# Validation of a Bedside Automated 3D Ultrasound-based Arteriovenous Fistula Cannulation Guidance Solution to Improve AV Fistula Outcomes

> **NIH NIH R44** · SONAVEX, INC. · 2022 · $710,000

## Abstract

PROJECT SUMMARY/ABSTRACT
End Stage Renal Disease (ESRD) impacts 4.3M patients worldwide and accounts for 7% of all
Medicare and Medicaid costs. The most prevalent modality of renal replacement, hemodialysis,
requires access to the circulation through which dialysis machinery is connected. The preferred
method of access is an arteriovenous (AV) fistula as it confers lower rates of mortality, infection
and interventions, however they are the most challenging for dialysis technicians to cannulate.
Cannulation damage is one of the primary causes of AV fistula complications and failure.
Cannulation failures and injury occur in 91% of patients within 6 months. These injuries can lead
to serious complications, such as hematoma, infection, and aneurysm formation including death
from hemorrhage, with a secondary impact on morbidity, hospitalization, access revision, and loss
of access. The annual rate of major infiltration is 5.2%, with each incident leading to an extra 97
days of catheter dependency and a mean of 2.4 diagnostic tests, surgery appointments, or
interventions. When factoring in the additional catheter time and secondary interventions, the
financial impact is $21,441 per major infiltration.
Ultrasound has been demonstrated to dramatically improve outcomes by reducing CVC time by
>30% (50 days) and infections by 37%. However, this was in the hands of nephrology physicians
in a study setting and current ultrasound options are too challenging for dialysis technicians and
are therefore not used.
We have developed an automated 3D ultrasound-based navigation solution, EchoGuide, that is
purpose build for dialysis technicians to improve cannulation without specialized training. This
study proposes to prove that EchoGuide, when used by dialysis technicians, can substantially
reduce cannulation errors and infiltrations for AV fistulae.
In this Phase II proposal, we will (1) develop the integrated EchoGuide with custom probe/display
hardware, lumen detection algorithms, and real-time interactive navigation; (2) iterate user
interface via human factors development to optimize navigation guidance; and (3) extend a
validated AVF cannulation simulator to enable ultrasound compatibility in order to demonstrate
EchoGuide effectiveness in improving cannulation success by technicians across challenging
AVF scenarios.
OVERALL IMPACT: EchoGuide will allow rapid and successful cannulation of AV fistulae. This will
reduce both the morbidity and costs associated with major infiltration and the associated catheter
time and additional interventions.

## Key facts

- **NIH application ID:** 10488261
- **Project number:** 5R44DK131644-02
- **Recipient organization:** SONAVEX, INC.
- **Principal Investigator:** Xin Kang
- **Activity code:** R44 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $710,000
- **Award type:** 5
- **Project period:** 2021-09-15 → 2024-03-14

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10488261

## Citation

> US National Institutes of Health, RePORTER application 10488261, Validation of a Bedside Automated 3D Ultrasound-based Arteriovenous Fistula Cannulation Guidance Solution to Improve AV Fistula Outcomes (5R44DK131644-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10488261. Licensed CC0.

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