Needle infiltration of arteriovenous fistulae in hemodialysis: risk factors and consequences

Am J Kidney Dis. 2006 Jun;47(6):1020-6. doi: 10.1053/j.ajkd.2006.02.181.

Abstract

Background: Needle infiltration of arteriovenous fistulae is a common problem in US hemodialysis units. This study evaluated the frequency of fistula infiltration, its risk factors, and clinical consequences of this complication.

Methods: Using a prospective computerized vascular access database, we identified all patients with a major fistula infiltration sufficiently severe to prolong catheter dependence for dialysis. These patients were compared with a control group without fistula infiltration. We also quantified subsequent access outcomes in patients with infiltrations.

Results: During a 5-year period, 47 patients had a major fistula infiltration, representing a 5.2% annual rate. On multiple variable logistic regression analysis, the likelihood of fistula infiltration was associated strongly with patient age (odds ratio, 1.039/1-year increment; 95% confidence interval, 1.016 to 1.062; P = 0.0007). Fistula infiltration was not associated with sex, race, diabetic status, peripheral vascular disease, body mass index, or fistula location. New fistulas (< 6 months in age) were more likely in patients with infiltrations compared with patients without infiltrations (43.5% versus 20.5%; odds ratio, 2.98; 95% confidence interval, 1.61 to 5.54; P = 0.0004). Each major fistula infiltration resulted in a mean of 2.4 diagnostic tests, surgery appointments, or interventions. Fistula thrombosis occurred in 12 patients (26%). Median prolongation of catheter dependence for dialysis in patients with major infiltrations was 97 days.

Conclusion: Needle infiltration of fistulae is more common in older patients and with new fistulae. These infiltrations result in numerous procedures, as well as prolongation of catheter dependence for more than 3 months.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Arteriovenous Fistula / complications*
  • Arteriovenous Fistula / physiopathology*
  • Catheterization / methods
  • Clinical Competence
  • Confidence Intervals
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Needles / adverse effects*
  • Odds Ratio
  • Regression Analysis
  • Renal Dialysis / methods*
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Venous Thrombosis / diagnosis
  • Venous Thrombosis / etiology*
  • Venous Thrombosis / physiopathology