ObjectiveTo systematically analyze the effects of puncture methods with needle beveled downward and upward on internal arteriovenous fistulas in maintenance hemodialysis（MHD）patients. MethodsThrough computer retrieval of PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, Wan Fang Database, VIP Database, Chinese Biomedical Literature Database and other Chinese and English databases, relevant studies on punctures of internal fistula with needle beveled downward and upward were collected. After screening the literature according to the literature inclusion and exclusion criteria, relevant data were extracted and literature quality evaluation was performed, RevMan 5.4 software was used for Meta-analysis. ResultsA total of 12 studies involving 748 patients were included in the end. The results of the Meta-analysis showed that the incidences of internal fistula hemangioma, internal fistula stenosis, internal fistula occlusion, and pain of internal fistula in the beveling downward puncture group were lower than those in the beveling upward puncture group (all P＜0.05), while there was no significant difference in the success rate of internal fistula at first attempt between the two beveling puncture methods (P＞0.05). ConclusionFor MHD patients, the application of needle beveled downward puncture of the internal fistula is conducive to reducing vascular injury and the incidences of internal fistula hemangioma, internal fistula stenosis and internal fistula occlusion, relieving the pain of internal fistula puncture, and does not affect the success rate of internal fistula puncture, which is worthy of clinical promotion.

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