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Stavert BM, Monaro S, Tienstra L, Naganathan V, Aitken SJ. Protocol for a qualitative study exploring haemodialysis dependent patients' arteriovenous fistula experience, values and concerns in Sydney, Australia. BMJ Open 2022; 12:e058152. [PMID: 36691241 PMCID: PMC9171227 DOI: 10.1136/bmjopen-2021-058152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 05/11/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION The experiences of patients from culturally and linguistically diverse backgrounds, with chronic mental illness, disabilities or who identify as sexual or religious minorities are under-represented in clinical research on arteriovenous fistula (AVF) for haemodialysis access. A greater understanding of the experiences, values and concerns of these diverse patient groups are needed to provide haemodialysis access care that addresses the needs of all haemodialysis-dependent patients. This study seeks to describe a broad range of patient experiences related to the creation, care and surveillance of AVFs, including interactions with healthcare teams. METHODS AND ANALYSIS This qualitative study will use semistructured interviews with individual patients purposefully selected to provide a diverse patient population. A deliberate strategy will be used to recruit a demographically broad range of participants. Thematic analysis of interview transcripts, using a constant comparative methodology, will generate themes that describe patient experiences, values and concerns. Findings from this study will give a nuanced insight into the experiences of patients on haemodialysis with respect to their AVF. ETHICS AND DISSEMINATION Ethical approval for this study was provided by the Sydney Local Health District Human Research Ethics Committee (REGIS identifier: 2021/ETH00362, CH reference number: CH62/6/2021-033). Results will be made available to the participants, local health district, funders and other researchers through various hospital and academic forums. Data will also be published in peer-reviewed journals and be part of a larger body of work looking into patient-reported outcome measures for patients with AVF.
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Affiliation(s)
- Bethany Miriam Stavert
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Vascular Surgery Department, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Susan Monaro
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Vascular Surgery Department, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Lisa Tienstra
- Renal Medicine Department, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Vasi Naganathan
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Education and Research on Ageing, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Sarah Joy Aitken
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Vascular Surgery Department, Concord Repatriation General Hospital, Concord, New South Wales, Australia
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Hossain S, Sharma A, Dubois L, DeRose G, Duncan A, Power AH. Preoperative point-of-care ultrasound and its impact on arteriovenous fistula maturation outcomes. J Vasc Surg 2018; 68:1157-1165. [DOI: 10.1016/j.jvs.2018.01.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 01/22/2018] [Indexed: 10/16/2022]
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Gray K, Korn A, Zane J, Gonzalez G, Kaji A, Bowens N, de Virgilio C. Ultrasound Vein and Artery Mapping by General Surgery Residents During Initial Consult Can Decrease Time to Dialysis Access Creation. Ann Vasc Surg 2018; 49:285-288. [PMID: 29477677 DOI: 10.1016/j.avsg.2018.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 02/06/2018] [Accepted: 02/12/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Formal preoperative ultrasound (US) mapping of vascular anatomy by radiology is recommended before hemodialysis access surgery. We hypothesized that US performed by general surgery residents in place of formal US would decrease the time from initial consult to creation of dialysis access without affecting patient outcomes. METHODS This is a retrospective review of all patients who underwent dialysis access surgery from November 2014 to July 2016 and received preoperative upper extremity US vein and artery evaluation by either radiology or general surgery residents. The primary endpoints were days from initial consult to dialysis access creation, rate of arteriovenous fistula (AVF) creation, fistula maturation, and 1-year primary assisted patency. RESULTS Of 242 patients, 167 (69%) had formal US, and 75 (31%) had only a resident US. The resident US group had 100% AVF creation compared with the formal US group with 92.2% AVF creation (P = 0.01). There was no difference between the groups in rate of fistula maturation (P = 0.1) and 1-year assisted patency (P = 0.9). Of the resident US 90.7% occurred in the outpatient setting. On multivariable analysis controlling for outpatient consult, the average time to the operating room was 13.7 days longer for the formal US group in the outpatient setting (P = 0.0006). CONCLUSIONS Ultrasound vein and artery evaluation at the time of the initial consult by general surgery residents can decrease the time to dialysis access creation by bypassing the need for formal US with a higher rate of AVF creation and no difference in fistula maturation or 1-year primary assisted patency.
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Affiliation(s)
- Kelsey Gray
- Department of Surgery, Harbor UCLA Medical Center, Torrance, CA
| | - Abraham Korn
- Department of Surgery, Harbor UCLA Medical Center, Torrance, CA
| | - Joshua Zane
- Department of Surgery, Harbor UCLA Medical Center, Torrance, CA
| | | | - Amy Kaji
- Department of Emergency Medicine, Harbor UCLA Medical Center, Torrance, CA
| | - Nina Bowens
- Department of Surgery, Harbor UCLA Medical Center, Torrance, CA; Division of Vascular Surgery, Department of Surgery, Harbor UCLA Medical Center, Torrance, CA
| | - Christian de Virgilio
- Department of Surgery, Harbor UCLA Medical Center, Torrance, CA; Division of Vascular Surgery, Department of Surgery, Harbor UCLA Medical Center, Torrance, CA.
