The occurrence of difficult arteriovenous fistulas makes the use of vascular access in hemodialysis patients face great challenges. With the widespread application of point-of-care ultrasound, POCUS technology, it provides a new solution for clinical practice. This article reviews the principle, basic process, application status, current clinical challenges and development direction of difficult arteriovenous fistulas cannulation guided by POCUS technology, in order to provide reference for the standardized clinical application and future research direction of this technology.
Wang Y, Yang L, Lei Y, 2024, The Global Status of Nursing Research on Hemodialysis: A Bibliometric and Visualized Analysis. Medicine (Baltimore), 103(39): e39707.
Yang C, Yang Z, Wang J, et al., 2024, Estimation of Prevalence of Kidney Disease Treated with Dialysis in China: A Study of Insurance Claims Data. American Journal of Kidney Diseases, 77(6): 889–897.
Bello A, Okpechi I, Osman M, et al., 2022, Epidemiology of Haemodialysis Outcomes. Nature Reviews Nephrology, 18: 378–395.
Lok C, Huber T, Lee T, et al., 2020, KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. American Journal of Kidney Diseases, 75(4 Suppl 2): S1–S164.
Chai J, Wu C, Yuan A, et al., 2024, Application of the Buttonhole Puncture Management Program for Difficult Autologous Arteriovenous Fistula in Hemodialysis Patients. Chinese Journal of Nursing Education, 21(9): 1132–1140.
Hong C, Jiang R, Ling K, et al., 2020, Application of Zero-Pressure Modified Puncture Technique in Hemodialysis Patients with Difficult Arteriovenous Fistula. Chinese Journal of Nursing, 55(5): 727–730.
Behera M, John E, Thomas A, et al., 2022, Difficult Cannulation of Hemodialysis Arteriovenous Fistula: Role of Imaging in Access Management (DICAF Study). Journal of Vascular Access, 23(6): 877–884.
Fu L, Huang L, 2018, Application of Intelligent Handheld Ultrasound Diagnostic Instrument for Difficult Puncture of Arteriovenous Fistula. Chinese Journal of Blood Purification, 17(8): 539–541.
Schoch M, Bennett P, Currey J, et al., 2023, Nurses’ Perceptions of Point-of-Care Ultrasound for Haemodialysis Access Assessment and Guided Cannulation: A Qualitative Study. Journal of Clinical Nursing, 32(23–24): 8116–8125.
Luo J, Chen L, Chen H, et al., 2024, Qualitative Research on Hindering and Promoting Factors in the Application of Ultrasound-Guided Puncture of Difficult Arteriovenous Fistula by Hemodialysis Specialist Nurses. Journal of Nurses Training, 39(22): 2437–2441.
Khanoussi A, Naciri M, 2024, Nurses’ Use of Ultrasound Location for Puncturing Arteriovenous Fistulas in Hemodialysis. Saudi Journal of Kidney Diseases and Transplantation, 33(6): 738–745.
Zhou H, Li H, Lou L, 2018, Propensity Score-Based Analysis of the Effectiveness of Ultrasound-Guided First Puncture of Arteriovenous Fistula. Chinese Journal of Integrated Traditional and Western Nephrology, 19(7): 635–636.
Avola D, Cinque L, Fagioli A, et al., 2021, Ultrasound Medical Imaging Techniques: A Survey. ACM Computing Surveys, 54(3): Article 67.
Kim J, Lee D, Schwartz M, et al., 2026, Point-of-Care Ultrasound in Hospital Medicine: A Narrative Review. Journal of Ultrasound in Medicine, 45(2): 225–239.
Chlorogiannis D, Bousi S, Zachiotis M, et al., 2024, Pre-Operative Ultrasound Mapping before Arteriovenous Fistula Formation: An Updated Systematic Review and Meta-Analysis. Journal of Nephrology, 37(2): 281–292.
Schoch M, Bennett P, Currey J, et al., 2020, Point-of-Care Ultrasound Use for Vascular Access Assessment and Cannulation in Hemodialysis: A Scoping Review. Seminars in Dialysis, 33(5): 355–368.
