Arteriovenous Fistula Care Research Articles

The influence of near-infrared therapy on arteriovenous fistula patency in haemodialysis patients: A multicentre, randomised, controlled clinical trial.

Arteriovenous fistula (AVF) is the preferred vascular access for patients undergoing haemodialysis (HD). AVF malfunction remains a major clinical problem and is a significant independent risk factor for death. Although far-infrared (FIR) therapy has been shown to reduce complications and improve the patency rate of AVFs in various studies, it has been cautiously recommended by the Kidney Disease Outcome Quality Initiative (KDOQI) guidelines for AVF care due to insufficient evidence. Therefore, it is necessary to identify more effective methods for preventing AVF dysfunction. Many in vitro studies and few clinical studies have examined the effects of near-infrared (NIR) therapy on the vasculature. This study will examine the effects of NIR therapy on AVF. A randomised, controlled, open-label, multicentre trial will compare the effect of NIR on AVF patency after 1 year of therapy with that of a control group of patients with existing AVF. One group of patients received NIR treatment above their AVFs, whereas the control group received regular care. The primary outcome is the primary fistula patency rate within 12 months. In addition, acute changes in inflammatory, vasodilatory and haemodynamic parameters after a single treatment in the first 40 participants will be examined. This study was registered in the Clinical Trials Registry (ChiCTR2300071305) at https://register.clinicaltrials.gov/. This study will explore the long-term and acute effects of NIR on AVFs. The study findings will provide information that can be used to develop new technical support for the prevention of AVF dysfunction in patients undergoing haemodialysis.

Hemodiyaliz Damar Erişim Yolları ve Bakımı

Hemodialysis remains the most widely used method for treating renal failure. Life expectancy and quality in hemodialysis are directly proportional to the quality of dialysis, and this quality depends on the reliability and integrity of the patient’s vascular access route. The ideal vascular access route provides reliable, uncomplicated access to dialysis and is also suitable for the patient’s needs. Hemodialysis vascular access options have not changed substantially over the past six decades, and arteriovenous fistula (AVF) remains the access of choice. Although AVF is a vascular intervention recommended and preferred in clinical practice guidelines for hemodialysis, it can develop into serious complications such as thrombosis, hematoma, edema, peripheral ischemia, bleeding, and infection. To prevent these complications, it is extremely important to educate patients about AVF care. This review has been prepared as a guide for healthcare professionals who care for hemodialysis patients.

Optimizing Arteriovenous Fistula Care in Kidney Transplant Recipients: A Complex Task.

Optimizing Arteriovenous Fistula Care in Kidney Transplant Recipients: A Complex Task.

Knowledge of arteriovenous fistula care in patients with end-stage kidney disease in south Asian countries: A systematic review and meta-analysis.

To find the prevalence of knowledge of arteriovenous fistula (AVF) self-care, its characteristics, and associated factors among hemodialysis patients and summarize the findings of various domains of AVF self-care in south Asian countries. The systematic literature search was performed on online databases and additional sources to retrieve published articles on AVF self-care. We estimated the pooled prevalence using a random effects model in meta-analysis. Additionally, thematic knowledge regarding various aspects of AVF self-care was narratively summarized. Among the articles retrieved seven studies met our inclusion and exclusion criteria. The prevalence of AVF self-care in individual studies ranged from 59% to 99%, with an overall random pooled prevalence of 81% (95% CI, 68% to 94%). Major factors associated with self-care of AVF knowledge included patients' educational status, age, vintage of hemodialysis, and healthcare personnel's advice. Knowledge scarcity regarding potential measures of AVF self-care obligates the need for continuous education in hemodialysis patients. A multidisciplinary approach is vital to enhance self-care from pre- to post-creation of AVF in hemodialysis patients as well as their caregivers in order to prolong the patency rates and decrease the subsequent morbidity and mortality due to failure of AVF.