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A Prospective Observational Study to Assess the Impact of Operator Seniority on outcome following Arteriovenous Fistula Formation. J Vasc Access 2015; 16:372-6. [DOI: 10.5301/jva.5000401] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose Arteriovenous fistula (AVF) surgery affords an excellent opportunity for junior surgeons to learn key vascular techniques. However, implementation of the European Working Time Directive has reduced trainee surgeon's working hours, leading to concerns regarding a possible effect on patient outcomes. Given high early postoperative failure rates and limited AVF sites, it has been proposed that AVF surgery should be performed by Consultants and senior trainees only. This prospective observational study aimed to establish how seniority impacts upon AVF surgery outcomes. Methods All patients referred for AVF formation were considered for inclusion. Demographic data, comorbidities, medications and previous access history were recorded. Surgery was performed by a Consultant Vascular Surgeon or a junior surgeon. Clinical review was undertaken 30 days postoperatively to assess patency and record any complications. Results Seventy-seven patients underwent AVF formation. About 63.6% procedures were carried out by a junior surgeon. The groups were well matched for demographics, comorbidities and medications. There was no difference in anatomical site of formation between groups operated on by consultant versus juniors (p = 0.373). More general anaesthetic procedures were undertaken by Consultant surgeons, for example basilic vein transposition when compared with juniors (p = 0.039). There was no significant difference in terms of early AVF failure (p = 0.710), complication rates (p = 0.139) or requirement for re-intervention (p = 0.256) between the groups. Patency rates were also equivocal between the groups. Conclusions The seniority of the operating surgeon does not appear to impact on outcomes following AVF formation. A greater proportion of general anaesthetic cases were undertaken by a Consultant, which may introduce bias. Junior surgeons with appropriate training and modest experience can perform access surgery without detriment to patients patient detriment.
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Georgiadis G, Charalampidis D, Argyriou C, Georgakarakos E, Lazarides M. The Necessity for Routine Pre-operative Ultrasound Mapping Before Arteriovenous Fistula Creation: A Meta-analysis. Eur J Vasc Endovasc Surg 2015; 49:600-5. [DOI: 10.1016/j.ejvs.2015.01.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/21/2015] [Indexed: 11/28/2022]
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Pre-Operative Ultrasonography and Arteriovenous Fistulae Maturation. J Vasc Access 2014; 15 Suppl 7:S60-3. [DOI: 10.5301/jva.5000249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2014] [Indexed: 11/20/2022] Open
Abstract
Background Arteriovenous fistulae (AVF) are preferred for haemodialysis access, but maturation is unpredictable. Results Clinical examination alone is unreliable for AVF planning. Duplex ultrasonography may provide useful anatomical and physiological data to allow more accurate prediction of likely AVF success. Conclusion Selective use of duplex ultrasonography appears to enhance AVF success rates, but there are insufficient data to recommend routine duplex screening of AVF candidates. Agreed vessel criteria are needed.
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Gołębiowski T, Kusztal M, Wątorek E, Garcarek J, Letachowicz K, Weyde W, Klinger M. Consider use of a collateral venous circuit before abandoning the arteriovenous fistula--the experience of a complex vascular access case. Ann Vasc Surg 2014; 28:1320.e9-13. [PMID: 24509381 DOI: 10.1016/j.avsg.2013.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 12/07/2013] [Accepted: 12/10/2013] [Indexed: 10/25/2022]
Abstract
We describe a 65-year-old woman with diabetes on hemodialysis maintenance, with a number of complications associated with high-flow arteriovenous fistula (AVF, anastomosis between brachial artery and medial vein of the forearm) requiring an extended diagnostic and individual approach. The patient was admitted to our hospital because of pain, edema of the limb, hand ischemia, and infection caused by steal syndrome. To reduce fistula flow, banding of the proximal cephalic vein was performed. Simultaneously because of necrosis, amputation of the fifth finger was necessary. Following this procedure, the cephalic vein on the arm thrombosed. The fistula was patent through the collateral circuit, which was diagnosed in detail during the late course. A long course of antibiotics and sessions in a hyperbaric chamber allowed limb rescue. Single-needle dialysis was carried out because of problems in finding an appropriate second place. After an episode of bleeding from the puncture site caused by ulceration, we were forced to search for an alternative needling point. On the basis of ultrasound scans, an anatomic schema of the blood circuit was created. The fistula demonstrated flow from the brachial artery resulting in retrograde flow in the section of the cephalic vein distal to the anastomosis in the upper forearm. This was then seen to drain in an antegrade direction via the median vein of the forearm after the 2 vessels connected in the mid forearm. Using the diagram, 2 alternative places for needling were found and it allowed the adequate hemodialysis to be continued. Complex and complicated cases associated with native AVF could be resolved using simple diagnostic tools to preserve the fistula use for hemodialysis. Both clinical examination and ultrasound scan with the Doppler option appear to be valuable methods for finding the optimal cannulation place.
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Affiliation(s)
- Tomasz Gołębiowski
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
| | - Mariusz Kusztal
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Ewa Wątorek
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy Garcarek
- Department of Radiology, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Letachowicz
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Wacław Weyde
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Marian Klinger
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
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