1
|
Alsolami E, Alobaidi S. Hemodialysis nurses' knowledge, attitude, and practices in managing vascular access: A cross-sectional study in Saudi Arabia. Medicine (Baltimore) 2024; 103:e37310. [PMID: 38552067 PMCID: PMC10977577 DOI: 10.1097/md.0000000000037310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/29/2024] [Indexed: 04/02/2024] Open
Abstract
Hemodialysis continues to be the primary approach for renal replacement therapy. Vascular access (VA), particularly arteriovenous fistula or arteriovenous graft, is the preferred technique for establishing hemodialysis access due to its lower risk of infection and central venous stenosis compared to catheters. The aim of this cross-sectional investigation was to examine hemodialysis nurses' knowledge, confidence, and practices in managing VA in Saudi Arabia. This is an online cross-sectional survey study that was conducted in Saudi Arabia between June and August 2023. This study utilized a previously validated questionnaire. Examined dialysis nurses' knowledge, attitude, practice, and self-efficacy pertaining to VA cannulation and evaluation. Binary logistic regression analysis was used to identify predictors of better knowledge of dialysis VA. A total of 197 participants were involved in this study. Around one-third of the study participants (37.0%) reported that they have received specialized training in managing VA. Participants agreement (answered agree or strongly agree) on statements that examined attitudes toward dialysis VA cannulation and management was high and ranged between 75.0% and 93.0%. The majority of participants (97.5%) reported that they perform this assessment. Most nurses (65%) preferred the rope-ladder technique. Participants agreement on statements that examined self-efficacy on dialysis VA cannulation and management was high and ranged between 72.1% and 98.0%. The most commonly agreed upon statement was that "they have confident in performing hemodialysis access (arteriovenous fistula and arteriovenous graft) assessment before cannulation." With 98.0% (answered agree and strongly agree). The mean knowledge score for our study sample was 6.4 (SD: 2.0) out of 12 (53.3%); which reflects marginal-level of knowledge on dialysis VA. Binary logistic regression analysis identified that nurses who have undergraduate degree are 92% more likely to be knowledgeable on dialysis VA compared to others (P < .05). Concerning VA, the level of knowledge among hemodialysis nurses working in Saudi Arabia was inadequate. Nurses who hold an undergraduate degree are presumed to have a more extensive understanding of dialysis VA. Further education programs are necessary for HD nurses to enhance their knowledge of VA, thereby optimizing their professional practices and enhancing the outcomes for their patients.
Collapse
Affiliation(s)
- Enad Alsolami
- Department of Internal Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Sami Alobaidi
- Department of Internal Medicine, University of Jeddah, Jeddah, Saudi Arabia
| |
Collapse
|
2
|
Chen PC, Sun JL, Hsu HC, Lai YH, Liao YC, Chen PY, Chang HC. Comparison of puncture methods in patients with hemodialysis: A randomized controlled trial. Semin Dial 2023; 36:454-461. [PMID: 36726291 DOI: 10.1111/sdi.13142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/17/2023] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Arteriovenous fistula or arteriovenous graft is essential to long-term survival and quality of life in patients receiving hemodialysis. To date, no research has examined the clinical impacts of different puncture methods. This study compared the rope ladder and area puncture techniques in terms of vascular patency, pain, and quality of life among patients receiving hemodialysis. METHODS A prospective longitudinal study was performed with 6-month follow-up. A total of 98 participants recruited from a hemodialysis center in Taiwan were randomly assigned to receive the rope ladder technique (experimental group) or the area puncture technique (control group). Vascular patency was assessed by examining access flow and percutaneous transluminal angioplasty rate. Pain and quality of life were measured using the Numerical Pain Rating Scale (NPRS) and Kidney Disease Quality of Life Instrument (KDQOL-36™), respectively. All outcome variables were measured repeatedly and analyzed using a generalized estimating equation. RESULTS Overall, quality of life was significantly better for the experimental group than for the control group (β = 47.23, p < 0.001). The percutaneous transluminal angioplasty rate was lower for the experimental group than for the control group (12.0% vs. 18.8%). However, no significant differences were found in access flow and pain level between the two groups over time. CONCLUSION Hemodialysis patients who received the rope ladder puncture technique had a lower percutaneous angioplasty rate and better quality of life than patients who received the area puncture technique, suggesting that the rope ladder technique could be implemented as a routine cannulation method in hemodialysis clinics.