Empowerment Program for Mothers to Improve the Quality of Life of Their Children undergoing Hemodialysis on Arteriovenous Fistula Care

Children who receive hemodialysis can experience difficulties that might lower their quality of life and that of their mothers. Thus, empowering initiatives based on educational assessment needs will aid in enhancing mothers' knowledge, practice, and the quality of life for their offspring. Because of this,

Luminal pressure gradient and risk of arteriovenous fistula nonmaturation.

While arteriovenous fistula (AVF) nonmaturation is a major issue of hemodialysis care, an effective treatment to improve AVF maturation remains lacking. AVF introduces pulsatile arterial blood flow into its venous limb and produces high luminal pressure gradient, which may have adverse effect on vascular remodeling. As such, the aim of the present study is to investigate effect of luminal pressure gradient on AVF nonmaturation. This single-center, prospective observational study includes patients receiving autologous AVF creation. Participants received early postoperative ultrasound 5–7 days after surgery to collect parameters including diameters, flow rates, and volume at inflow and outflow sites. Luminal pressure gradient was estimated by using modified Bernoulli equation. The outcome was spontaneous AVF maturation within 8 weeks after surgery without intervention. Thirty patients were included, of which the mean age was 66.9 years and 70% were male. At the end of study, 13 (43.3%) patients had spontaneous AVF maturation. All demographic and laboratory characteristics were similar between patients with mature and nonmature AVF. Regarding ultrasonographic parameters, nonmature AVF showed significantly higher inflow/outflow diameter ratio, inflow velocity, and luminal pressure gradient. While these 3 parameters were significantly correlated, multivariate logistic regression showed their significant association with AVF nonmaturation. Receiver operating characteristic curve exhibited their high predictive value for AVF nonmaturation. Our findings showed that higher inflow/outflow ratio, inflow velocity, and AVF luminal pressure gradient in early postoperative ultrasound predicted risk of AVF nonmaturation. Reducing inflow/outflow diameter ratio or inflow rate may be an approach to improve AVF maturation. The predictive value of this early assessment might have impact on the clinical practice of AVF care.

Value of Targeted Nursing in the Care of Arteriovenous Fistula in Maintenance Hemodialysis Patients

Value of Targeted Nursing in the Care of Arteriovenous Fistula in Maintenance Hemodialysis Patients

Effect of self-instructional module on knowledge regarding care of arteriovenous fistula among hemodialysis patients in selected hospitals, Guwahati, Assam

BACKGROUND: Chronic kidney disease is a major public health problem. Arteriovenous fistulas (AV fistulas) are considered the gold standard for hemodialysis vascular access based on their superior patency, low complication rates, improved adequacy, lower cost to the healthcare system, and decreased risk of patient mortality. A failing AV fistula places the patient at risk for inadequate dialysis, which can lead to numerous complications and increased morbidity and mortality. Patient education support patients to live the best possible quality of life. It instills patient self-confidence to help them carry out behavior necessary to reach the desired goal.OBJECTIVE: The purpose of the study is to determine the effect of self-instructional module by comparing the pretest and posttest knowledge scores regarding care of AV fistula among hemodialysis patients.MATERIALS AND METHODS: With a quantitative approach, preexperimental one-group pretest-posttest design was adopted for the study. In this study, 64 hemodialysis patients with AV fistula were selected by using nonprobability convenient sampling technique. The tools used for the study were demographic variables, self-structured knowledge questionnaire and self-instructional module.RESULTS: The study revealed that the mean posttest knowledge score (12) was significantly higher than the mean pretest knowledge score (7.32) as evidenced by t = 5.65 (P = 0.05) and P = 0.0001, which shows that self-instructional module was effective on care of AV fistula. It also revealed that there was significant association between pretest knowledge score and selected demographic variables of educational status and previous exposure to information.CONCLUSION: A similar study can be taken on large scale for better generalization. On the basis of the findings, the researcher concluded that self-instructional module on care of AV fistula was effective among hemodialysis patients.

