3D printed hemodialysis access and subcutaneous volume model as a guide for cannulation: A proof of concept training tool

A 54-year-old underwent brachiocephalic arteriovenous fistula placement. Following maturation of the access, consistent cannulation for routine hemodialysis was challenging for clinical specialists. A three-dimensional intraluminal access model was generated, but clinical specialists adept at cannulation had difficulty orienting the model to the patient's anatomy without repeat supervision. When provided the model prima facie, 50% (4/8) clinical specialists were not able to spatially orient the model appropriately in the x-axis with respect to the coronal plane (2/8) or in the z-axis with respect to the transverse plane (2/8). Spatial renderings of the subcutaneous volume available for cannulation were then printed and physically applied to the vascular access model resulting in appropriate spatial orientation among all clinical specialists (n = 12) that were presented the models for the first time. Mean Kt/V increased during the 3-month period directly following model introduction. This case demonstrates the potential utility of 3D-modeling to readily visualize the subcutaneous volume of a hemodialysis vascular access and reduce cannulation error.