Arteriovenous Fistula Cannulation Research Articles

The effect of using a local skin cooling device on arteriovenous fistula cannulation pain and comfort level of patients on hemodialysis: A single-blind randomized controlled study.

The study aimed to investigate the impact of the using local skin cooling on arteriovenous fistula cannulation pain and the comfort levels of hemodialysis patients. The single-blind randomized controlled trial was formed with 50 patients between June 20, 2023, and July 31, 2023, in the hemodialysis units of two state hospitals in Turkey. Patients were randomly assigned to either the experimental group (n = 25) or the control group (n = 25) using the block randomization method. This data were collected through the use of the CoolSense device, the "Patient Information Form," the "Verbal Category Scale," and the "General Comfort Scale." Patients in the experimental group received the local skin cooling for five seconds during arteriovenous fistula cannulation, while the control group followed the standard hospital protocol. The study was registered on Clinical Trials (NCT06144801). The study revealed that the application of the local skin cooling during arteriovenous fistula cannulation significantly reduced pain and increased patients' comfort levels, demonstrating an anesthetic effect (p < 0.001). Furthermore, it was observed that as pain levels decreased, patient comfort levels increased (p < 0.001). It is concluded that the using lokal skin cooling is an effective tool for reducing pain and enhancing comfort during arteriovenous fistula cannulation in hemodialysis patients.

Infection prevention in home dialysis

Purpose of review Among patients with kidney failure, home dialysis modalities, including peritoneal dialysis (PD) and home hemodialysis (HHD) provide several individual and healthcare system benefits over in-center hemodialysis (HD). Infection remains a major source of morbidity and mortality in this population, and a core outcome of critical importance to patients, caregivers, and kidney health professionals. This narrative review provides evidence-based measures for infection prevention among individuals receiving home dialysis, with a particular emphasis on dialysis and access-related infections. Recent findings Patient and care partner education and training is an important and major theme for infection prevention in home dialysis. In PD, identifying and managing modifiable risk factors for infections such as hypokalemia, constipation, use of gastric acid suppressants, and domestic pets, along with the use of antimicrobial prophylaxis, when indicated, can substantially reduce peritonitis risk. Reducing the use of central venous catheters (CVC), and duration of CVC dependence is the most effective means of prevention of HD access-related bloodstream infections in individuals receiving HHD. For arteriovenous fistula cannulation, rope ladder technique is associated with lower risk of infection compared to buttonhole cannulation. Summary Developing and instituting a well structured and evidence-based patient training and education program within home dialysis units is the most important measure in preventing and reducing dialysis and access-related infections. Kidney care providers should be familiar with different infection risk factors among individuals receiving home dialysis.

A variant deep femoral artery passing anterior to femoral vein: an anatomical observation with implication in femoral vein cannulation.

The common femoral artery (CFA) typically gives rise to its superficial and deep branches, with the deep femoral artery (DFA) being the largest and most substantial of these branches. This case study presents a rare variation of the DFA characterized by an unusual branching pattern and its specific relationship with the femoral vein within the subinguinal region. In nutshell, the DFA and the medial femoral circumflex artery shared a common origin from the medial aspect of the CFA. The DFA assumed an unusual course, initially passing anterior to the femoral vein above the saphenofemoral junction, followed by a spiraling trajectory around the medial aspect of the femoral vein before running posteriorly. The embryological origins and clinical implications of this anatomical variation are thoroughly examined. This unusual vascular relationship in the subinguinal region may potentially result in arterial injury during femoral vein cannulation or formation of arteriovenous fistula after the procedure.

PEMIJATAN TITIK LI-4 DAPAT MENGURANGI NYERI KANULASI ARTERIOVENOUSFISTULA PADA PASIEN CKD YANG MENJALANI HEMODIALISA: STUDI KASUS

Background, one of the vascular accesses used for hemodialysis is arteriovenous fistula. Arteriovenous fistula cannulation causes pain problems in patients. The cannulation procedure is felt as a painful sensation that needs to be treated, because the size of the needle used when cannulating an arteriovenous fistula is quite large compared to cannulating when installing an IV, namely 16 gauge. General purpose, to provide acute pain nursing care for Chronic Kidney Disease (CKD) patients undergoing hemodialysis in the hemodialysis room at RSU Aghisna Medika Kroya. Case collection method, pain scale measurement using a VAS instrument for 5 CKD patients undergoing hemodialysis without massage intervention and with massage intervention at the LI-4 point for 2 minutes or approximately 30-50 pressures. The results of nursing care, nursing care for acute pain in CKD patients undergoing hemodialysis after nursing for 1x4 hours with the application of massage at point LI-4 showed a decrease in the pain scale in patients without massage and with massage at point LI-4. In conclusion, LI-4 point massage therapy can be an therapeutic option to reduce the pain of arteriovenousfistula cannulation in CKD patients undergoing hemodialysis. Recommendation is hoped that more and larger case subjects will be taken in the next research so that the results will be more effective.