Collapse
Affiliation(s)
- Pei-Ching Chen
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan
- Dialysis Center, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Jia-Ling Sun
- Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Hsiu-Chuang Hsu
- Dialysis Center, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Yao-Hui Lai
- Division of Cardiology, Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Department of Nursing, MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
| | - Yu-Chien Liao
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Pei-Ying Chen
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Hui-Chen Chang
- School of Nursing and Midwifery, Western Sydney University, Rydalmere, NSW, Australia
| |
Collapse
|
3
|
Meng L, Guo W, Lou L, Teo BW, Ho P. Dialysis nurses’ knowledge, attitude, practice and self-efficacy regarding vascular access: A cross-sectional study in Singapore. J Vasc Access 2023:11297298231162766. [DOI: 10.1177/11297298231162766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Introduction: Dialysis nurses play a paramount role in vascular access (VA) management. The aim of this study is to evaluate dialysis nurses’ knowledge, attitude, practice and self-efficacy (KACP-SE) pertaining to VA cannulation and evaluation. Method: An anonymous self-administered survey was administered to dialysis nurses from two tertiary hospitals (four dialysis units) and two community dialysis centres from April to May 2022. The 37-items survey consists of four dimensions of questions relating to VA cannulation and management: knowledge, attitude, practice and self-efficacy. The content validity and face validity of the survey was reviewed by three experienced VA professionals and five dialysis nurses respectively. The internal consistency and construct validity of the survey have been assessed with psychometric tests. Results: There were 23 and 47 nurses, working in the participated community and tertiary hospital dialysis centres respectively, responded to the survey. The internal consistency coefficients indicated acceptable reliability of the instrument (KR-20 coefficient was 0.55 and 0.76 for knowledge and practice domains; Cronbach’s α was 0.85 and 0.64 for self-efficacy and attitude domains). In the exploratory factor analysis for attitude and self-efficacy, the instrument could account for 64.0% and 53.0% of the total variance respectively. In the knowledge domain, five out of eight single-select multiple-choice questions were correctly answered by >70% of the participants. Overall, the mean (±SD) of participants’ total self-efficacy score was 24.3 (±3.1) over total score of 30. The majority of the participants (82.4%) either agreed or strongly agreed that ultrasound guidance is useful for cannulation. Conclusion: This KAP-SE instrument can be used to evaluate knowledge, attitude, practice and self-efficacy of dialysis nurses toward VA management. The participants demonstrated acceptable knowledge level, but with some knowledge gaps identified. It also revealed nurses’ good self-efficacy level and welcoming attitude towards adopting ultrasound in VA cannulation among the participants.
