Cannulation practices at haemodialysis initiation via an arteriovenous fistula or arteriovenous graft

Dialysis Needle-Related Distress: Patient Perspectives on Identification, Prevention, and Management

Introduction

Needle-related distress is common among people receiving hemodialysis and affects quality of life and treatment decisions, yet little evidence exists to guide management. This study explored patients' experiences of needle-related distress to inform the development of prevention, identification, and management strategies.

Methods

Semistructured interviews concerning dialysis cannulation, needle-related distress, and potential solutions were conducted with people with current or recent experience of hemodialysis (N = 15) from a tertiary hospital-based service. Interviews ceased at thematic saturation. Transcripts were analyzed thematically.

Results

There were 4 themes and 11 subthemes generated: (i) uncovering a hidden source of distress (dismissal and minimization by others; suffering in silence to stay alive; preparation, assessment, and education); (ii) coping with cannulation pain and trauma (interaction between physical damage, pain, and distress; operator dependency-the importance of nurse skill and technique); (iii) the environment created by dialysis nurses (emotional transference; communication during cannulation; valuing empathy and person-centered care; a psychosocially supportive dialysis unit); and (iv) supporting patient self-management of distress (accessing tools to help themselves; distraction to reduce distress).

Conclusion

Needle-related distress is an often-hidden element of the hemodialysis experience. Patients learn to tolerate it as an inevitable part of dialysis for survival. Nurses' technical skills and the dialysis environment they create are key determinants of the patient cannulation experience. Proposed solutions include psychological screening, education for patients to self-manage distress, and training for nurses in communication and providing relevant psychological support.

Nephrology nurses' perspectives working with patients experiencing needle-related distress

BACKGROUND

A key skill of nephrology nursing is cannulation of patients receiving haemodialysis. Traumatic and unsuccessful cannulation experiences, particularly in the initial weeks of haemodialysis, may contribute to the onset of needle distress for patients.

OBJECTIVES

To identify the key knowledge, skills and attitudes of nephrology nurses working with haemodialysis patients and the competencies relevant to nephrology nursing working with patients with needle-related distress.

DESIGN

A qualitative study involving semistructured interviews. Interviews were audio-recorded, transcribed and deductive, and inductive thematic analysis applied.

PARTICIPANTS

Nephrology nurses (n = 17) were interviewed from a tertiary kidney service in South Australia. Nurses had varying roles and years of experience (range 1-30 years) working with dialysis patients within the service.

RESULTS

Two overarching themes, (1) Flexibility in Practice and Care and (2) Responsibility of Nephrology Nursing, were identified as relevant across all knowledge, skills and attitudes of nephrology nurses working with patients with needle-related distress. Thirty-six knowledge, skills and attitudes were identified; 12 related to knowledge, 14 related to skills and 10 were identified as attitudes and were summarised under seven broad competencies.

CONCLUSION

This study identifies potential knowledge, skills and attitudes and competencies required for nephrology nurses working with patients with needle-related distress. It highlights strategies that may prevent the onset and worsening of needle-related distress, as well as reduce it. It also brings to light that nurses desire additional education regarding strategies to improve the patient experience of cannulation and nurse confidence and skill in this area.

Evaluation of point of care ultrasound (POCUS) training on arteriovenous access assessment and cannula placement for haemodialysis

BACKGROUND

Haemodialysis requires a permanent vascular access and relies on cannulation with two large bore needles. Point Of Care Ultrasound (POCUS) is a tool that may assist nursing staff with visualising cannula placement and prevent miscannulation. This can be particularly useful in regional hospitals with limited access to vascular access specialists.

AIMS

To examine the impact of POCUS provision and education for nursing staff on confidence in cannulation and to understand the patient experience at three regional hospital haemodialysis units in South Australia.

METHODS

A POCUS machine and dedicated nursing education were provided at each of the three sites. A pre-test post-test model was used to assess the individual nurses perceived competency before and after the delivery of a series of online ultrasound education modules and face to face training. Patient reported outcome measures (PROMs) were collected to understand the use of POCUS from the client perspective.

RESULTS

There was a shift towards 'agree' or 'strongly agree' for all nursing surveys in regard to perceived competency (n = 15). This was statistically significant (p ⩽ 0.05) for all questions other than question 1 'I am confident in my ability to physically assess vascular access' (p = 0.06). The patients that completed the PROMs (n = 17) overall supported the ease and use of POCUS for haemodialysis cannulation and felt that it contributed to the nursing staff competency in cannulation.