The effect of multiple single cannulation technique on complications of arteriovenous fistulae: A meta-analysis.

To evaluate the effect of multiple single cannulation technique on the complications of arteriovenous fistula. A comprehensive literature search was conducted to investigate the impact of multiple single cannulation technique on the complications of arteriovenous fistula. The search was performed in both Chinese and English databases including Wanfang Medicine, China National Knowledge Infrastructure, Vip, Pubmed, Embase, and The Cochrane Library, with a search period up to December 20, 2023. Following literature screening and data extraction, the quality of the included studies was assessed using the Cochrane Bias Assessment Tool for Randomized Controlled Trials. Statistical analysis was performed using Review Manager version 5.3. Thirteen papers, totaling 1299 patients, were included in the analysis. The experimental group consisted of 646 patients, while the control group had 595 patients. The meta-analysis revealed that the multiple single cannulation technique was more effective than rope ladder cannulation and buttonhole cannulation in reducing the incidence of angiomas (odds ratio [OR] = 0.19; 95% confidence interval [CI] = 0.10-0.35), stenosis (OR = 0.22; 95% CI 0.13-0.39), thrombosis (OR = 0.17; 95% CI = 0.07-0.39), and blood seepage (OR = 0.13; 95% CI = 0.08-0.21) of arteriovenous fistulas (P < .05). Additionally, it was found to increase the success rate of nurses' single cannulation (OR = 4.20; 95% CI = 1.78-9.95) of arteriovenous fistulas (P < .05). Multiple single cannulation technique could effectively reduce the incidence of complications of arteriovenous fistula, improve the success rate of cannulation, prolong the life span of arteriovenous fistula, and prolong the survival cycle of hemodialysis patients.

The effect of virtual reality glasses on pain and patient satisfaction in arteriovenous fistula cannulation procedure

AimsTo determine the effect of virtual reality glasses intervention on pain, vital signs, and patient satisfaction of hemodialysis patients undergoing AVF catheter puncture. DesignRandomized controlled study. MethodsThe study was conducted in 60 patients receiving dialysis treatment in the HD unit of a public hospital in Turkey. The data were collected via the “Patient Identification Form”, “Visual Analog Scale/VAS” and “Hemodynamics Variables Inspection Form”. The patients in the experiment group watched videos through the virtual reality glasses for totally 5 minutes in average, 2 minutes before the AVF cannulation process and 3 minutes during the process. No intervention was applied to the patients in the control group other than the normal nursing interventions in the HD unit. ResultsIn the intra-group comparisons, the 2nd and 3rd measurement average pain level scores of the patients with in the experimental group were determined to be statistically significantly lower compared to their 1st measurement (p < 0.05); the 3rd measurement average pain level scores of the control group were determined to be statistically significantly lower compared to their 1st and 2nd measurements (p < 0.05). ConclusionsIt was determined that the virtual reality glasses decreased the pain that emerges during the AVF cannulation process and increased the patient satisfaction level. It is suggested that the virtual reality glasses should be used by the nurses in the HD unit since it is easily applicable in coping with pain in the patients and since it is an invasive method.

Pain management associated with arteriovenous fistula cannulation among children undergoing haemodialysis: Systematic review.

To evaluate studies related to pain management associated with arteriovenous fistula cannulation among children. The systematic review comprised literature search on Embase, ProQuest, Science Direct, Scopus, SpringerLink and Wiley Online databases for studies published in English between 1998 and 2021. The search used key words, including pain management OR analgesia AND child OR paediatric AND haemodialysis OR dialysis AND arteriovenous fistula OR arteriovenous fistula cannulation OR fistula needle OR arteriovenous fistula insertion OR needle insertion. The quality of the studies was evaluated using the Joana Briggs Institute checklist. General characteristics of the and pain outcomes were noted. Of the 2,877 studies initially identified, 8(0.27%) were analysed; 7(87.5%) quasi-experimental and 1(12.5%) randomised controlled trial. Overall, there were 283 participants aged 6-18 years. The strategies used for reducing arteriovenous fistula puncture-related pain among children undergoing haemodialysis included cryotherapy, lidocaine agents, virtual reality (VR), guided visualisation, balloon inflation, aromatherapy, and other programmed distractions. The strategies had a positive effect on reducing arteriovenous fistula cannulation-related pain among children. Non-pharmacological pain management is an easier, simpler, inexpensive and more effective method of atraumatic care among children undergoing haemodialysis.