Collapse
|
4
|
Wang LP, Tsai LH, Huang HY, Okoli C, Guo SE. Effect of buttonhole cannulation versus rope-ladder cannulation in hemodialysis patients with vascular access: A systematic review and meta-analysis of randomized/clinical controlled trials. Medicine (Baltimore) 2022; 101:e29597. [PMID: 35866782 PMCID: PMC9302278 DOI: 10.1097/md.0000000000029597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Safe and effective arteriovenous fistula (AVF) puncture techniques must be used to reduce harm to hemodialysis patients. The relative benefits of buttonhole (BH) cannulation over those of rope ladder (RL) cannulation for AVF remain unclear and inconsistent. METHODS This systematic review and meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Literature searches were conducted in June 2020 in multiple scientific databases including Cochrane library, CINAHL, PubMed/ Medline, Airiti Library, National Digital Library of Theses and Dissertations in Taiwan, Google scholar, Embase, and ProQuest. We included all randomized controlled trials (RCTs) and clinical controlled trials (CCTs) that explored the efficacy of BH cannulation in hemodialysis patients. These included reports published in either English or Chinese that enrolled adults aged 18 years or older who underwent hemodialysis using an autogenous AVF. Studies that showed poor design, such as use of a self-control group or no control group, were excluded from analysis. The critical appraisal skills program checklist for RCTs were used to assess the quality of the evidence and RevMan software were used to perform the meta-analysis. RESULTS Fifteen studies (11 RCTs and 4 CCTs) met the inclusion criteria and were used for the meta-analysis. Meta-analysis showed that BH cannulation significantly reduced aneurysm formation (RR = 0.18, 95% confidence interval [CI] [0.1, 0.32]), stenosis (RR = 0.44, 95% CI [0.25, 0.77]), thrombosis formation (RR = 0.4, 95% CI [0.2, 0.8]), and hematoma (RR = 0.63, 95% CI [0.40, 0.99]) and showed no differences in AVR infection (≦6 months, RR = 2.17, 95% CI [0.76, 6.23]; >6 months, RR = 2.7, 95% CI [0.92, 7.92]) compared to RL cannulation. CONCLUSIONS Given the benefits of BH, this meta-analysis found that BH cannulation should be recommended as a routine procedure for hemodialysis but that hospitals and hemodialysis clinics should strengthen staff knowledge and skills of BH cannulation to reduce the risk of AVF infection.
Collapse
Affiliation(s)
- Li-Ping Wang
- Department of Nursing, Chi Mei Medical Center, Chiali, Tainan City, Taiwan, R.O.C
| | - Li-Hwa Tsai
- Department of Nursing, Chi Mei Medical Center, Chiali, Tainan City, Taiwan, R.O.C
| | - Hisang-Yun Huang
- Department of Nursing, Chi Mei Medical Center, Chiali, Tainan City, Taiwan, R.O.C
| | - Chizimuzo Okoli
- Behavioral Health Wellness Environments for Living and Learning (BH WELL) & College of Nursing, University of Kentucky College of Nursing, Lexington, KY, USA
| | - Su-Er Guo
- Department of Nursing, and Graduate Institute of Nursing, and Chronic Diseases and Health Promotion Research Center, College of Nursing, Chang Gung University of Science and Technology (CGUST), Chiayi County, Taiwan, R.O.C
- Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi County, Taiwan, R.O.C
- Department of Safety Health and Environmental Engineering, Ming Chi University of Technology, New Taipei City, Taiwan, R.O.C
- *Correspondence: Su-Er Guo, No. 2, Sec. W., Jiapu Rd., Puzi City, Chiayi County 61363, Taiwan, ROC. (e-mail: )
| |
Collapse
|
5
|
Rønning MI, Benschop WP, Øvrehus MA, Hultstrøm M, Hallan SI. Direction- and Angle-Assisted Buttonhole Cannulation of Arteriovenous Fistula in Hemodialysis Patients: A Multicenter Randomized Controlled Trial. Kidney Med 2021; 4:100393. [PMID: 35243305 PMCID: PMC8861953 DOI: 10.1016/j.xkme.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Rationale & Objective Arteriovenous fistula cannulation with the buttonhole technique is often preferred by patients but has been associated with an increased infection risk. Guidelines disagree on whether it should be abandoned, thus we assessed a technologically simple method to facilitate gentler arteriovenous fistula cannulation with potentially less discomfort and damage to the epithelial lining of the buttonhole tract. Study Design 8-week, prospective, open-label, randomized controlled trial. Setting & Participants Patients with buttonhole tracts receiving hemodialysis at 7 dialysis centers in Norway were randomized to the intervention group (43 patients, 658 cannulations) or control group (40 patients, 611 