- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05556915
Benefit of Ultrasound Guidance in Arteriovenous Fistula (AVF) Cannulation in Pediatric Hemodialysis (PafusGuC)
Intérêt de l'échoguidage Dans Les Ponctions de Fistule artério-veineuse en hémodialyse pédiatrique
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The European and American recommandations emphasize that the arteriovenous fistula (AVF) is the first choice vascular access in hemodialysis for both adult and pediatric patients. Indeed, infections and thrombotic complications are lower with an AVF than with a central venous catheter. In addition, the efficiency of dialysis is better in patients with AVF in both pediatric and adult patients.
The pediatric population has its own characteristics. On the one hand, the size of the vessels, in particular in patients weighing less than 20 kilos, complicates the creation of the AVF. On the other hand, the time for AVF maturation in children (corresponding to the time required between the creation of the AVF and its use) is much higher than that of the adult population. These specific anatomical characteristics partly explain the more frequent AVF cannulation difficulties in pediatric patients.
Inadequate dialysis is considered to be a session in which the therapy goals were not achieved. This rate of inadequate dialysis is estimated at 8-10% in children due to vascular access problem, whereas this rate is only 1 to 5% in adults. There is also an increase in side effects related to these pediatric AVF cannulation difficulties (trauma, hematoma, edema following diffusion, etc.) responsible for inadequate dialysis and, in the long term, AVF dysfunction (stenosis, thrombosis).
The preservation of the vascular access by means of new cannulation techniques aimed at limiting trauma is therefore a primary objective in pediatric hemodialysis. The introduction of new cannulation methods as well as the training of nurses/childcare workers in the various puncture techniques would thus make it possible to improve the quality of dialysis sessions, the lifespan of AVFs, to increase the number of puncture sites and reduce the number of punctures per session and the occurrence of complications.
Recently, the ultrasound-guided AVF cannulation technique has shown promising results in adults with regard to the prevention of vascular access complications, the feeling of pain and the obtaining of adequate dialysis.
A recent review points to the need to confirm the benefit of ultrasound-guided cannulation through randomized studies, the current data being promising but needing to be confirmed. To date, no data concerning the benefit of ultrasound-guided cannulation in pediatrics is available in the literature. Our project will therefore be the first research to compare 2 AVF cannulation methods in pediatric hemodialysis. The hypothesis adopted is that the AVF cannulation using ultrasound guidance in children undergoing dialysis will allow an overall improvement of dialysis quality, a reduction of complication occurrence and an improvement of patient comfort.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Jean Philippe BOUDET
- Phone Number: 04 67 33 66 38
- Email: jp-boudet@chu-montpellier.fr
Study Locations
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Montpellier, France, 34295
- Recruiting
- UH Montpellier
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Contact:
- FILA, MD
- Email: fila@chu-montpellier.fr
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Pediatric patients ˂ 18 years of age at enrollment
- Patients with end-stage renal disease undergoing hemodialysis therapy
- Patients carrying an arteriovenous fistula created more than 6 weeks before enrollment
- Prior agreement of the patient and their legal representative by signing the parent's informed consent form
- Patients affiliated to social security system
Exclusion Criteria:
- Non-matured arteriovenous fistula according to the referring pediatrician
- Patients undergoing dialysis at least partly through a central venous catheter
- Estimated duration of dialysis less than 1 month in the investigation center
- Participation in other intervention research
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Ultrasound-guided AVF cannulation method
The AVF cannulation is carried out using ultrasoud guidance
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For ultrasound-guided cannulation, the same ultrasound device will be used for all patients (TE5-POC ultrasound MINDRAY® system).
The ultrasound device will identify the AVF aspect , the location including the depth (distance from the skin surface) , the vessel diameter and guide the cannulation in real-time.
The device will be disinfected between uses and covered with a transparent adhesive film to avoid any direct contact with the patient.
Sterile gel will be used for the cannulation.
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Other: Conventional AVF cannulation method
The AVF cannulation is carried out by palpation
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The AVF cannulation is carried out by palpation.
This technique consists of manually evaluating the position, direction and depth of the fistula in order to determine the puncture site where the 2-dialysis catheters will be inserted.
After local asepsis, the AVF is therefore needled at 2 points 5 cm apart.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Compare the rate of inadequate dialysis after ultrasound-guided AVF cannulation vs. conventional cannulation in pediatric patients (<18 years) with end-stage renal disease undergoing hemodialysis therapy.
Time Frame: 12 months
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Inadequate dialysis is defined by the presence of one of the following parameters:
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12 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of cannulations required for the insertion of the 2 dialysis catheters
Time Frame: During procedure
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Compare the number of cannulations required for the insertion of the 2 dialysis catheters in conventional method vs ultrasound-guided method
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During procedure
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The time required for the insertion of the 2 catheters
Time Frame: During procedure
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Compare the time required for the insertion of the 2 catheters in conventional method vs ultrasound-guided method
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During procedure
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The occurrence of cannulation complications
Time Frame: During procedure
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Compare the occurrence of cannulation complications (hematoma, diffusion, aneurysm, etc.) in conventional method vs ultrasound-guided method
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During procedure
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The occurrence of dialysis incidents caused by catheters dysfunction
Time Frame: During procedure
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Compare the occurrence of dialysis incidents caused by catheters dysfunction (decrease in dialysis flow, single-puncture dialysis, shortening of dialysis time, loss of circuit) in conventional method vs ultrasound-guided method
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During procedure
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Patient satisfaction
Time Frame: 30 days, 90 days, 180 days and 12 months after enrollment
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Compare the patient satisfaction in conventional method vs ultrasound-guided method using a satisfaction questionnaire
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30 days, 90 days, 180 days and 12 months after enrollment
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Patient comfort
Time Frame: During the procedure
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Compare the patient comfort in conventional method vs ultrasound-guided method.
The visual analogue scale (VAS) will be used by patients > 5 years of age.
The VAS measures from 0 to 10 the intensity of pain.
The higher the score the less comfortable the procedure
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During the procedure
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Patient comfort
Time Frame: During the procedure
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Compare the patient comfort in conventional method vs ultrasound-guided method. The neonatal pain and discomfort scale (EDIN Échelle Douleur Inconfort Nouveau-Né ) will be used by patients ≤ 5 years of age. The EDIN scale uses five behavioural indicators of pain: facial activity, body movements, quality of sleep, quality of contact with nurses, and consolability. The scale measures friom 0 to 15 the intensity of pain. The higher the score the less comfortable the procedure |
During the procedure
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Jean Philippe BOUDET, University Hospital, Montpellier
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- RECHMPL21_0526
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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