Nurse-assisted arterio-venous fistula cannulation during home hemodialysis: first results of the DIADIDEAL study

We have launched a pilot study, called DIADIDEAL, to propose nurse-assistance at home for arterio-venous fistula (AVF) cannulation in home hemodialysis (HHD) patients. The aim of the present study was to describe enrollment of the patients and their nurses. All prevalent HD patients on 30th November 2018 with no medical contraindication to HDD treatment and all incident patients on dialysis from the 30th November 2018 to the 21st April 2023 were eligible. Among 155 prevalent HD patients, 4 patients were included. Among the 276 incident patients on dialysis during the study period, 6 were included. We have phoned 23 nurse centers during the recruitment period. Eight of them agreed to learn in our unit how to cannulate AVF; 27 private nurses were enrolled. The results of the DIADIDEAL study will be available in 2024; we hope it will lead to a reimbursement of nurse-AVF cannulation at home in HDD.

Barriers and facilitators to vascular access point-of-care ultrasound in haemodialysis: An international survey of haemodialysis clinicians.

Utilising point-of-care ultrasound for assessment and cannulation of vascular access in people receiving haemodialysis has shown positive clinical results. Nonetheless, there is variation in how renal health care professionals worldwide embrace this method, and there's a lack of research on the factors that promote or hinder its adoption. To explore regional differences, and barriers and facilitators, to the use of point-of-care ultrasound for assessment and cannulation of vascular access in haemodialysis. Exploratory descriptive cross-sectional web-based survey. Healthcare clinicians working in haemodialysis responsible for cannulation of arteriovenous fistula or grafts. The survey was completed by 645 health care clinicians from 38 countries. 75% to 93% of respondents from Australia/New Zealand, Canada, Europe and United Kingdom/Ireland reported access to ultrasound, compared to 26% (n = 43/167) from the United States. United States respondent's reported lower levels of ultrasound training than other regions. Facilitators for using ultrasound were: the availability of ultrasound training (87%, n = 558), to reduce miscannulations (76%, n = 255/336) and to improve patient outcomes (73%, n = 246/336). Point-of-care ultrasound barriers were lack of access to ultrasound education (82%, n = 196/239), lack of ultrasound machines (33%, n = 212/645) or believing that ultrasound was someone else's role (38%, n = 29/86). This study revealed national and regional differences related to haemodialysis point-of-care ultrasound. Understanding the regions requiring more education and implementation of ultrasound and what motivates staff, or deters from using ultrasound, is crucial for effectiveness of future implementation and workplace change initiatives.

A STUDY TO ASSESS THE EFFECT OF CRYOTHERAPY ON PAIN AND SELECTED BIOPHYSIOLOGICAL PARAMETERS DURING ARTERIOVENOUS FISTULA CANNULATION AMONG PATIENTS ON MAINTENANCE HAEMODIALYSIS

The current study entitled a study to assess the effect of Cryotherapy on pain and selected Biophysiological parameters during arteriovenous fistula cannulation among patients on maintenance Hemodialysis at KMCH, Coimbatore was undertaken, during the year 2010 - 2011 in partial fulfillment of the requirement for the degree of Master of Science in Nursing at KMCH College of Nursing, Coimbatore which is affiliated to Dr. M.G.R. Medical University, Chennai. Objectives: To assess the pain intensity during Xylocaine infiltration. To determine the effect of Cryotherapy on pain and Biophysiological parameters during AV fistula cannulation. To associate the level of pain with selected demographic variables. Design: Repeated Measures design. Setting: Hemodialysis unit of Kovai Medical Center and Hospital, Coimbatore. Sample: Sample size was 50. Conceptual framework: Modified Orlando‟s Nursing process model. Outcome measures: The demographic data was collected from the subjects. The pain intensity was measured during cannulation with Xylocaine and with Cryotherapy using Numerical Pain rating Scale. The investigator recorded the Biophysiological parameters during the procedure. Intervention: Cold application was done prior and during cannulation over on the web between the thumb and index finger of the hand which does not have the AV fistula. Results: The mean pain score with Xylocaine infiltration at arterial site was 4.81 and at the venous site was 4.86.There was a significant reduction in the pain score during cannulation with the application of Cryotherapy. The mean pain score during cannulation after Xylocaine at the arterial site was 1.59 and at the venous site was 1.51 whereas the mean pain score during cannulation after Cryotherapy was 0.96 and 0.92 correspondingly. But there was no statistically significant difference between the values of Biophysiological parameters such as BP, PR and RR during cannulation done with Xylocaine and with Cryotherapy. There was no significant association between pain score and age and gender of the subjects but there was significant association between pain and duration of illness and duration of treatment Conclusion: Cryotherapy is an effective nonpharmacological measure in reducing pain during AV fistula cannulation among Hemodialysis patients.

