Single Needle Distal Return Technique Achieves Zero Catheter and Improves Outcomes in Patients with Dysfunctional Arteriovenous Fistulas.
Source: PubMed, NCBI / U.S. National Library of Medicine
The periprocedural window surrounding percutaneous transluminal angioplasty (PTA) for dysfunctional arteriovenous fistula (AVF) is a high risk phase often complicated by metabolic instability and temporary central venous catheter (CVC) dependence. This study characterised this window and evaluated a "zero catheter" multidisciplinary strategy centred on the single needle distal return (SNDR) technique. This single centre, retrospective cohort study included all maintenance haemodialysis patients undergoing PTA for AVF dysfunction. The study had two phases: phase 1 (conventional care, February 2023 - March 2024) and phase 2 ("zero catheter" SNDR protocol, April 2024 - February 2026). Patients were categorised by source (in centre vs. referred). Clinical characteristics at presentation were compared between sources. Periprocedural outcomes were compared between phases. The primary outcome was temporary CVC utilisation. A total of 452 patients (700 procedures) were included. Referred patients (n = 186) exhibited significantly worse profiles at presentation than in centre patients (n = 266): higher potassium (6.2 ± 1.9 vs. 5.1 ± 0.8 mmol/L), elevated NT-proBNP (1 850 vs. 852 pg/mL), and higher prevalence of pre-existing CVCs (31.7% vs. 0.8%, all p < .001). After SNDR protocol implementation, phase 2 (n = 237) demonstrated more dramatic improvements than phase 1 (n = 215): CVC utilisation decreased from 24.2% to 0% (p < .001), time to PTA shortened from 4.2 ± 2.5 to
Abstract
The periprocedural window surrounding percutaneous transluminal angioplasty (PTA) for dysfunctional arteriovenous fistula (AVF) is a high risk phase often complicated by metabolic instability and temporary central venous catheter (CVC) dependence. This study characterised this window and evaluated a "zero catheter" multidisciplinary strategy centred on the single needle distal return (SNDR) technique. This single centre, retrospective cohort study included all maintenance haemodialysis patients undergoing PTA for AVF dysfunction. The study had two phases: phase 1 (conventional care, February 2023 - March 2024) and phase 2 ("zero catheter" SNDR protocol, April 2024 - February 2026). Patients were categorised by source (in centre vs. referred). Clinical characteristics at presentation were compared between sources. Periprocedural outcomes were compared between phases. The primary outcome was temporary CVC utilisation. A total of 452 patients (700 procedures) were included. Referred patients (n = 186) exhibited significantly worse profiles at presentation than in centre patients (n = 266): higher potassium (6.2 ± 1.9 vs. 5.1 ± 0.8 mmol/L), elevated NT-proBNP (1 850 vs. 852 pg/mL), and higher prevalence of pre-existing CVCs (31.7% vs. 0.8%, all p < .001). After SNDR protocol implementation, phase 2 (n = 237) demonstrated more dramatic improvements than phase 1 (n = 215): CVC utilisation decreased from 24.2% to 0% (p < .001), time to PTA shortened from 4.2 ± 2.5 to 1.9 ± 1.3 days (p < .001), and first post-PTA dialysis adequacy (spKt/V) improved from 1.21 ± 0.18 to 1.48 ± 0.15 (p < .001). All 32 referred patients arriving with CVCs in phase 2 had them removed within 24 hours. Ninety day re-intervention free survival significantly improved in phase 2 (log rank p < .01). Referred patients bear a disproportionately higher burden of periprocedural complications. Implementation of a "zero catheter" SNDR based strategy effectively eliminated temporary catheter dependence, stabilised metabolic profiles, and improved access outcomes, offering a reproducible framework for optimising peri-PTA care.