cannulations). Intervention Direction and angle of the established buttonhole tract were marked on the forearm skin in the intervention group, whereas the control group had no structured cannulation information system. Outcomes The primary outcome was successful cannulation, defined as correct placement of both blunt needles at the first attempt without needing to change needles, perform extra perforations, or reposition the needle. The secondary outcomes were patient-reported difficulty of cannulation (verbal rating scale: 1 = very easy, 6 = impossible) and intensity of pain (numeric rating scale: 0 = no pain, 10 = unbearable pain). Results After a 2-week run-in period, successful cannulation was achieved in 73.9% and 74.8% of the patients in the intervention and control groups, respectively (relative risk [RR], 0.99; 95% CI, 0.87-1.12; P = 0.85). However, the probability of a difficult arterial cannulation (verbal rating scale, 3-6) was significantly lower in the intervention group (RR, 0.69; 95% CI, 0.55-0.85; P = 0.001). There were no improvements for venous cannulations. Furthermore, the probability of a painful cannulation (numeric rating scale, 3-10) was lower in the intervention group (RR, 0.72; 95% CI, 0.51-1.02; P = 0.06). Limitations Unable to evaluate hard end points such as infections and thrombosis owing to the small sample size. Conclusions Marking direction and angle of cannulation did not improve cannulation success rates; however, patients more often reported an unproblematic procedure and less pain. Funding None. Trial Registration ClinicalTrials.gov (NCT01536548).
Collapse
Affiliation(s)
| | | | | | - Maria Hultstrøm
- Department of Nephrology, St. Olav Hospital, Trondheim, Norway
| | - Stein I. Hallan
- Department of Nephrology, St. Olav Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Address for Correspondence: Stein I. Hallan, MD, PhD, Department of Nephrology, St. Olav Hospital, Prinsesse Kristinas gate 1, 7030 Trondheim, Norway.
| |
Collapse
|
6
|
Yin J, Tian Z, Li P, Li H, Dong Y, Yang X. A time-saving method of creating AVF buttonholes: indwelling trocar technique. J Clin Nurs 2021; 31:3102-3109. [PMID: 34780093 DOI: 10.1111/jocn.16136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/13/2021] [Accepted: 10/25/2021] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES This study aims to explore the convenience and practicality of the method of establishing buttonholes with indwelling trocars. BACKGROUND Compared with rope-ladder technique, buttonhole cannulation has better applicability for haemodialysis patients, and the method of buttonhole establishment is particularly important. DESIGN Prospective, observational and cohort study. METHODS We conducted a 12-month observational study on 30 patients who used sharp needles to establish buttonholes and 33 patients who used indwelling trocars to establish buttonholes, and compared the differences between the two groups in the buttonhole formation time, patient-reported cannulation pain, buttonhole success rate, AVF-related infection and patency of AVF. The study adhered to STROBE guidelines. RESULTS The buttonhole formation time of the indwelling trocar group is less than that of the sharp needle group (5.48 ± 0.51 vs. 23.23 ± 3.07, p < .01). When the buttonhole was used for the first time, the cannulation pain of the indwelling trocar group was less than that of the sharp needle group (4.94 ± 1.50 vs. 6.03 ± 1.13, p = .002), but there was no significant difference in this result after 1 month (sharp needle group with 4.50 ± 0.94 vs. indwelling trocar group with 4.12 ± 1.19, p = .169). Compared with all the buttonholes in the indwelling trocar group were established successfully, there were 5 unsuccessful buttonholes in the sharp needle group (p = .02). Three cases of unsuccessful buttonhole patients in the sharp needle group developed AVF-related infection, this result did not appear in the indwelling trocar group (p = .102). The difference in arterial pressure and venous pressure between the two groups was not significant (p = .061, p = .222). CONCLUSIONS Our new method can help buttonhole patients get less track formation time, less cannulation pain, and less fistula infection, thereby bringing them a more comfortable dialysis experience. RELEVANCE TO CLINICAL PRACTICE The new method used in this study not only meets the needs of patients to protect AVF, but also provides convenience for clinical work. In addition, this study analyzed the causes of the AVF infection in buttonhole patients, and provided directions for future research.