Tang S, Chen L, Zhang Y, et al., 2024, Evidence Summary for Ultrasound-Guided Autogenous Arteriovenous Fistula Puncture. Chinese Journal of Blood Purification, 23(11): 859–863.
Schoch M, Bennett P, Currey J, et al., 2023, Point-of-Care Ultrasound-Guided Cannulation versus Standard Cannulation in Hemodialysis Vascular Access: A Controlled Random Order Crossover Pilot Feasibility Study. Journal of Vascular Access, 24(5): 1140–1149.
Iglesias R, Lodi M, Rubiella C, et al., 2021, Ultrasound Guided Cannulation of Dialysis Access. Journal of Vascular Access, 22(1 Suppl): 106–112.
Schoch M, Fielding C, Marticorena R, et al., 2024, Barriers and Facilitators to Vascular Access Point-of-Care Ultrasound in Haemodialysis: An International Survey of Haemodialysis Clinicians. Journal of Renal Care, 50(4): 405–412.
Xiao G, Wang Y, 2018, Manual of Integrated Management for Blood Purification Access. Beijing: Beihang University Press.
Xiao G, Wang Y, Zhan S, et al., 2018, Handheld Ultrasound Examination for Real-Time Guidance on Cannulation in Patients with a New Arteriovenous Fistula for Hemodialysis. Chinese Journal of Blood Purification, 17(9): 633–636.
Zhang J, Li J, Zhao D, et al., 2024, Investigation on the Operational Status of Point-of-Care Ultrasound Assisted Difficult Arteriovenous Fistula Puncture in 18 Hospitals. Chinese Journal of Blood Purification, 23(9): 706–710.
Wu T, Chen J, Fang X, et al., 2022, Application of Multidisciplinary Teamwork Centered on Hemodialysis Nurses in the Management of Autogenous Arteriovenous Fistula in Maintenance Hemodialysis Patients. Shanghai Nursing, 22(9): 12–16.
Jin J, Wang H, Gu X, 2020, Ultrasound-Guided First Cannulation of Arteriovenous Fistula in Hemodialysis Patients: An Observational Study. The Medical Forum, 24(24): 3465–3467.
Liu H, Wang K, 2018, Use of Doppler Ultrasound to Facilitate Difficult Arteriovenous Fistula Cannulation: A Clinical Study. Journal of Nurses Training, 33(11): 1038–1039.
Cheng Y, Hong T, Zhang L, et al., 2022, Portable Ultrasound-Guided Cannulation for Difficult Arteriovenous Fistula Access: A Clinical Study. Modern Medical Imageology, 31(3): 591–594.
Ibrahim M, Abdelaal B, Alameri R, 2022, Assessment of Pain and Anxiety during Arteriovenous Fistula Cannulation among Hemodialysis Patients. Journal of Multidisciplinary Healthcare, 15: 705–718.
Wen F, 2020, Ultrasound-Guided Cannulation for Challenging Arteriovenous Fistula Access: Efficacy and Outcomes. Medical Equipment, 33(11): 2.
Liu W, Gao M, Zhang L, et al., 2023, Application of Ultrasound-Based Vascular Puncture Positioning Technology in Patients with Difficult Arteriovenous Fistula in Hemodialysis. Modern Medical Journal, 51(2): 170–174.
Zhang P, Zhang D, Yu Y, et al., 2023, Ultrasound-Guided Cannulation for Challenging Arteriovenous Fistulae in Tibetan Hemodialysis Patients. Xizang Science and Technology, 45(5): 59–61 + 74.
Gage S, Reichert H, 2021, Determining the Incidence of Needle-Related Complications in Hemodialysis Access: We Need a Better System. Journal of Vascular Access, 22(4): 521–532.
Xiong C, Liu S, Liu M, 2023, Application of Color Doppler Ultrasound Guided Puncture of Autologous Arteriovenous Fistula in the Initial Stage of Difficult Internal Fistula. The Medical Forum, 27(24): 22–24.
Zhang F, Yuan P, Li M, et al., 2023, Application Effect of Real-Time Ultrasound Guided Puncture of Difficult Arteriovenous Fistula. Chinese Evidence-Based Nursing, 9(7): 1264–1268.