CONCLUSION

POCUS has the potential to be a valuable tool in regional haemodialysis units to support vascular access cannulation and potentially avoid metropolitan transfer due to cannulation difficulties. The non-significant change post intervention for question 1 likely reflects the haemodialysis nurses inherent pre-existing capacity to assess vascular access without the use of POCUS using the standard process of visual inspection, the use of a stethoscope and palpation ('look, listen and feel').

Radiocephalic Arteriovenous Fistula Patency and Use

We sought to confirm and extend the understanding of clinical outcomes following creation of a common distal autogenous access, the radiocephalic arteriovenous fistula (RCAVF).

Mini-abstract: In this post hoc analysis of randomized clinical trial data including 914 adults with chronic kidney disease, the most robust predictors of radiocephalic arteriovenous fistula patency were larger cephalic vein diameter and access creation prior to a chronic hemodialysis requirement. Successful use occurred at increased rates in men, patients with larger diameter cephalic veins, smaller diameter arteries (albeit ≥2 mm), and when accesses were created using regional anesthesia and at higher volume centers.

Direct arterial puncture for hemodialysis, a neglected but simple and valuable vascular access

Introduction

The purpose of this study is to present the prevalence and effects of direct arterial puncture (DAP) for hemodialysis patients, and to introduce optimal option for the vascular access (VA) in certain hemodialysis patients with poor condition of vascular or cardiac function in a compelling situation.

Methods

This was a cross-sectional study. Demographic characteristics and laboratory data were extracted from the health care system. Relevant DAP information was collected by a questionnaire. Case-control matching was performed to compare the hemodialysis adequacy between DAP and other VAs.

Results

A total of 526 patients were selected for analysis by convenience sampling, of which 38 patients relied https://www.baidu.com/link?url=eaDh8Hn-yZGJyDB0_h4zBenKd7qY1yX-KNxO-qU49gktQOGTJJg3slTjIbG095st4hRfprQIHRjfhfeGOZyH73y8tvSUCwMmvWbUhyix2ZKon DAP for hemodialysis. The main reasons using DAP for hemodialysis included the cost of arteriovenous access creation or maintenance in 19(50%) patients and the poor condition of vascular or cardiac function in 14 (39.5%) patients. Some complications of DAP occurred, such as aneurysm or pseudoaneurysm in 16(42.1%) patients, infiltration in 12 (31.6%) patients. Differences in hemodialysis adequacy were not statistically significant between DAP and other types of VA.

Conclusion

In conclusion, DAP can meet the need of prescription hemodialysis, yet it has several limitations. Although the patients in our study were long-term dependent on DAP for hemodialysis with various reasons, we do not recommend DAP as a long-term vascular access if better options are available. However, DAP should not be overlooked to be a supplemental VA for hemodialysis with adequate blood flow and availability for individuals with poor condition of vascular or cardiac function in a compelling situation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-022-02836-1.

"Outcomes of arteriovenous fistulae cannulation in the first 6 weeks of use: A retrospective multicenter observational study"

BACKGROUND

Arteriovenous fistula (AVF) management for haemodialysis (HD) is one of the most challenging aspects of clinical care. A successful cannulation outcome when an AVF or arteriovenous graft (AVG) is used for the first time can be influenced by many factors, including access maturity, staff skill, and patient factors. This study examined AVF/AVG outcomes at initiation of HD across two major metropolitan public hospitals.

METHODS

Electronic medical records were reviewed to collect data retrospectively for a cohort of all newly commencing ESRD HD starts during 2018 to identify cannulation outcomes in the first 6 weeks.

RESULTS

Of the 117 patients included, AVG use was low (5%). Twenty-four percent of patients required a surgical intervention to salvage a poorly functioning AVF prior to commencing HD. About 32.5% of the cohort had an uneventful start with all successful cannulations. For the remainder of the cohort the number of treatments with unsuccessful cannulation ranged from 1 to 4 or more. About 36% required a surgical intervention for a poorly functioning AVF after commencing HD. Commencing HD with a CVC is associated with a lower likelihood of subsequent successful cannulation (p < 0.001).

CONCLUSION

Even in experienced centres, a subset of patients experienced complicated cannulation in the first 6 weeks of HD. Several areas of improvement could be considered for these patients; timely referral for access creation, post-operative surveillance to ensure AVF maturation inclusive of duplex ultrasonography, gentle induction using small gauge needles and low blood flows, and consideration of a single needle HD initiation pathway.