There are three main types of cannulation for vascular access: 1. Rope ladder method is the most recommended as it helps prevent infections, stenosis, aneurysms and extends the life of the fistula. 2. Area puncture method is easiest but puncturing the same area each time can lead to aneurysms, stenosis and bleeding. 3. Button hole method punctures the exact same spot each time, which is less painful, extends the fistula life, and prevents complications but requires more training.

1. TYPES OF CANNULATION
A. ROPE LADDER
B. AREA
CANNULATION
C. BUTTON HOLE

2. ROPE LADDER METHOD
This is the most recommended
method for cannulation helps to
prevent infection, stenosis,
aneurysm and expand the life span
of fistula

3. AREA PUNCTURE METHOD
It is the easiest method
session after session
puncturing at the same general
area may prone to aneurysm ,
stenosis and bleeding.

4. BUTTON HOLE METHOD
Everytime cannulating at the exact
same spot , at the same angle and
depth of penetration.
It is less painful, prolong AVF life
span, prevent aneurysm and
bleeding , promotes self care.

5. COMPLICATIONS
Needle sites
bleeding more
than 10 minutes
due to various
reasons , need to
find the cause of
bleeding.
BLEEDING
INFECTION
ANEURYSM
Redness,
swelling, fever,
tenderness,
warmth, pain
and discharge
are signs and
symptoms.
Weak spot in the
wall of vessel wall
causes ballooning
of the AVF
overtime vein
become tortuous.

6. COMPLICATIONS
STENOSIS
Narrowing of AVF at
certain part.
Reduction in 50% of
diameter in vessel
wall compared to
adjacent vessel
wall has been used.
THROMBOSIS
STEAL
SYNDROME
Formation of blood
clot in the uninjured
or minor injured
vessels. Absence of
bruit / thrill on
palpation.
Deprivation of blood
supply distal to AVF
lead to ischemia of
the hand, results
severe pain and
neurological
damage to the hand