Bundle of Care Promotes Arteriovenous Fistula Maturity in Patients with End-Stage Kidney Disease

Abstract

Arteriovenous fistula (AVF), as the hemodialysis access, has the advantages of safety, sufficient blood flow, and long use time. To establish an ideal AVF, patients require good vascular condition. However, many teams often neglect preoperative preparation and exercises and have no concept of specialized nursing or bundle of care, directly leading to stenosis of the outflow tract and seriously affected surgical efficacy. This study aimed to evaluate the influence of bundle of care on AVF. A total of 260 patients with end-stage kidney disease were included from January 2019 to December 2020 at Qilu Hospital, Shandong University. Patients were divided into 2 groups, and were treated with ordinary nursing care (the control group) or bundle of care (the observation group). Maturity of AVF fistula and postoperative complications were compared between 2 groups. The observation group was associated with larger internal diameter of the cephalic vein (6.524±0.347 vs. 6.346±0.32 4mm) and faster blood flow at the anastomosis of AVF (568.2±26.8 vs. 565.7±27.5mL/min) than the control group at 2weeks after surgery (both P<0.05). The observation group had a higher maturity rate than the control group (93.1% vs. 81.5%, P<0.05) at 8weeks after surgery. There were lower incidences of fistula stenosis (4.6% vs. 10.8%) and fistula thrombosis (2.3% vs. 7.7%) in the observation group than in the control group (both P<0.05). The secondary patency was higher in the observation group than in the control group (97.7% vs. 92.3%, P<0.05). The use of bundle of care promotes AVF maturity and reduces postoperative complications in patients with end-stage kidney disease.