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Sensing Savvy

Rule of Sixes Key to Successful HD Cannulation

Posted by Deborah Brouwer-Maier RN, CNN on Jun 26, 2017 7:00:00 AM

successful HD cannulationThe 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:

  1. Flow in the fistula should be greater than 600 mL/min;
  2. The diameter of the fistula should be at least 6 mm;
  3. The fistula should be no more than 6 mm deep;
  4. The fistula should have discernible margins;
  5. 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/

Day in the Life of a Vascular Access Coordinator

Topics: Hemodialysis