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Pinto R, Barros J, Ferreira R, Alves P, Sousa R, Oliveira L, Pereira L, Correia AL, Silva AR, Henriques A, Magda Guerra, Mata F, Salgueiro A, Fernandes I, Alves R, Sousa C. Advancing arteriovenous fistula needling: The role of physical exam and doppler ultrasound. J Ren Care 2024. [PMID: 38850083 DOI: 10.1111/jorc.12505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/22/2024] [Accepted: 05/29/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND The success of haemodialysis (HD) critically depends on the effective use of arteriovenous fistulas (AVFs). The precise needling technique is vital to minimise complications and ensure functional vascular access. OBJECTIVE This study assesses the effectiveness of a nursing consultation protocol, which integrates physical examination (PE) with Doppler Ultrasound (DUS), in preparing patients for the first AVF needling. DESIGN/PARTICIPANTS A cross-sectional analysis at a Portuguese National Health Service Hospital engaged thirty new HD patients, four HD needling experienced nurses and one HD vascular access nurse. This study examines the accuracy of PE in assessing the matured AVF by the four nurses compared to a trained vascular access nurse encompassing systematic PE and DUS. MEASUREMENTS The primary data incorporated AVF characteristics derived from PE (inspection, palpation, and auscultation) and DUS findings (vein depth, diameter, and blood flow). A secondary focus was evaluating the change in nurses' perceived needling complexity following the nursing consultation. RESULTS The nursing consultation significantly enhanced the identification of crucial AVF features, such as accessory veins (p = 0.002), and improved the accuracy of AVF morphology assessments. This led to identifying longer needling tracks (p = 0.031) and a higher number of safe needling points (p = 0.016). Nurses reported a notable reduction in perceived complexity and potential adverse events following this method (p = 0.027). CONCLUSIONS Integrating structured PE with DUS in a nursing consultation framework significantly improves the preparation for AVF needling. This approach enhances the efficiency and safety of AVF needling and boosts nurse confidence and patient care in HD settings.
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Affiliation(s)
- Rui Pinto
- Unidade Local de Saúde de Coimbra. Dialysis Unit-Nephrology, University Hospital Centre, Coimbra, Portugal
| | | | - Ricardo Ferreira
- Unidade Local de Saúde de Coimbra. Dialysis Unit-Nephrology, University Hospital Centre, Coimbra, Portugal
| | - Pedro Alves
- Unidade Local de Saúde de Coimbra. Dialysis Unit-Nephrology, University Hospital Centre, Coimbra, Portugal
| | | | | | - Lénia Pereira
- Portuguese Red Cross North Health School, Oliveira de Azeméis, Portugal
| | - Ana Luísa Correia
- Unidade Local de Saúde de Coimbra. Dialysis Unit-Nephrology, University Hospital Centre, Coimbra, Portugal
| | - Ana Rita Silva
- Unidade Local de Saúde de Coimbra. Dialysis Unit-Nephrology, University Hospital Centre, Coimbra, Portugal
| | - Andreia Henriques
- Unidade Local de Saúde de Coimbra. Dialysis Unit-Nephrology, University Hospital Centre, Coimbra, Portugal
| | - Magda Guerra
- Centre for Interdisciplinary Research in Health-Hospital Centre Tondela and Viseu, Viseu, Portugal
| | - Fernando Mata
- Unidade Local de Saúde de Coimbra. Dialysis Unit-Nephrology, University Hospital Centre, Coimbra, Portugal
| | - Anabela Salgueiro
- Health Sciences Research Unit: Nursing-Nursing School Coimbra, Coimbra, Portugal
- Portuguese Vascular Access Association, Coimbra, Portugal
| | - Isabel Fernandes
- Health Sciences Research Unit: Nursing-Nursing School Coimbra, Coimbra, Portugal
| | - Rui Alves
- Unidade Local de Saúde de Coimbra. Dialysis Unit-Nephrology, University Hospital Centre, Coimbra, Portugal
| | - Clemente Sousa
- Centre Health Technology Services Research, Faculty of Medicine, Porto University, Porto, Portugal
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Duncanson EL, Chur-Hansen A, Le Leu RK, Macauley L, Burke AL, Donnelly FF, Collins KL, McDonald SP, Jesudason S. Dialysis Needle-Related Distress: Patient Perspectives on Identification, Prevention, and Management. Kidney Int Rep 2023; 8:2625-2634. [PMID: 38106606 PMCID: PMC10719600 DOI: 10.1016/j.ekir.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/20/2023] [Accepted: 09/04/2023] [Indexed: 12/19/2023] Open
Abstract
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.
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Affiliation(s)
- Emily L. Duncanson
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Anna Chur-Hansen
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Richard K. Le Leu
- Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Luke Macauley
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Anne L.J. Burke
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Psychology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Fiona F. Donnelly
- Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kathryn L. Collins
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Psychology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephen P. McDonald
- Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Shilpanjali Jesudason
- Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Hill K, Jaensch A, Childs J, McDonald S. Evaluation of point of care ultrasound (POCUS) training on arteriovenous access assessment and cannula placement for haemodialysis. J Vasc Access 2023:11297298231194100. [PMID: 37622472 DOI: 10.1177/11297298231194100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
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').