Late postoperative complications of arteriovenous fistula for hemodialysis

<p>The vascular approach is a prerequisite for performing hemodialysis, but their "weak points" are different and frequent complications. Modern guidelines recommend native arteriovenous fistula (AVF) as the first choice of vascular approach because it is characterized by the longest survival and the least complications compared to other vascular approaches. All complications of AVF can be divided into intraoperative, early, and late postoperative. This paper presents the late postoperative complications of AVF, their frequency, causes, diagnosis and treatment. The most important late postoperative complications are: stenosis, thrombosis, aneurysm or pseudoaneurysm formation, infection, hand edema, hematoma, ischemic steal syndrome, ischemic neuropathy, congestive heart failure. Large differences in the frequency of each complication in earlier studies can be explained by differences in surgical technique, localization of AVF, diagnostic methods, but, above all, differences between the presented groups of patients. It is described that the age of patients, sex, underlying disease, the presence of comorbid conditions and various metabolic and immune disorders characteristic of chronic renal failure, as well as the way of using and caring for AVF significantly affect the occurrence of AVF complications. One of the main predictors of AVF success and survival is the quality of the patients' blood vessels, and therefore careful examination of blood vessels before approaching AVF creation is of particular importance. The creation, use and care of AVF is the task of the team of health professionals who take part in the treatment of these patients, and successful treatment requires their good cooperation, as well as cooperation with patients.</p>

Determination of adaptation levels and applications for fistulas care and protection to disease of patients with arteriovenous fistula

Introduction: The aim of this study was to the determinate adaptation to chronic disease and applications for arteriovenous fistula (AVF) care and protection of hemodialysis (HD) patients with an AVF, and to determine the relationships between adaptation and application.
 Methods: This research is a prospective, descriptive, and cross-sectional type of research. The universe of the study accounted for 180 patients who underwent HD. The research was completed with 114 patients. The research was conducted from July 2019 to September 2019, in two different dialysis centers in Osmaniye Province. The data were collected using The Patient Identification Form and Adaptation to Chronic Illness Scale. Mean ± Standard deviation, percentages, and independent samples t-test analysis were used.
 Results: When the scale scores of the patients participating in the study were evaluated, determined to level of total adaptation with chronic disease and physical adaptation was to above the average score (40.24 ± 5.99). Social adaptation (21.82 ± 6.39) and psychological adaptation (22.91 ± 5.39) levels can be said to be moderate. Individuals who exercised with the ball to mature the fistula, who was careful to dress and keep the area dry on the 1st day of the operation, who was careful not to apply lotion to the fistula area, and who complied with the fluid restriction were found to have higher levels of adaptation with the disease.
 Conclusion: It can be said that the patients who make the right application for fistula care and protection have in general adaptation levels can also be said to be high. The level of adaptation is effective for applications. The level of adaptation is effective on applications for AVF care and protection.

A Study to Assess the Knowledge and Self Reported Practices Regarding Care of Arterio Venous Fistula among Patients at Selected Haemodialysis Units of Sangli City

A Study to Assess the Knowledge and Self Reported Practices Regarding Care of Arterio Venous Fistula among Patients at Selected Haemodialysis Units of Sangli City

A real-time rule-based method of stenosis evaluation for arteriovenous fistula care by multiple sites blood flow measurement

