Abstract
BackgroundPoint-of-care ultrasound (POCUS) has been used in various vascular access contexts; however, to date, it has not been widely adopted in haemodialysis clinics. People with end-stage kidney disease receiving haemodialysis require an arteriovenous fistula (AVF), arteriovenous graft (AVG), or central venous access device (CVAD) in order to access their blood for therapy/treatment. Cannulation issues, such as haematoma and extravasation, related to AVFs and AVGs are common. This pilot and feasibility study will assess the feasibility of a randomised controlled trial aimed at evaluating whether POCUS-guided cannulation results in more successful and accurate AVF needle placement than the standard practice of blind cannulation.MethodsA controlled, random order crossover design will be used to evaluate two clinical conditions: (1) POCUS-guided cannulation and (2) standard practice of blind cannulation, when used by haemodialysis nurses. The feasibility of conducting this type of trial for these two clinical conditions will be assessed through recruitment, retention, and attrition rates; perceptions of acceptability; implementation measures; and assessment of methods of data collection. Clinical outcomes to be assessed are overall cannulation success on first attempt, accuracy of needle tip placement, number of extravasations, procedural time, and patient and nurse perceptions. The setting is a 16-chair dialysis unit in regional Australia. Participants will include adult haemodialysis patients with an AVF in situ for greater than 2 months and haemodialysis-trained registered nurses working full- or part-time. Clinical outcomes will be analysed using generalised linear mixed models. Feasibility data will be reported using descriptive statistics. Qualitative audio data will be digitally recorded, transcribed verbatim, and analysed using thematic analysis.DiscussionPoint-of-care ultrasound for cannulation has the potential to promote high-quality, safe nursing care and decrease cannulation damage for patients on haemodialysis. Due to the lack of evidence for patient benefit and its innovative and niche use in haemodialysis centres, POCUS is currently only specified in one international guideline. This study will inform sample size calculations for a future multi-site trial.Trial registrationAustralian New Zealand Clinical Trials Registry, (21/11/2017) ACTRN12617001569392
Highlights
Point-of-care ultrasound (POCUS) has been used in various vascular access contexts; to date, it has not been widely adopted in haemodialysis clinics
Point-of-care ultrasound has been introduced into haemodialysis units sporadically throughout the world, but currently, there is no evidence to support or refute the use of POCUS guidance as an adjunct tool to use in the haemodialysis setting
This will be the first study of the use of POCUS guidance for cannulation in the haemodialysis setting
Summary
Point-of-care ultrasound (POCUS) has been used in various vascular access contexts; to date, it has not been widely adopted in haemodialysis clinics. People with end-stage kidney disease receiving haemodialysis require an arteriovenous fistula (AVF), arteriovenous graft (AVG), or central venous access device (CVAD) in order to access their blood for therapy/treatment. Cannulation issues, such as haematoma and extravasation, related to AVFs and AVGs are common. To facilitate the removal of toxins from the blood via haemodialysis, three vascular access options are available: arteriovenous fistula (AVF), arteriovenous graft (AVG), or central venous access device (CVAD). The AVF allows access to the blood, maturation issues can arise from poor arterialisation or vessel calcification, in older patients and in patients with peripheral vascular disease and/or diabetes [1]. The proportion of patients commencing dialysis with poorer quality vessels is increasing
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