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Affiliation(s)
- Kathleen Hill
- University of South Australia, Adelaide, SA, Australia
| | | | - Jessie Childs
- University of South Australia, Adelaide, SA, Australia
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Comparison of catheters or new arteriovenous fistulas for commencement of haemodialysis in pregnant women with chronic kidney disease: an international observational study. J Nephrol 2022; 35:1689-1698. [PMID: 35347647 PMCID: PMC9300570 DOI: 10.1007/s40620-022-01288-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/16/2022] [Indexed: 12/20/2022]
Abstract
Background Evidence surrounding vascular access options for commencing dialysis in pregnancy complicated by chronic kidney disease (CKD) is limited. Creation of new arteriovenous fistulas (AVFs) in pregnant women is rare. Methods Retrospective cohort study of approaches to vascular access in pregnancy in centres in Australia, the United Kingdom (UK) and Canada (2002–2018). Results Twenty-three women with advanced CKD commenced dialysis in pregnancy (n = 20) or planned to commence (n = 3). Access at dialysis start was a tunnelled catheter (n = 13), temporary catheter (n = 1), AVF created pre-conception but used in pregnancy (n = 3) and AVF created during pregnancy (n = 3). No women commencing dialysis with an AVF required a catheter. No differences in perinatal outcomes were observed comparing AVFs and catheters at dialysis commencement. No AVFs were created in pregnancy in Canadian women. From Australia and the UK, 10 women had a new AVF created in pregnancy, at median gestation 14.5 weeks (IQR 12.5, 20.75). Four women still needed a catheter for dialysis initiation and 3 eventually used the new AVF. Six AVFs were successfully used in pregnancy at median gestation 24 weeks (IQR 22.5, 28.5), 2 were successfully created but not used and 2 had primary failure. No catheter-associated complications were identified except one episode of catheter-related sepsis. Conclusions Catheter-related complications were minimal. In selected women, with sufficient pre-planning, an AVF can be created and successfully used during pregnancy to minimise catheter use if preferred. Pre-conception counselling in advanced CKD should include discussing vascular access options reflecting local expertise and patient preferences. Graphic abstract ![]()
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Radisic G, Duncanson E, Le Leu R, Collins KL, Burke ALJ, Turner JK, Chur-Hansen A, Donnelly F, Hill K, McDonald S, Macauley L, Jesudason S. Improving management of needle distress during the journey to dialysis through psychological education and training-the INJECT study feasibility pilot protocol. Pilot Feasibility Stud 2022; 8:28. [PMID: 35120560 PMCID: PMC8815234 DOI: 10.1186/s40814-022-00989-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Needle-related distress is a common yet poorly recognised and managed problem among haemodialysis (HD) patients. The aim of this pilot study is to test the feasibility and acceptability of the INJECT Intervention-an innovative psychology-based intervention to empower patients to self-manage needle distress with the support of dialysis nurses. METHODS This investigator-initiated, single-arm, non-randomised feasibility study will take place in a large dialysis service in Adelaide, Australia. Participants will include patients aged ≥ 18 years, commencing or already receiving maintenance HD, recruited through dialysis physicians and nursing staff as individuals believed to be at risk of needle distress. They will be screened for inclusion using the Dialysis Fear of Injection Questionnaire (DFIQ) and enrolled into the study if the score is ≥ 2. The multi-pronged intervention encompasses (i) psychologist review, (ii) patient self-management program and (iii) nursing education program. The primary aim is to evaluate feasibility and acceptability of the intervention from patient and dialysis nurse perspectives, including recruitment, retention, engagement with the intervention and completion. Secondary exploratory outcomes will assess suitability of various tools for measuring needle distress, evaluate acceptability of the nursing education program and measure cannulation-related trauma and vascular access outcomes. CONCLUSION The results will inform the protocol for larger trials addressing needle distress in HD patients. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000229875, approved 4 April 2021, https://www.anzctr.org.au/ .
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Affiliation(s)
- G Radisic
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, 5000, Australia.
| | - E Duncanson
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, 5000, Australia.,School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, 5000, Australia
| | - R Le Leu
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, 5000, Australia.,School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, 5000, Australia
| | - K L Collins
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, 5000, Australia.,Psychology Department, Royal Adelaide Hospital, Adelaide, South Australia, 5000, Australia
| | - A L J Burke
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, 5000, Australia.,Psychology Department, Royal Adelaide Hospital, Adelaide, South Australia, 5000, Australia
| | - J K Turner
- Psychology Department, Royal Adelaide Hospital, Adelaide, South Australia, 5000, Australia
| | - A Chur-Hansen
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, 5000, Australia
| | - F Donnelly
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, 5000, Australia
| | - K Hill
- University of South Australia, South Australia, 5000, Adelaide, Australia
| | - S McDonald
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, 5000, Australia.,School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, 5000, Australia
| | - L Macauley
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, 5000, Australia.,School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, 5000, Australia
| | - S Jesudason
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, 5000, Australia.,School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, 5000, Australia
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