Arteriovenous fistula (AVF) care is crucial for hemodialysis patients. Neglecting the care of patients on strict AVF care may cause stenosis and affect hemodialysis efficiency. Hence, AVF has been called a lifeline for these patients. Currently, in clinical care, angiography and ultrasound are used to evaluate the degree of stenosis (DOS) in AVF. However, these tools are expensive, time-consuming, and inappropriate for quick assessments before dialysis therapy or even at home care. This study proposed a real-time rule-based method of stenosis evaluation for AVF care by measuring the blood flow of multiple sites with Doppler ultrasound. The features of blood flow analyzed were the average flow rate (AFR) and the ratio of flow variation (RFV), which were measured in the fistula and arteriovenous anastomosis sites, respectively. In the clinical examinations of 60 patients, the results indicated that AFR would gradually decrease with DOS, and RFV reached the maximum at 30% to 50% stenosis and the lowest at 30%; this difference was statistically significant (p<0.05). Moreover, the classification results indicated that the proposed method achieved a high classification rate of 95% as well as a shorter processing time within 10 ms. This study also compared the results from a phantom experiment, which had three different DOS simulated vessel classes, and it showed the same trend. The proposed method was considered to be potentially suitable for real-time program design with a microsystem in wearable or small monitoring devices so as to provide a simple and fast rapid screening method for clinical AVF care.

ARTERIOVENOUS FISTULA CARE

Objectives: To determine knowledge, attitude and practice regarding AV fistulacare in patients of end stage renal disease on hemodialysis. Study Design: Cross sectionalstudy. Setting: ESRD patients in Nephrology Department of Lahore General Hospital by usingself-designed questionnaire. Period: Six months from Jan 2017 to June 2017. Method: Thestudy included about 141(consecutive sampling) patients of chronic kidney disease using AVfistula for hemodialysis. Data was collected using self designed questionnaire. Data analysiswas done using SPSS version 22. Result: The most well- known precautionary measures to betaken for arteriovenous fistula care are to avoid taking blood pressure and intravenous line on thearm bearing AV fistula and to avoid trauma and weight lifting with that limb. The knowledge wasseen to be particularly deficient about the measures to be taken in case of swelling. The attitudetowards AV fistula care was observed to be positive, majority of our study population claimed tofollow maximum precautionary measures most of the time, but percentage of practicing doesnot coincide with that (85.1% vs.74.7% respectively). The least practiced measure is elevationof limb in case of swelling, observed by only 36.9% of our study population. Conclusion:Knowledge regarding fistula care was adequate about most of the precautionary measures,most of the participants showed positive attitude towards practicing precautionary measures forfistula care, but number of patients actually practicing these precautions is less than the numberof patients that have knowledge about them.

KNOWLEDGE, ATTITUDE AND PRACTICE IN ESRD PATIENTS ON HEMODIALYSIS

Objectives: To determine knowledge, attitude and practice regarding AV fistulacare in patients of end stage renal disease on hemodialysis. Study Design: Cross sectionalstudy. Setting: ESRD patients in Nephrology Department of Lahore General Hospital by usingself-designed questionnaire. Period: Six months from Jan 2017 to June 2017. Method: Thestudy included about 141(consecutive sampling) patients of chronic kidney disease using AVfistula for hemodialysis. Data was collected using self designed questionnaire. Data analysiswas done using SPSS version 22. Result: The most well- known precautionary measures to betaken for arteriovenous fistula care are to avoid taking blood pressure and intravenous line on thearm bearing AV fistula and to avoid trauma and weight lifting with that limb. The knowledge wasseen to be particularly deficient about the measures to be taken in case of swelling. The attitudetowards AV fistula care was observed to be positive, majority of our study population claimed tofollow maximum precautionary measures most of the time, but percentage of practicing doesnot coincide with that (85.1% vs.74.7% respectively). The least practiced measure is elevationof limb in case of swelling, observed by only 36.9% of our study population. Conclusion:Knowledge regarding fistula care was adequate about most of the precautionary measures,most of the participants showed positive attitude towards practicing precautionary measures forfistula care, but number of patients actually practicing these precautions is less than the numberof patients that have knowledge about them.