Collapse
Affiliation(s)
- Jinmei Yin
- Blood Purification Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Zhiwu Tian
- Blood Purification Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Peiqiu Li
- Blood Purification Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Huiwen Li
- Blood Purification Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Yi Dong
- Blood Purification Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xiaoyue Yang
- Nursing Department, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| |
Collapse
|
7
|
Borghese O, Pisani A, Di Centa I. Puncture Site Necrosis Over Hemodialysis Native and Prosthetic Vascular Accesses. Ann Vasc Surg 2020; 73:178-184. [PMID: 33383140 DOI: 10.1016/j.avsg.2020.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to detail our experience in the management of skin necrosis/ulceration over hemodialysis vascular accesses. METHODS We collected demographics and operative data about patients undergoing surgery for skin necrosis over native or prosthetic vascular accesses. The different procedural techniques used and outcomes achieved were analyzed. RESULTS Over a six-year period (2013-2019), 593 hemodialysis accesses were created and 16 patients (50%, 8 male; median age 63.6 years, range 42-87; 12 native and 4 prosthetic accesses) were emergently/urgently treated for skin necrosis with danger of rupture (n 9), minor active bleeding (n 4) or life-threatening hemorrhage (n 3). Underlying causes were local infection, aneurysm/pseudo-aneurysm formation and venous stenosis. Most accesses were preserved. Rescue procedures consisted in excision of skin necrosis in association with aneurysmorrhaphy (n 1, 6.3%), simple closure of the venous breach (n 2, 12.5%) or resection and direct re-anastomosis (n 7, 43.8%). Concomitant endoluminal dilatation of venous outflow was needed in 7 (43.8%) cases. No intraoperative complications were observed. At a median of 13 months (range 1-39), 90% of rescued accesses were still functional. CONCLUSIONS Skin necrosis/ulceration over vascular access requires prompt surgical intervention ahead the risk of life-threatening hemorrhage. The rescue of a functional access is possible in most patients and provides an efficient dialysis in postoperative period.
Collapse
Affiliation(s)
- Ottavia Borghese
- Department of Vascular and Endovascular Surgery, Foch Hospital, Suresnes, France; Sapienza University, Rome, Italy.
| | - Angelo Pisani
- Department of Cardiovascular Surgery Bichat-Claude Bernard Hospital, Paris, France
| | - Isabelle Di Centa
- Department of Vascular and Endovascular Surgery, Foch Hospital, Suresnes, France
| |
Collapse
|
8
|
Kumbar L, Ramani K, Brouwer-Maier D. Considerations in Access Cannulation: Traditional and Evolving Approaches. Adv Chronic Kidney Dis 2020; 27:199-207. [PMID: 32891303 DOI: 10.1053/j.ackd.2020.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 02/08/2023]
Abstract
Needle cannulation of hemodialysis access is the soft underbelly of hemodialysis access care that has remained unchanged for a long time. Cannulation error results in complications such as infiltration, hematoma, subsequent revision procedures, and potential loss of hard-earned access. The "best" cannulation method is contingent upon access type and characteristics along with local expertise. The rope ladder technique of cannulation, characterized by successive rotation of puncture sites with each hemodialysis session, permits sufficient time for healing of prior cannulation sites, and reduction in complications such as bleeding, infection, and aneurysm development. A steeper needle angle, higher blood flow rates, and deep needle tip can lead to wall stress on the posterior wall and up to 10 cm from the needle cannulation site. Plastic cannulas provide a viable alternative to metallic needles; they have lower complications and a favorable cost-benefit ratio. There is lack of evidence to support an optimal arterial needle direction configuration. Needle injury may promote intimal thickening, but its effect on access outcomes is currently unknown. Percutaneous creation of arteriovenous fistula presents new challenges in dialysis access cannulation. Point-of-care ultrasound-guided cannulation will likely lead to a paradigm shift in access cannulation. Novel care delivery using cannulation stations is a promising development.
