Recommendations for fistulae:
2.1 When a new native fistula is infiltrated (ie, presence of hematoma with associated induration and edema), it should be rested until the swelling is resolved.
There are no studies evaluating the need to rest a fistula after an infiltration. Common sense dictates that cannulation should be avoided in the involved area until landmarks can be seen clearly. The most common reason for infiltration is poor cannulation. Successful cannulation and use of the fistula can be engendered by providing a digital photo map of the fistula based on ultrasound. This educates the staff and develops expertise. Dialysis units should develop a new AVF cannulation protocol to prevent trauma to the newly cannulated AVF, such as progressive evolution of needle gauge used for cannulation (see CPG 3). The needle gauge and BFR should be increased slowly to prevent infiltrations and should be detailed clearly in the fistula “break-in” cannulation protocol. The role of improving the cannulation needles requires further investigation.397