Effect of needles distance of arteriovenous fistula cannulation on hemodialysis adequacy based on KT/V: a randomized controlled trial.

This study aims to assess the effect of needle distance of arteriovenous fistula (AVF) cannulation on haemodialysis adequacy based on KT/V. This study was a parallel-group, randomized controlled trial. Patients who met the inclusion criteria were divided into two groups with 3 and 6cm needle distances using block randomization. Data acquisition transpired through a comprehensive checklist encompassing demographic variables such as age and sex, alongside clinical metrics comprising actual weight, dry weight, average dialysis duration, fistula longevity, and KT/V rate. A total of 42 haemodialysis patients were enroled in this investigation, with 21 allocated to the 3cm needle distance group and another 21 to the 6cm needle distance group. The mean post-haemodialysis KT/V values for the 3cm and 6cm needle distance groups were 1.25 (SD=0.25) and 1.42 (SD=0.24), respectively, demonstrating a statistically significant difference (P<0.001). While there was no significant difference in the average pre-haemodialysis and post-haemodialysis KT/V values within the 3cm needle distance group (t=1.93, P=0.068), the corresponding values for the 6cm needle distance group exhibited a notable discrepancy (t=9.66, P<0.001). In general, a needle distance of 6cm between arteriovenous points yielded superior enhancements in dialysis adequacy compared to a 3cm needle distance following haemodialysis. Consequently, health administrators and policymakers may consider instituting efficacious interventions to scrutinize the care and therapeutic protocols for haemodialysis patients, involving the development of policies and applications.

Effects of virtual reality on pain induced by arteriovenous fistula needle insertion in patients undergoing hemodialysis: A randomized clinical trial.

Chronic kidney disease (CKD) is characterized by irreversible damage to renal function. For patients undergoing replacement therapies like hemodialysis (HD), the pain caused by arteriovenous fistula (AVF) cannulation becomes a significant aspect of their daily lives. This study aimed to examine the impact of virtual reality (VR) distraction techniques on the pain experienced during AVF needle insertion in patients undergoing HD. This randomized clinical trial (RCT) recruited a total of 60 patients undergoing HD from the 9 Dey Hospital in Torbat Heydariyeh, Iran, between March and August 2022. These patients were then divided into two groups: the intervention group and the control group. The intervention group received distraction techniques using the Shinecon 4th Gen Virtual Reality Headset, while the control group received routine care services. To assess the level of pain experienced during AVF cannulation, the Visual Analog Scale (VAS) was utilized. The collected data were analyzed using SPSS20. Various statistical tests, including the Chi-square test, Mann-Whitney U test, Multiple linear regression, and independent-samples t-test, were employed for data analysis. Additionally, Cohen's d was used to determine the effect size of the intervention. The analysis of the data revealed a statistically significant difference in the mean (SD) pain scores between the control group (7.6 ± 0.8) and the intervention group (5.1 ± 0.9) (p < 0.002 after Bonferroni correction). Furthermore, it was observed that a majority of patients in the intervention group reported experiencing moderate pain, whereas the control group experienced more severe pain. The study findings demonstrated that the use of virtual reality (VR) was effective in reducing the intensity of pain experienced during AVF needle insertion in patients undergoing HD. Based on these results, it is recommended to incorporate VR as a routine practice in the HD department of the hospital. This study, with the code no. IRCT20180429039463N3, was registered on the Iranian Registry of Clinical Trials on 28/03/2022.

