Rule of Sixes Key to Successful HD Cannulation
The KDOQI Work Group and Dr. Michelle L. Robbin from the University of Alabama at Birmingham, offer valuable guidelines for successful hemodialysis cannulation of fistulas in end-stage-renal-disease (ESRD) patients. It is recommended that a 4 mm or greater vessel diameter and flow of 500 mL/min or greater is needed to support successful hd cannulation and dialysis blood flow rates. Ultrasound is not needed for cannulation. Also suggested is the following Rule of Sixes:
- Flow in the fistula should be greater than 600 mL/min;
- The diameter of the fistula should be at least 6 mm;
- The fistula should be no more than 6 mm deep;
- The fistula should have discernible margins;
- The fistula should be ready for use within six weeks.
The goal of the Rule of Sixes is to guide a Dialysis Access Care team in the four- to six-week maturation assessment of a new vascular access. The measurements are all obtainable with a standard ultrasound technique available in many surgeons’ offices. If an AV fistula is not reaching the needed vessel diameter the surgeon and/or interventionalist may decide to use angioplasty on the vein. If the AV fistula is > 6 mm deep, the surgeon may need to superficialize the vein to the skin so that the vessel can be cannulated. See: http://esrdncc.org/en/resources/patients/access-monitoring/