Collapse
|
9
|
Viecelli AK, Howell M, Tong A, Teixeira-Pinto A, O’Lone E, Ju A, Craig JC, Hooi LS, Lee T, Lok CE, Polkinghorne KR, Quinn RR, Vachharajani TJ, Vanholder R, Zuo L, Tordoir J, Pecoits-Filho R, Yuo T, Kopperschmidt P, Smith R, Irish AB, Mori TA, Pascoe EM, Johnson DW, Hawley CM. Identifying critically important vascular access outcomes for trials in haemodialysis: an international survey with patients, caregivers and health professionals. Nephrol Dial Transplant 2019; 35:657-668. [DOI: 10.1093/ndt/gfz148] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/18/2019] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Vascular access outcomes reported across haemodialysis (HD) trials are numerous, heterogeneous and not always relevant to patients and clinicians. This study aimed to identify critically important vascular access outcomes.
Method
Outcomes derived from a systematic review, multi-disciplinary expert panel and patient input were included in a multilanguage online survey. Participants rated the absolute importance of outcomes using a 9-point Likert scale (7–9 being critically important). The relative importance was determined by a best–worst scale using multinomial logistic regression. Open text responses were analysed thematically.
Results
The survey was completed by 873 participants [224 (26%) patients/caregivers and 649 (74%) health professionals] from 58 countries. Vascular access function was considered the most important outcome (mean score 7.8 for patients and caregivers/8.5 for health professionals, with 85%/95% rating it critically important, and top ranked on best–worst scale), followed by infection (mean 7.4/8.2, 79%/92% rating it critically important, second rank on best–worst scale). Health professionals rated all outcomes of equal or higher importance than patients/caregivers, except for aneurysms. We identified six themes: necessity for HD, applicability across vascular access types, frequency and severity of debilitation, minimizing the risk of hospitalization and death, optimizing technical competence and adherence to best practice and direct impact on appearance and lifestyle.
Conclusions
Vascular access function was the most critically important outcome among patients/caregivers and health professionals. Consistent reporting of this outcome across trials in HD will strengthen their value in supporting vascular access practice and shared decision making in patients requiring HD.
Collapse
Affiliation(s)
- Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
| | - Martin Howell
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | | | - Emma O’Lone
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Angela Ju
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Lai-Seong Hooi
- Department of Medicine and Haemodialysis Unit, Hospital Sultanah Aminah, Johor Bahru, Malaysia
| | - Timmy Lee
- Department of Medicine and Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
- Section of Nephrology, Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Charmaine E Lok
- Division of Nephrology, University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kevan R Polkinghorne
- Department of Nephrology, Monash Medical Centre, Melbourne, VC, Australia
- Department of Medicine, Monash University, Melbourne, VC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VC, Australia
| | - Robert R Quinn
- Departments of Medicine & Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Tushar J Vachharajani
- Department of Nephrology & Hypertension, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Raymond Vanholder
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Li Zuo
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Jan Tordoir
- Department of Surgery, University Hospital Maastricht, Maastricht, The Netherlands
| | | | - Theodore Yuo
- Department of Surgery, Division of Vascular Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Rob Smith
- Nightcliff Renal Unit, Darwin, NT, Australia
| | - Ashley B Irish
- Department of Nephrology, Fiona Stanley Hospital, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Trevor A Mori
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| |
Collapse
|
10
|