The effect of cold packs, lidocaine spray, and flashlights on cannulation pain in patients undergoing hemodialysis: a randomized controlled trial

BackgroundPain is a frequent and critical problem in daily hemodialysis practice. The pain experienced during arteriovenous fistula cannulation varies from 12% to even 80% in hemodialysis patients depending on the pain assessment tools used. Pain can lead to sleep problems, decreased compliance with hemodialysis therapy, frequent hospital hospitalizations, a decline in quality of life, and high death rates. Despite utilizing several methods as pain relief, it is still unknown in the literature and practice which method is the most effective. The purpose of the study was to compare the effect of lidocaine spray, cold packs, and flashlights on the pain induced by arteriovenous cannulation in hemodialysis patients. This was a prospective randomized open-label controlled trial. Hundred and eight adult patients on regular hemodialysis were recruited and simply randomized into one of four groups (lidocaine spray, cold packs, flashlights, and control) before cannulation.ResultsThe mean pain severity using visual analog scale was 4.3 (3.3–5.7) in lidocaine group, 4 (3–5.7) in cold packs group, 4.3 (3.3–5.3) in flashlight group, and 4.7 (3–6) in control group. There was a borderline significant difference between groups using Kruskal–Wallis test (p = 0.054). The post hoc Tukey test showed that only cold packs differ from control group with borderline significance (p = 0.051).ConclusionThe results showed that cold packs were safe and effective than lidocaine spray or flashlights in reducing cannulation pain. It is suggested to implement this method before cannulation in hemodialysis patients to reduce pain and improve quality of life. Future studies are needed to compare different application times of cold packs and its impact on pain scores to recommend the optimum time needed to achieve maximum analgesic effect.Trail registration: Clinical trials.gov NCT05822063, REC #194.Graphical abstract

Infectious complications associated with buttonhole cannulation of native arteriovenous fistulas: a 22-year follow-up.

Buttonhole (BH) cannulation of native arteriovenous fistulas (AVFs) appears to be associated with an increased infectious risk. We previously reported a dramatic increase in the incidence of infectious events (IE) after shift to the BH technique in an in-center hemodialysis unit, which was largely reduced after staff (re)education regarding strict respect of the procedure. We assessed the evolution over the following 12-year period in our center. In this prospective follow-up of a previous, pre [rope-ladder (RL)]-post (BH) comparison (2001-10), all in-center hemodialysis patients with a native AVF were included from 1 July 2010 to 31 December 2022. Primary and secondary outcomes were IE (unexplained bacteremia due to skin bacteria and/or local AVF infection) and complicated IE (metastatic infection, AVF surgery, death). Overall, the impact of several quality improvement strategies was tested according to the events rate over six periods: Period 1: RL in all; Period 2: switch to BH; Period 3: BH in all, before workshops; Period 4: BH in all, after workshops; Period 5: BH withdrawal in problematic AVFs; Period 6: additional procedural changes. This extended observation period allowed the addition of 195180 AVF-days to our previous report. Overall, 381661 AVF-days (366 AVFs, 345 patients) were analysed. After an increase of the IE rate in 2012, the shift to RL in problematic AVFs during Period 5 did not have a significant impact. The incidence of IE decrease significantly during Period 6 compared with Periods 3, 4 and 5 {incidence rate ratio (IRR) 0.24 [95% confidence interval (CI) 0.09-0.52], P=.0001, IRR 0.22 (95% CI 0.09-0.47), P<.0001 and IRR 0.29 (95% CI 0.11-0.66), P=.001, respectively}, and became eventually for the first time comparable to Period 1 [IRR 0.59 (95% CI 0.21-1.62), P=.27]. The constant observance of reinforced hygiene protocols by trained staff and central coordination succeeded in significantly mitigating the infectious risk associated with buttonhole cannulation.

Hypnotherapy Intervention on Pain Scale Level of Arteriovenous Fistula Cannulation in Haemodialysis Patients with Chronic Renal Failure

This study aims to determine the effectiveness of hypnotherapy intervention on the level of pain scale of arteriovenous fistula cannulation installation in haemodialysis patients with chronic renal failure. This research method is quasi experimental (one pre-post group desaign). The sample of this study was chronic renal failure patients in arteriovenous fistula cannulation access insertion totalling 45 respondents using total sampling technique. The results obtained before hypnotherapy were 11 respondents (24.4%) experienced a mild pain scale level response, 34 people (75.66%) experienced a moderate pain scale level response while after hypnotherapy intervention showed all 45 respondents (100%) with a mild pain scale with a P value of 0.000 (α &lt;0.05). In conclusion, hypnotherapy intervention can significantly reduce or eliminate pain during arteriovenous fistula cannulation in haemodialysis

Investigation of the effect of breathing exercise on invasive pain associated with arteriovenous fistula cannulation in hemodialysis patients: Randomized controlled, single-blind study.

