A Randomized Control Trial of MuST for Vascular Access Cannulation in Hemodialysis Patients: Contributions for a Safe Nursing Intervention

<h2>Abstract</h2><h3>Rationale & Objective</h3> Preservation and maintenance of a complication-free arteriovenous fistula (AVF) remains significant challenge. An adequate cannulation technique and successful puncture are critical for preserving AVF and ensuring patient safety. The study investigated whether the Multiple Single Cannulation Technique (MuST) leads to improved AVF survival and a lower complication rate compared to the rope-ladder technique (RL). <h3>Study Design</h3> The MuST study was a multicenter, prospective, non-blind, parallel group, randomized controlled trial. <h3>Setting & Participants</h3> A total of 101 patients received hemodialysis in 3 peripheral units, 49 patients have been assigned to the MuST group and 52 to the control group. <h3>Intervention</h3> The intervention group received MuST, while the control group underwent RL, with both groups followed for period of 12 months <h3>Outcomes</h3> The primary outcome was to evaluate the AVF survival rate at 12 months, defined as unassisted patency. The secondary outcome included the assessment of assisted primary patency, complication rates, and pain perception. <h3>Results</h3> There were no statistically significant differences between the MuST and RL techniques in unassisted patency (HR = 1.02, 95% CI=0.38, 2.71, <i>p</i> = 0.98) or in assisted patency (HR = 0.74; 95% CI=0.37, 1.47, <i>p</i> = 0.39). There were no statistically significant differences in the incidence of haematoma or thrombosis, and no infections occurred during the study period. The MuST presented an advantage over RL in the development and new aneurysms formation. There were no significant differences observed in pain perception between the two cannulation techniques. <h3>Limitations</h3> The sample size was smaller than expected due to limitations in the selection of patients during the SARS-CoV-2 pandemic phase. <h3>Conclusions</h3> We could not definitively demonstrate a difference in AVF survival between MuST and RL. The low incidence of AVF thrombosis in both techniques shows that MuST can be a choice in patient safety and well-being when nursing teams decide which cannulation technique to perform.