Examining the Efficacy of an Improved CanSim for Quantifying Hemodialysis Cannulation Skills

Cannulation of a patient's vascular access is a daily requisite procedure for initiating hemodialysis for those with End-Stage-Kidney Disease. Skills training and assessment for hemodialysis cannulation needs attention; currently, trainees lack effective teaching tools and practice on patients-leading to stress for the cannulator and potentially multiple attempts with pain and infiltration (extravasation of blood into soft tissue) for the patient. We created a cannulation simulator (CanSim) with the goal of measuring cannulation skill and tested the hypothesis that the simulator's process metrics are able to predict cannulation outcomes on the simulator. Data collected on CanSim from a recent study with improved simulation technology were compared with a previous dataset collected on an earlier prototype. Multiple sensors were used to measure different aspects of cannulation behavior and outcome on the simulator. The infiltration rate on the improved system was less than half that of the previous prototype (20% v 53%). Additionally, only one trial included an extra attempt (1.4%) in the new group, with 15% requiring more than one attempt on the older simulator. Analysis of performance metrics revealed key predictors of successful cannulation, specifically shallower insertion angles. These results could inform design of objective, reproducible cannulation training for providers in a safe, simulated environment.