Christensen LD, Skadborg MB, Mortensen AH, Mortensen C, Møller JK, Lemming L, Høgsberg I, Petersen SE, Buus NH. Bacteriology of the Buttonhole Cannulation Tract in Hemodialysis Patients: A Prospective Cohort Study. Am J Kidney Dis 2018; 72:234-242. [PMID: 29605379 DOI: 10.1053/j.ajkd.2018.01.055] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 01/28/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND The buttonhole cannulation technique for arteriovenous fistulas is widely used, but has been associated with an increased rate of vascular access-related infections. We describe the frequency and type of bacterial colonization of the buttonhole tract over time and associated clinical infections. STUDY DESIGN A prospective observational cohort study with 9 months of follow-up. SETTING & PARTICIPANTS 84 in-center hemodialysis patients using the buttonhole cannulation technique at 2 Danish dialysis centers. OUTCOMES Bacterial growth from the buttonhole tract and dialysis cannula tip and clinically important infections during follow-up. MEASUREMENTS On 3 occasions 1 month apart, cultures before dialysis (from the skin surrounding the buttonhole before disinfection and from the cannulation tract after disinfection and scab removal) and the cannula tip after dialysis. Patients with positive cultures from the buttonhole tract or cannula tip had repeat cultures within 1 week, along with blood cultures. RESULTS Growth from the cannulation tract and/or cannula tip at each of the 3 monthly sets of cultures was found in 18%, 20%, and 17% of patients, respectively. 38% of patients had at least 1 positive culture from the buttonhole tract. Sustained growth was detected in 11% of patients, whereas asymptomatic bacteremia was seen in 30% of those with positive buttonhole cultures. Staphylococci species were the most common pathogens (Staphylococcus aureus, 25%; and Staphylococcus epidermidis, 41%). Colonization-positive buttonholes had more localized redness and slightly more tenderness. During follow-up, significantly more access-related infections were diagnosed among those with positive buttonhole cultures (P<0.001). LIMITATIONS No comparison to area puncture cannulation technique. Blood cultures were obtained only from patients with positive buttonhole bacteriology. CONCLUSIONS Transient or sustained colonization of the buttonhole tract by staphylococci and asymptomatic bacteremia is common in hemodialysis patients, implying a substantial risk for access-related infections among patients using a buttonhole cannulation technique. These findings suggest the possible value of surveillance of buttonhole colonization.
Collapse
Affiliation(s)
| | - Mai-Britt Skadborg
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Agnete H Mortensen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jens K Møller
- Department of Clinical Microbiology, Lillebaelt Hospital, Vejle, Denmark
| | - Lars Lemming
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Irene Høgsberg
- Department of Medicine, Lillebaelt Hospital, Fredericia, Denmark
| | | | - Niels H Buus
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
11
|
Wang S, Wang MS. Successful use of partial aneurysmectomy and repair approach for managing complications of arteriovenous fistulas and grafts. J Vasc Surg 2017; 66:545-53. [DOI: 10.1016/j.jvs.2017.03.429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 03/21/2017] [Indexed: 11/20/2022]
|
12
|
Koratala A, Alquadan KF, Chornyy V, Qadri I, Ejaz AA. Subscapular abscess associated with buttonhole cannulation technique of arteriovenous fistula for hemodialysis access. J Vasc Access 2017; 18:e18-9. [PMID: 27768208 DOI: 10.5301/jva.5000605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2016] [Indexed: 11/20/2022] Open
|
13
|
Di Nicolò P, Cornacchiari M, Mereghetti M, Mudoni A. Buttonhole Cannulation of the AV Fistula: A Critical Analysis of the Technique. Semin Dial 2016; 30:32-38. [DOI: 10.1111/sdi.12547] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Pierpaolo Di Nicolò
- Nephrology and Dialysis Unit; “S. Maria della Scaletta” Hospital; Imola Bologna Italy
| | | | - Marco Mereghetti
- Internal Medicine Unit; “ASST Milano Ovest”; Magenta Milan Italy
| | - Anna Mudoni
- Nephrology and Dialysis Unit; “Cardinale G. Panico” Hospital; Tricase Lecce Italy
| |
Collapse
|
14
|
Nesrallah G. Opponent's comments. Nephrol Dial Transplant 2016; 31:529-30. [DOI: 10.1093/ndt/gfw030a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 03/07/2016] [Indexed: 11/13/2022] Open
|
15
|
Labriola L, Jadoul M. Moderator's View: Buttonhole cannulation of arteriovenous fistulae: great caution is warranted: Table 1. Nephrol Dial Transplant 2016; 31:530-3. [DOI: 10.1093/ndt/gfw028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/01/2016] [Indexed: 11/12/2022] Open
|