Improved Dialysis Cannulation Needle

Project Summary/Abstract
The proposed project relates to the development and evaluation of an innovative dialysis cannulation needle
that aims to reduce the rate of accidental needle infiltration injury and thereby improve the safety and efficacy
of home and in-center renal dialysis therapy. Access to an arterial and venous blood source with adequate
blood flow is needed to facilitate hemodialysis. Care and preservation of patent, well-functioning dialysis
accesses are among the most difficult clinical problems in the long-term treatment of patients undergoing
dialysis and loss of access is frequent. A well-functioning arteriovenous fistula has been recognized as a
preferred access modality by the renal community. Dialysis generally requires cannulation with two large-bore
needles three-times weekly to achieve blood flow sufficiently high to ensure adequate dialysis and more than
150 million dialysis cannulations are conducted per year in the U.S. alone. Cannulation accuracy with correct
needle position is vital to successful access without damage to the arteriovenous fistula. An infiltration injury
occurs when the cannulation needle puncture initially enters the vessel but subsequently pierces the vessel wall
elsewhere, resulting in a localized subcutaneous hematoma causing pain, swelling, bruising and other physical
and psychological impacts on the patient, which often lead to additional testing and interventions. Minor
infiltrations are common, occurring in some 50% of patients within the first three dialysis sessions after
arteriovenous fistula maturation. Major infiltrations are less common, more consequential, and occur at a rate
of 5% annually for all patients with arteriovenous fistula. Six months after a major infiltration, only 65% of patients
have resumed use of their arteriovenous fistula. Qualitative studies evaluating barriers to home dialysis, which
comes with many benefits, indicate that self-cannulation is a significant source of fear and anxiety. A novel safer
needle is proposed that requires no action from the operator and no change to current dialysis workflow to
achieve benefit. An advanced prototype needle will be designed, manufactured and tested.

Grant Number: 1R43DK145258-01
NIH Institute/Center: NIH
Principal Investigator: Patrick Boldenow