Ultrasound-Guided Cannulation of Arteriovenous Fistulas in Hemodialysis Units: A Systematic Review

Background/Objectives: Arteriovenous fistulas are the preferred vascular access for hemodialysis, but difficult or unsuccessful cannulation may cause pain, complications, and access dysfunction. This review evaluated whether ultrasound-guided cannulation improves outcomes compared with standard cannulation. Methods: A systematic review was conducted according to PRISMA guidelines. PubMed, Web of Science, Scopus, CINAHL, Cochrane Library, and ClinicalTrials.gov were searched for randomized controlled trials comparing ultrasound-guided and standard arteriovenous fistula cannulation in hemodialysis patients. Findings were synthesized narratively. Risk of bias was assessed using RoB 2, and certainty of evidence using GRADE. Results: Of 1210 records identified, five randomized trials involving 142 patients were included. Some trials reported improved cannulation success or lower pain with ultrasound guidance, but findings varied across populations and outcome measures. Three of four trials reporting procedure time found longer durations with ultrasound guidance. A consistent reduction in complications or improvement in patient satisfaction was not established. Staff findings mainly concerned confidence and acceptability. The certainty of evidence was low. Conclusions: The effects of ultrasound-guided AVF cannulation on pain varied across trials. These uncertain findings should be interpreted alongside the longer procedure times reported in several trials. Larger randomized trials with clearly defined outcomes and analyses accounting for repeated observations are needed before recommending routine use.