Twenty-four studies met the eligibility criteria. The key characteristics of these studies are outlined in Table 2. The 24 studies encompass data from 11,687 patients, 801 dialysis ward staff, 150 haemodialysis units, 29 local guidelines and 82 studies conducted across 14 countries. Overall, the quality scores of the studies were high, as indicated in Table 2. After assessing the methodological quality, one study with a low quality score was excluded.

AVF cannulation outcomes were categorised into five groups: (1) planning cannulation, (2) cannulation technique, (3) needle-related factors, (4) ultrasound-guided cannulation and (5) post-cannulation aspects.

Wilson et al. [16]. analysed the opinions of both patients and professionals regarding AVF cannulation, and Harwood et al. [4] developed a qualitative study that explored factors contributing to cannulation success. Both studies highlighted the importance of person-centred care for successful cannulation.

In the former study, both patients and nurses agreed on the significance of the patient’s comfort level and the presence of direct support staff. In the latter study, nurses highlighted the importance of educating patients about the benefits of AVFs, and of the need for empathy. They also emphasised the significance of being sensitive to the patient’s emotional responses, approaching cannulation with a pre-planned strategy, and avoiding transferring their own nervousness to the patient. When nurses were asked about aspects of developing cannulation skills, a commonly expressed desire was to have more opportunities to practice the skill [4].

A mixed-method study by Staaf et al. [17] explored cannulation-related factors. They found that nurses perceived cannulation knowledge as being closely linked to experience. Nurses also found it important to keep their skills up to date by attending educational events, consulting with experts, and observing other expert nurses execute the procedure, and felt that teamwork and relying on colleagues were essential for successful cannulation [4].

Staaf et al. [17] analysed 29 local guidelines and recommended ‘the rule of 6’ (6 mm deep, 6 mm wide, blood flow of > 600 ml/min, 6 weeks to maturation) when describing factors indicating that a newly created AVF is ready for cannulation. The planning of AVF care and the management of AVF complications were referred to the access nurse, who is the key person responsible for informing patients. The local guidelines also emphasised the need to conduct a thorough physical examination of the fistula (inspection, auscultation, palpation) before cannulation. Staaf et al. [17] also highlighted the importance of hygiene routines for nurses and patients during the aseptic cannulation process (Table 3).

Staaf et al. [18] conducted a mixed-method study to elucidate the reasons behind the nurses’ choice of cannulation technique for AVF. The blunt needle buttonhole method was the most popular technique among nurses, while the least popular was area puncture. Nurses tended to prefer the blunt needle buttonhole method when the patient was also undergoing dialysis three times a week or more, if the cannulation area was short, and/or the patient feared needles. Conversely, the authors stated that the blunt needle buttonhole method should be avoided if the patient shows signs of poor hygiene or prefers a different technique.

Staaf et al. [17] and two systematic reviews with meta-analysis [19, 20] reported on the strengths of the buttonhole technique (e.g. low risk of infiltration, ease of placement, less pain, prolonged patency, fewer aneurysms, less stenosis, haematoma risk reduction and fewer thrombi). However, a systematic review conducted by Delgado-Ramírez et al. [21] found that the buttonhole technique is rarely implemented because knowledge about it is primarily theoretical and the nurses dislike it. Furthermore, the buttonhole technique is associated with some complications, such as the risk of false tracks and bacterial growth.

The rope-ladder technique has been described as a temporary solution if the buttonhole technique does not work for a particular patient [18]. However, a cross-sectional study conducted by Parisotto et al. [9] found a relationship between using the rope-ladder technique and an increased risk of multiple cannulations.

Wang et al. [20], Ren et al. [19] and Delgado-Ramírez et al. [21] found that infections were one of the most common cannulation-related complications. However, Wang et al. [20] and Ren et al. [19] found no statistically significant difference in the incidence of infections relative to puncture technique, while Delgado-Ramírez et al. [21] reported some discrepancies concerning the buttonhole technique.

A retrospective study conducted by Staaf and Uhlin [22] collected patient data and found that alternating between the blunt needle buttonhole technique and the sharp needle buttonhole technique significantly increased the incidence of local infections. Interdialytic bleeding was more common among patients cannulated with the sharp needle buttonhole technique compared to those cannulated with the blunt needle buttonhole technique.

Finally, Ren et al. [19] and Wang et al. [20] reported no statistically significant difference between using the buttonhole and rope-ladder techniques with regard to fistula survival.

De Barbieri et al. [23] explored cannulation-related complications by interviewing nurses and found that metal needles were the most popular. Plastic cannulas were viewed as needing improvement, such as the need to incorporate wings (74.7%) and improve the blood visualisation system (39.8%). Pedreira-Robles et al. [24] conducted a cross-sectional study to analyse the nurses’ experiences with the use of plastic cannulas. They found that 42.3% of nurses reported that plastic cannulas were available at their workplace and 55.8% had received formal training on using plastic cannulas. However, a sizeable percentage of nurses mentioned cost when asked about the reasons for not using plastic cannulas (32.2%). A randomised controlled pilot study conducted by Marticorena et al. [25] assessed cannulation-related complications and found no significant differences between metal needles or plastic cannulas for blood pressure, pulse, blood-flow rate (Qa), dialysis circuit flow (Qb), urea reduction ratio (URR) and Kt/V. In a randomised open-label study, Choi et al. [26] found that patients cannulated with plastic cannulas showed lower dynamic pressures, allowing for a higher Qb. Choi et al. [27] also conducted a randomised controlled trial to determine whether implementing plastic cannulas for new AVFs affected cannulation failure rates and haemodialysis adequacy compared to traditional metal needles. They reported that initial cannulation failure was statistically significantly more frequent among patients cannulated with a metal needle. Lastly, Marticorena et al. [25] found more complications in the metal needles group. Furthermore, Choi et al. [27] found that plastic cannula use was associated with a shorter time to haemostasis at first needling. The local guidelines of haemodialysis units analysed by Staaf et al. [17] tended to recommend plastic cannulas when the AVF was new or if the patient was moving around, because of the reduced infiltration risk. De Barbieri et al. [23] also reported more adverse events in AVFs during cannulation, haemodialysis treatment, needle removal and haemostasis in patients cannulated with metal needles.