Arteriovenous Fistula (AVF) Self-Care: A Study at a Tertiary Care Hospital in Lahore, Pakistan

Most complications associated with the use of arteriovenous fistula (AVF) access site for hemodialysis can be prevented by adopting a daily self-care plan for AVF access site. Therefore, the aim of this study was set to assess the knowledge, attitude and practice (KAP) about self-care of AVF access site amongst end stage renal disease (ESRD) patients who are on maintenance hemodialysis. Methods: This comparative cross sectional study with quantitative approach was carried out in hemodialysis unit of Shalamar Institute of Health Sciences, Lahore for the month of July, 2017. All patients with ESRD, on maintenance hemodialysis through an AVF access for at least last 30 days, were included in the study. Each patient was given a questionnaire comprising of 21 questions during his/her routine dialysis. Knowledge of ESRD patients was categorized into poor (&lt;50%), average (50-70%) and good (&gt; 70%). Results: Out of 138 patients, 94% had good knowledge about AVF self-care and 99% had good attitude about AVF access care. However a few practices like daily AVF thrill checkup, pre-hemodialysis AVF site washing and pre and post hemodialysis disinfection were not in correspondence with the level of knowledge representing a discrepancy between knowledge and practice in some aspects of the of the AVF care. Knowledge scores when compared between different age groups, greater proportion of patients between age of 45- 65 (p&lt;0.017) possessed good knowledge as compared to age groups of 25-45, 65-85 years. Conclusion: Despite good understanding and adequate attitude, few practices were not being followed in parallel to the knowledge acquisition. Therefore, regular reminder and periodic evaluation of practical aspects of AVF care is recommended for each ESRD patient visiting for hemodialysis.

Using Interdisciplinary Cooperation to Improve the Rate of Proper Performance of a Hand Exercise Among Hemodialysis Patients With Arteriovenous Fistula Construction

Patients who undergo new arteriovenous fistula (AVF) construction as part of their hemodialysis treatment program are required to perform hand exercises properly in order to maintain AVF function. However, poor performance of these hand exercises currently results in the failure of many patients to preserve AVF function. To increase the rate of performing this hand exercise properly from 55% to 80%. A comprehensive investigation identified the following five main problems: (a) Insufficient muscular endurance; (b) Resistance was not labeled on the ball; (c) Difficulties with maintaining a grip on the ball during the exercise; (d) Lack of standardized education procedures; and (e) Nurses lack latest knowledge on the hand exercise. The strategies used to improve the situation included: (a) Interdisciplinary team cooperation with physiotherapists to design individualized resistance training regimens; (b) Exercise tool improvement; (c) Standardized AVF care; (d) Continuous education for nursing staffs; and (e) Seed teacher program for hand exercise. The rate of proper hand exercise performance increased from 55% to 93%. This nursing project involved an interdisciplinary team that included physiotherapists in order to successfully improve the rate at which the hand exercise was performed properly. This positive experience may be applied to other hemodialysis departments in the treatment of patients with AVF.

The Effects of Comfort-Based Interventions (Back Massage and Patient and Family Education) on the Level of Comfort Among Hemodialysis Patients

Background: Providing patients with comfort is the basis of nursing care and a favorable outcome of nursing care measures. Comfort is of special importance to hemodialysis patients because they spend a large part of their lives in hemodialysis units and are constantly dealing with different physical and mental health problems. This study aimed to evaluate the effects of comfort-based interventions (back massage along with patient and family education) on the level of comfort among hemodialysis patients. Methods: As a randomized controlled trial, this study was undertaken in 2016 in the hemodialysis unit of Shahid Chamran hospital, Ferdows, Iran. A convenience sample of forty hemodialysis patients was recruited. Patients were alternately allocated to control or intervention groups based on their hemodialysis days. The hospice comfort questionnaire was completed for all participants at the beginning and at the end of the study. This questionnaire showed that the comfort needs of patients were related to muscle cramps, headache, back pain, nausea, lack of knowledge about arteriovenous fistula care, dietary and treatment regimens, itching, rest and sleep disorders, and impaired comfort. Patients in the intervention group received massage as well as patient and family education in six consecutive hemodialysis sessions, while their counterparts in the control group solely received the routine care services of the study setting. The SPSS software (v. 18.0) was used for data analysis through running the paired- and the independent-sample t tests. The significance level was set at less than 0.05. Results: The mean scores of comfort and its environmental and psychospiritual dimensions significantly increased in the intervention group (P 0.05). However, after the intervention, there were significant between-group differences in the mean scores of comfort and its environmental dimension as well as in the pretest-posttest mean difference for the environmental dimension of comfort.

