Point-of-Care Ultrasonography Use for Vascular Access Training in Home Hemodialysis

Background: Successful vascular access is critical for optimal outcomes in Home Hemodialysis (HHD). Previous studies have shown increased vascular access intervention in HHD. Point-of-Care Ultrasound (POCUS) has emerged as a valuable tool to guide cannulation and vascular access training. However, data on its longitudinal impact in HHD programs remains unexplored. We evaluate the utilization and impact of POCUS in vascular access training for patients undergoing HHD. Methods: This retrospective cohort study analyzed HHD patients trained between 2014 and 2025 at a single academic center. Patients were divided into two groups: cases(n=12) who received POCUS-guided vascular access training, and controls (n=12) who underwent standard training without POCUS. POCUS was used by trained nephrologists and dialysis nurses during cannulation instruction or evaluation. Figure 1 shows the protocol for POCUS utilization during the training. Primary outcomes included need for vascular interventions, and access outcomes. Results: A total of 24 patients were included, with 12 in the POCUS-assisted group and 12 in the control group. 50 % of patients had permanent AV access during initial training in POCUS trained group while 80% of them completed successfully cannulation within 1 year. Although, 91% had successful cannulation who standard training without POCUS. The POCUS group had significantly fewer fistulograms (9 vs. 19 cases, p < 0.01) during first year of HHD. Conclusion: Incorporating POCUS into vascular access training reduces the need for interventions during the first year of HHD. Broader adoption of POCUS may support expanded use of HHD by addressing one of its most significant barriers—vascular access management.