Regarding needle size, a cross-sectional study conducted by Martins-Castro et al. [28] analysed patient questionnaires to assess Kt/V, the distance between needles, the direction of the needles and needle size. Most respondents preferred 15G over 16G needles. Conversely, Sallée et al. [29] conducted a cross-sectional study that analysed questionnaires answered by nurses regarding haemostasis-related factors. The local guidelines reviewed by Staaf et al. [17] found 16G needles to be the most frequently used. Nevertheless, Staaf et al. found that most haemodialysis units recommended either 17G or 16G needles at the first cannulation. Parissotto et al. [9] analysed 10,807 cannulation procedures and found that 15G needles were most commonly used to cannulate AVFs and 16G needles were most widely used to cannulate AVGs. Most haemodialysis units included in Staaf et al.’s [18] mixed-methods study stated that 15G needles were saved for chronic (i.e. ‘non-acute’) AVFs. According to Parisotto et al. [9], cannulating with 16G needles or 17G needles was associated with a higher risk of complications, such as multiple cannulations, haemorrhage, haematoma, infiltration, etc. Along this line, a prospective cohort study by Coventry et al. [30] discussed cannulation episode success, cannulation-related complications and dialysis adequacy per session and found that cannulation was 265% more successful when a 14G venous needle was used instead of a 17G or a 15G, and 358% more successful than when a 17G needle was used.

Bayoumi and Khonji [31] conducted a cross-sectional study that analysed patient surveys. They found the most common needle placement was bevel up (72.4%). There was a consensus among the local guidelines reviewed by Staaf et al. [18], the cohort study carried out by Coventry et al. [30], the cross-sectional study of Sallée et al. [29], Parisotto et al. [9] and Staaf et al. [17]. However, in a single-blind crossover study, Özen et al. [32] found that patients experienced less pain when cannulated with the bevel facing down. Moreover, post-removal bleeding time was reduced when the bevel was pointed downwards. Parisotto et al. [9] found that rotating the needle post-puncture increased the risk of cannulation-related complications. This statement was also supported by Coventry et al. [30] who found that keeping the arterial needle upright, rather than rotating, increased the chances of cannulation success.

Elias et al. [33] prospectively explored cannulation-related factors. They found the median recirculation rate was 10% (range 6–13%) when patients were cannulated with anterograde needles compared to 9% (range 5–13%) when fistulas were cannulated with retrograde needles. Moreover, Özen et al. [35] found that Kt/V was lower when the needle was placed in the anterograde direction.

Dialysis units varied in their tourniquet recommendations [17]. When choosing a cannulation site, the researchers found that the arterial needle should be placed within 2 to 5 cm of the anastomosis. Some units recommended moving the next cannulation site 0.5–2 cm [17].

The scoping review carried out by Schoch et al. [36] concluded that point-of-care ultrasound (POCUS) could be used to assess AVFs that have not reached the minimum required diameter of 6 mm to enable cannulation, and that POCUS was considered complementary to the nurses’ physical assessment. Furthermore, the use of ultrasound was associated with the potential to improve the cannulation experiences for patients with new AVFs, to increase the cannulation accuracy, and to increase dialysis pump speed tolerance. In fact, in a retrospective study by Darbas-Barbé et al. [34] that assessed the adjustment of the cannulation technique, the use of ultrasound findings allowed the switch from the area puncture technique to the rope-ladder technique.

Needle placement can affect both venous and arterial pressure. In the study conducted by Staaf et al., the lower limit of arterial pressure during the first cannulation was set to − 100 mmHg, dropping to − 200 mmHg over time. During the first treatments, venous pressure was not raised above 100 mmHg, and once the AVF had matured, it was not to be raised above 150- or 200 mmHg [17].

Sallée et al. [29] found that the most common method for bleeding control was placing a dressing followed by a gloved finger. Staaf et al. [17] found that most units recommend removing both needles simultaneously at the same angle as their insertion, and applying no pressure before complete removal. All responding haemodialysis units recommended providing compression with sterile or clean gauze. Coalgan/Coalgan H (calcium alginate) was the most widely used dressing. In this study, the compression force applied to stop the bleeding for 10 or more minutes was reported as being strong in 77.2% of the cases, and when bleeding exceeded 10 min, the force was strong in 74.6% of cases. Staaf et al. recommended constant pressure, although the AVF thrill should be palpable the whole time. Finally, a growing trend toward using adjustable devices for applying pressure has been reported [51].