Into Arteriovenous Fistulas for Treatment by. Repeated Dialysis. For repeated hemodialysis, the Cimi- no-Brescia fistula is the best method of access because of ...
0 Zbylut Twardowski, M.D. •; Helena Kubara, R.N., Renal Unit, Hospital for Miners, Bytom, Poland
Different Sites Versus Constant Sites of Needle Insertion Into Arteriovenous Fistulas for Treatment by Repeated Dialysis or repeated hemodialysis, the Cimino-Brescia fistula is the best method F of access because of the limited number of complications and the likelihood of long-term patency . 1•2 The inconveniences of a subcutaneous fistula in contradistinction to an external shunt are the slowing of the dialysis set-up process and the pain·connected with venipuncture. There are few reports concerning the method of using subcutaneous fistulas. It is suggested that in repeated dialysis the site of insertion should be changed and that the needle or cannula should be inserted in an antegrade direction in order to decrease the frequency of · hematoma formation. 3·4 From 1969 to 1973 in our unit, we generally used different sites for needle insertion in repeated dialyses for both the afferent and efferent needle insertion. At that time, we had one patient who had a very limited area for puncture, so that a constant site of insertion became a matter of necessitY. It was observed that the insertion w~s not extremely painful af!d was accomplished quickly, and that no complications were noted. Eventuall\' this method came to brmed the basis ft~r examination. Twent\'-five fistulas were created bv side-t;>-side anastomosis of the radial arter\' and the cephalic \'cin, and four fist~las were • Pr('.f(!ll t add rcwx: Dc7Utrl m C'lll of NepiJ roiOf!.!f· /11.