Wu A, Huang H, Zhang H, et al., 2022, In-Plane Guided Upper Arm Arteriovenous Fistula Cannulation with Color Ultrasound. Hemodialysis International, 26(4): 496–502.
Wang C, Ni D, Qin X, 2022, Application of Ultrasound Guidance in the Puncture of Difficult Arteriovenous Fistula in Maintenance Hemodialysis Patients. Health Must-Read, (27): 85.
Kumbar L, Soi V, Adams E, et al., 2018, Coronal Mode Ultrasound Guided Hemodialysis Cannulation: A Pilot Randomized Comparison with Standard Cannulation Technique. Hemodialysis International, 22(1): 23–30.
Chen S, Liu J, Chai C, et al., 2023, Handheld Ultrasound-Guided Cannulation of Difficult Hemodialysis Arteriovenous Access: A Randomized Controlled Trial. Hemodialysis International, 27(1): 21–27.
Eves J, Cai P, Latham R, et al., 2021, A Randomised Clinical Trial of Ultrasound Guided Cannulation of Difficult Fistulae for Dialysis Access. Journal of Vascular Access, 22(4): 635–641.
Knutsen K, Solbakken R, 2025, Utilisation of Point-of-Care Ultrasound by Critical Care Nurses: A Scoping Review Protocol. BMJ Open, 15(6): e100911.
Xu M, Jin G, Chen Q, et al., 2025, Construction and Pilot Implementation of a Bedside Ultrasound Stratified Training Curriculum for Intensive Care Nurses. Chinese General Practice Nursing, 23(3): 497–502.
Wu A, 2021, Comparative Application of Two Different Color Ultrasound-Guided Methods in the Puncture of Autologous Arteriovenous Fistula in Obese Patients. Biomedical Engineering and Clinical Medicine, 25(1): 41–46.
Schoch M, Fielding C, Marticorena R, et al., 2024, Barriers and Facilitators to Vascular Access Point-of-Care Ultrasound in Haemodialysis: An International Survey of Haemodialysis Clinicians. Journal of Renal Care, 50(4): 405–412.
Zhan Y, Jiang X, 2022, Application Value of Vascular Puncture Technique of Difficult Arteriovenous Fistula Guided by Color Doppler Ultrasound. Shenzhen Journal of Integrated Traditional Chinese and Western Medicine, 32(9): 80–83.
Huang Y, Wang H, 2017, Application of Color Doppler Ultrasound-Guided Internal Arteriovenous Fistula in Hemodialysis Patients with Poor Vascular Condition. China & Foreign Medical Treatment, 36(35): 27–29.
Naylor A, Ricco J, Borst G, et al., 2018, Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery. European Journal of Vascular and Endovascular Surgery, 55(1): 3–81.
Marticorena R, Mills L, Sutherland K, et al., 2015, Development of Competencies for the Use of Bedside Ultrasound for Assessment and Cannulation of Hemodialysis Vascular Access. CANNT Journal, 25(4): 28–32.
Xiao G, Wang Y, Zhan S, 2021, Effects of Hierarchical Authorization Management of Vascular Access Nurses on the Safety of Complex Arteriovenous Fistula Puncture. Hebei Medical Journal, 43(4): 628–630 + 34.
Nyhsen C, Humphreys H, Koerner R, et al., 2017, Infection Prevention and Control in Ultrasound: Best Practice Recommendations from the European Society of Radiology Ultrasound Working Group. Insights into Imaging, 8(6): 523–535.
Iglesias R, Lodi M, Rubiella C, et al., 2021, Ultrasound Guided Cannulation of Dialysis Access. Journal of Vascular Access, 22(1 Suppl): 106–112.
Cao L, Zhang L, Wang X, et al., 2020, Expert Consensus on Intensive Care Ultrasound. Chinese Journal of Modern Nursing, 26(33): 4577–4590.
Wang J, Wang F, Zhao Q, et al., 2024, Research Status of Microbial Contamination of Medical Ultrasonic Probes and Couplings. China Modern Medicine, 31(15): 194–198.