# The Chain of Cannulation: A Qualitative Comparison of the Cannulation Process and European Guidelines

## TL;DR

This paper compares the cannulation process and guidelines across different European dialysis contexts to see how well they align.

## Contribution

The study introduces a qualitative comparison of cannulation guidelines from different European countries using the chain of cannulation framework.

## Key findings

- Most subcategories of the chain of cannulation showed partial agreement between guidelines.
- Silence and dissonance were found in subcategories like hygiene routines and needle withdrawal.
- Two new subcategories were identified in British guidelines: patient involvement and screening and control.

## Abstract

The cannulation of an arteriovenous fistula can be performed using several different techniques and surrounding routines, which are presently not well‐defined. The recently described chain of cannulation includes planning cannulation, pre‐cannulation, during cannulation, evaluating cannulation and post‐cannulation, and was based on the Swedish context, in which the buttonhole cannulation technique is the most common.

To explore whether the chain of cannulation is in agreement with nursing guidelines from other dialysis contexts, in terms of cannulation techniques and their preconditions.

Qualitative comparison of guidelines regarding arteriovenous fistula cannulation.

Two guidelines regarding the process of arteriovenous cannulation, written in English, were included and compared to a compilation of Swedish local guidelines.

The British and European guidelines were analysed using deductive qualitative content analysis. The utilised categorisation matrix was based on the chain of cannulation and its subcategories. The identified subcategories were compared among guidelines, using qualitative triangulation to find agreement, dissonance or silence.

The majority of subcategories showed partial agreement between at least two of the guidelines. Silence and dissonance were identified in the following subcategories: hygiene routines, preventing pain, how to needle, angle during cannulation, needle withdrawal and haemostasis. Two new subcategories were identified in the British guidelines: patient involvement, and screening and control.

The chain of cannulation, which originated in the Swedish context, showed agreement with needling guidelines from other nursing contexts regarding arteriovenous cannulation techniques and their preconditions.