Arteriovenous fistula patency and self-care behaviors in hemodialysis patients

This study aimed to determine the factors affecting arteriovenous fistula (AVF) patency and the relationship between AVF self-care behaviors in hemodialysis (HD) patients. This was a descriptive and correlational study. The data were collected from 195 HD patients between August and December 2023. The mean score of the AVF Assessment Scale (AVF-AS) was significantly higher in diabetic patients and patients with the elbow AVF site. A significant positive correlation was found between the AVF-AS and the total number of AVF operations. AVF-AS was found to be lower in patients with very high levels of AVF self-care behaviors compared to high-level and moderate levels. A statistically significant negative correlation was found between the AVF-AS and the pump speed, Kt/V, URR, and AVF self-care behaviors. This study found that patient-related factors and self-care behaviors effectively maintain AVF patency.

A scoping review of outcomes with routine surveillance of arterio-venous fistulas

The arteriovenous fistula (AVF) is the preferred venous access for maintenance haemodialysis. AVF dysfunction can progress to access failure, with all the associated morbidity and costs of revising vascular accesses. Routine surveillance of AVFs using specialised equipment has the potential to enable early detection of potential problems. The KDOQI Clinical Practice Guidelines for Vascular Access: Update 2019 suggest that surveillance may be useful to supplement regular clinical monitoring but acknowledge a lack of evidence to make firm recommendations. This scoping review of peer-reviewed literature explored outcomes with the routine surveillance of AVFs using specialised equipment in haemodialysis dependent adults. A systematic search was undertaken using terms such as 'vascular access', haemodialysis, surveillance and 'access flow', utilising the data bases ProQuest (Medline), CINAHL and Embase to include original research articles published between October 2016 and August 2022. A total of eight papers were identified for comprehensive analysis, including two randomised controlled trials, two cross-sectional studies, two retrospective reviews and two evaluations. Themes identified include the incidence of thrombotic events, the role of access blood flow measurements, the need for follow-up angiograms after surveillance and identification of the at-risk access. This review of research published in recent years demonstrated an ongoing paucity of evidence for the benefits of routine AVF surveillance. More research focused on actual outcomes is needed in this important area that is a routine part of dialysis unit workloads everywhere.

The knowledge, attitudes, and practices of arteriovenous access assessment among hemodialysis nurses: A multicenter cross-sectional survey

INTRODUCTION

Hemodialysis nurses' cannulation technique, monitoring, and management methods can affect patients' vascular access longevity. An arteriovenous access assessment comprises a medical history and vascular assessment through physical examination and surveillance. However, further exploration is needed to fully understand hemodialysis nurses' knowledge, attitudes, and practices (KAP) in this area.

METHODS

Between June and July 2023, we recruited hemodialysis nurses from 21 cities in Guangdong Province using a convenience sampling method. Four questionnaires-the General Data Questionnaire, the KAP Scale of Arteriovenous Access Assessment among Hemodialysis Nurses, the Utrecht Work Engagement Scale, and the NASA Task Load Index-were utilized for data collection through the Questionnaire Star platform.

FINDINGS

Of the 530 hemodialysis nurses participating in the study, 458 (86.4%) had a valid response. The participants demonstrated moderate knowledge and practice levels regarding arteriovenous access assessment and exhibited positive attitudes. We identified several factors related to arteriovenous access assessment that predict KAP in hemodialysis nurses. These factors included years of experience as a hemodialysis nurse, whether a nurse's knowledge of physical examination was sufficient to meet clinical needs, whether a nurse had received training in performing physical examination, whether a nurse's department regularly checked the quality of physical examination, and nurses' levels of work engagement and mental workload. All factors explained 32.4% of the variance in participants' KAP regarding arteriovenous access assessment.

DISCUSSION

Improving hemodialysis nurses' assessment of arteriovenous access is crucial to ensure optimal patient care. Dialysis center managers and educators should prioritize understanding hemodialysis nurses' KAP of arteriovenous access assessment and any factors influencing these areas.

To Explore the Application of PDCA in Hemodialysis Center and Its Effect on the Maintenance of Internal Fistula

Background

The survey found that in recent years, with the incidence of chronic kidney disease (CKD) increasing, some patients with CKD even progressed to end-stage renal disease. Luckily, progressive hemodialysis technology and nursing level can improve the quality of life and prognosis of patients.

Objective

To explore the application of plan-do-check-adjust (PDCA) cycle in the management of nurses in hemodialysis center and its effect on the maintenance of internal fistula in patients.

Methods

In this study, a randomized controlled trail (RCT) was used to select 90 patients who underwent maintenance hemodialysis in the hemodialysis center of our hospital from January 2018 to June 2021 as objects. They were divided into a PDCA group (with PDCA nursing management) and routine group (with routine nursing management) by random number table with each of 45 cases for 6 months to compare the differences of the internal fistula complications, internal fistula maintenance quality, patients' microinflammatory state, and satisfaction with nursing, as well as nursing staff's operational and theoretical performance between the two groups.

Results

There was no significant difference in CRP, IL-1, TNF-α, and IL-6 levels between the two groups before intervention (P > 0.05); after that, these levels in the PDCA group were lower than those in the routine group, with statistically significant difference (P < 0.05); before intervention, there was no statistically significant difference in the qualification rate of blood flow, the awareness rate of health education, and the incidence of nursing defects between the two groups (P > 0.05); after that, the qualification rate of blood flow and the awareness rate of health education among nurses in PDCA group were higher than those in routine group, while the incidence of nursing defect accidents in the PDCA group was lower than that in routine group, and the differences were statistically significant (P < 0.05); before intervention, there was no significant difference in the complication rate between the two groups (P > 0.05); after that, the complication rate of the PDCA group was lower than that of the routine group, and the differences were statistically significant (P < 0.05); after intervention, the theoretical assessment and practical skills assessment scores of the PDCA group were higher than those of the routine group, and the differences were statistically significant (P < 0.05); after intervention, the nursing satisfaction of the PDCA group was higher than that of the routine group, and the differences were statistically significant (P < 0.05).

Conclusion

The application of PDCA approach in the management of nurses in hemodialysis centers can effectively improve the quality of internal fistula management and improve the practical and theoretical level of nurses, as well as reduce the microinflammation of patients.

Factors influencing arteriovenous fistulas: A multicenter study

In this cross-sectional, descriptive study, the arteriovenous fistulas (AVF) of HD patients were evaluated by physical examination and factors associated with AVF function and longevity were investigated. Data were collected using a patient information form and the Arteriovenous Fistula Assessment Scale (AVF-AS). The study population included 279 patients under chronic HD treatment. Their mean age was 61.14 ± 14.00 years and 58.6% were men. Age, AVF location, and number of AVFs created were identified as factors associated with AVF needle entry site and flow problems, stenosis, and risk of developing ischemic complications (p = 0.005, p = 0.000, p = 0.006, respectively). AVF dysfunction adversely affected HD pump speed (p = 0.000) and HD adequacy (p = 0.000). It was determined that gender, AVF location, last AVF duration, and total number of previous AVF were identified as the risk of AVF complications. The results of this study revealed that regular follow-up and evaluation are needed to minimize the risk of dysfunction and failure due to AVF complications.