EFFECT OF IMPLEMENTING EDUCATIONAL GUIDELINE ON CLINICAL OUT COME OF PATIENTS UNDERGOING ARTERIOVENOUS FISTULA

Background: Arteriovenous fistula (AVF) is the life-line for the majority of the patients with chronic kidney disease when hemodialysis (HD) is the treatment of choice; it must be followed by necessary instruction to increase knowledge and practice for patients related to AVF care and healing to complete its success and reduce its complication. Aim of the study: to evaluate the effect of implementing educational guideline on clinical outcome of patients undergoing arteriovenous fistula. Study design: Quasi-experimental research design was conducted in this study.90 adult patients were systemic randomly selected from Vascular Surgery Clinic - Mansoura University Hospital to participate in the study which divided into two groups, n=(45 study and 45 control) .Two tools were used for data collection. Patients interviewing questionnaire sheet included two parts socio-demographic data and Interview based questionnaire sheet to assess patient knowledge and practice regarding AVF procedure and Access assessment tool to assess fistula complication. Results: Knowledge of the study group improved significantly after health educational guideline implementation (post test), where P ≤ 0.001and minor of the study group experienced AVF complication. On the other hand there is no improvement of the knowledge of the control group post test, where P = 1.000 and Majority of control group had most AVF complications. Conclusions: Majorities of the control group had unhealthy fistula post test& about one third of them had fistula failure .While the majorities of the study group had healthy fistula following the educational guideline implementation, which indicated the effectiveness of this educational guideline to decrease complications. Recommendation: All patients scheduled for AVF procedure and their families need adequate knowledge and skills to help them to adapt with their life post-AVF.

Effect on Anxiety of Education Programme about Care of Arteriovenous Fistula in Patients Undergoing Hemodialysis

This study investigated the impact of education, provided to individuals, in whom AV fistula was preferred as a vascular access, regarding information and anxiety. This experimental study was performed on 32 patients undergoing hemodialysis between November 2009 and February 2010 in the Nephrology Clinic of Sivas Cumhuriyet University Hospital. Patients' data was collected by means of Personal Information Form (PIF), AV Fistula Information Form (AV-FIF), and Beck Anxiety Inventory (BAI); education brochures were used in order to inform the individuals. Collected data were assessed with SPSS . Statistical analyses were used in order to assess the data: percentage account, paired samples t test. When comparing information and anxiety score of individuals prior to and following education about AV fistula care, it was seen that information and anxiety scores were low and high respectively, prior to the education. Following education, patients' information and anxiety scores became higher and lower respectively. All these results were statistically significant (P< 0.001). Education about fistula increased the information level about fistula care and decreased anxiety in patients undergoing hemodialysis. It is important to perform patient education regularly, because it increases the level of orientation towards illness and interventions in patients.

The clinical application and the nursing care of arterio-venous fistula replanted by artificial blood vessel

目的 探讨人工血管动静脉内瘘的临床应用方法及护理对策.方法 从1999年1月-2005年1月,对52例行人工血管动静脉内瘘术的患者进行随访.结果 52例患者中,术后3个月至5年间共有16例血栓形成,感染5例,假性动脉瘤3例.结论 人工血管内瘘需要专业化护理,加强内瘘保护知识的教育,正确地使用内瘘,采用绳梯式穿刺,压迫止血力度适当,能减少术后并发症发生,延长人工血管的使用寿命。