary patency than BHC. Primary patency at 12\u2009months was 76.3% in MuST, 59.6% in BHC, and 76.8% in RLC group. Mean AVF survival times were 10.5\u2009months (95% CI\u00a0=\u00a09.6, 11.3) in the MuST group, 10.4\u2009months (95% CI\u00a0=\u00a09.5, 11.2) in RLC, and 9.5\u2009months (95% CI\u00a0=\u00a08.6, 10.4) in BHC. BHC was a significant risk predictor for AVF survival with 2.13 times more events than the other two CT (HR 2.13; 95% CI\u00a0=\u00a01.07, 4.21; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>MuST was easy to implement without a diagram and there is no need to use blunt needles. This study showed MuST was efficacious and safe in maintaining the longevity of AVF in dialysis patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hdi.12962","type":"journal-article","created":{"date-parts":[[2021,7,7]],"date-time":"2021-07-07T05:15:13Z","timestamp":1625634913000},"page":"4-12","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Multiple single cannulation technique of arteriovenous fistula: A randomized controlled trial"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6962-1073","authenticated-orcid":false,"given":"Ricardo","family":"Peralta","sequence":"first","affiliation":[{"name":"NephroCare Portugal Fresenius Medical Care Portugal  Maia Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o","family":"Fazendeiro Matos","sequence":"additional","affiliation":[{"name":"NephroCare Portugal Fresenius Medical Care Portugal  Maia Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Pinto","sequence":"additional","affiliation":[{"name":"NephroCare Portugal Fresenius Medical Care Portugal  Maia Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Gon\u00e7alves","sequence":"additional","affiliation":[{"name":"NephroCare Viseu Fresenius Medical Care Viseu  Viseu Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Sousa","sequence":"additional","affiliation":[{"name":"NephroCare Viseu Fresenius Medical Care Viseu  Viseu Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Felix","sequence":"additional","affiliation":[{"name":"NephroCare Portugal Fresenius Medical Care Portugal  Maia Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Instituto Universit\u00e1rio de Lisboa (ISCTE\u2010IUL), Centro de Investiga\u00e7\u00e3o e Estudos de Sociologia (CIES\u2010IUL)  Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Vinhas","sequence":"additional","affiliation":[{"name":"Nephrology Department Set\u00fabal Hospital Centre  Set\u00fabal Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Ponce","sequence":"additional","affiliation":[{"name":"NephroCare Portugal Fresenius Medical Care Portugal  Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,7,6]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2018.02.001"},{"key":"e_1_2_7_3_1","first-page":"1","article-title":"Vascular access management for haemodialysis: A value\u2010based approach from NephroCare experience","author":"Canaud B","year":"2019","journal-title":"Vasc Access Surg \u2010 Tips Tricks"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.01690213"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2014.96"},{"key":"e_1_2_7_6_1","first-page":"1","article-title":"Canula\u00e7\u00e3o do acesso vascular em pacientes em hemodi\u00e1lise: Abordagem t\u00e9cnica","volume":"42","author":"Carlos M","year":"2019","journal-title":"Brazilian J Nephrol"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfp420"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1755-6686.2011.00211.x"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.02730312"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2013.09.015"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2013.01.011"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2019.12.001"},{"key":"e_1_2_7_13_1","unstructured":"SousaR SilvaA CoimbraM Gon\u00e7alvesP MatosJF.Must cannulation technique minimizes cannulation site problems. 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