Pain due to puncture during arteriovenous fistula (AVF) cannulation is a very important symptom that affects the quality of life in patients undergoing continuous hemodialysis (HD) therapy. The aim in this study is to examine the effect of breathing exercise applied for long-term on invasive pain experienced during AVF cannulation in HD patients. This randomized controlled, single-blind design study was conducted in a private dialysis center in Istanbul between November 2021 and April 2022. The patients in the intervention group were given breathing exercises before fistula cannulation during 12 HD sessions. Before the dialysis nurse performed the cannulation procedure, the patient was told by the researcher to perform breathing exercises and the exercise was completed after intervention for the cannulation. No intervention was made for the patients in the control group. Pain was assessed with the Visual Analog Scale (VAS) by a nurse who is not involved in the study. Mann-Whitney U Test, Chi-Square Test, Fisher's Exact Test, Friedman Test for repeated measurements were used in statistical analysis of data. The study was completed with a total of 112 patients, 59 in the intervention group and 53 in the control group. It was determined that the VAS scores of the patients in the intervention group were statistically significantly lower than the patients in the control group from the first measurement to the twelfth measurement (p < 0.001). It was determined that the breathing exercise applied before the AVF cannulation reduced the invasive pain experienced during cannulation.

Skin pigmentation as landmark for arteriovenous fistula cannulation in hemodialysis.

The cannulation of the arteriovenous fistula (AVF) for hemodialysis (HD) has traditionally depended on the nurse's tactile sensation, which has been associated with suboptimal needle placement and detrimental effects on vascular access (VA) longevity. While the introduction of ultrasound (US) has proven beneficial in mapping the AVF outflow vein and assisting in cannulation planning, aneurysmal deformations remain a common occurrence resulting from various factors, including inadequate cannulation techniques. Within this context, the utilization of skin pigmentation as a clinical landmark has emerged as a potential approach to enhance cannulation planning in HD. A prospective longitudinal study was undertaken to investigate the correlation between the occurrence of venous morphological deformations and the cannulation technique guided by skin pigmentation after a 2-month period of implementation. Thirty patients were enrolled in the study with 433 cannulations being described within the first 2 months of AVF use. The overall rate of cannulation-related adverse events was 21.9%. Comparative analysis demonstrated a statistically significant relationship (p < 0.001) between aneurysmal deformation and non-compliance with the proposed cannulation technique, resulting in cannulation outside the designated points. Non-compliance was primarily attributed to nurse's decision (57.1%). The integration of US mapping of the AVF outflow vein and the utilization of skin pigmentation as a guiding tool have shown promising results in enhancing cannulation planning over time. Consistent adherence to a cannulation technique other than the area technique has been found to reduce the risk of AVF morphological deformation. These findings underscore the potential benefits of incorporating skin pigmentation as a clinical landmark in cannulation practices, highlighting its ability to impact positively cannulation outcomes.

Early Follow-Up after Arteriovenous Fistula Creation is Associated with Improved Access-Related Outcomes

Up to 60% of arteriovenous fistulas (AVF) require intervention to assist maturation, which prolongs the time until it can be used for hemodialysis (HD). Current guidelines recommend early postoperative AVF examination to detect and address immaturity to decrease time to maturation. This study evaluates how the timing of postoperative follow-up to assess AVF maturity affects patients' outcomes. All patients who underwent AVF creation between 2017 and 2021 in an academic medical center were retrospectively reviewed, excluding patients lost to follow-up or not on HD. Outcomes were compared between patients that had delayed follow-up to assess AVF maturity, >8 weeks post-surgery, versus early follow-up, <8 weeks post-surgery. AVF evaluation for maturity consisted of physical exam and duplex ultrasound. Primary endpoints were time to first cannulation (interval from AVF creation to first successful cannulation) and time to catheter-free dialysis (interval from AVF creation to central venous catheter removal). A total of 400 patients were identified: 111 in the delayed follow-up group and 289 in the early follow-up group. The median time to follow-up was 78 days (IQR 66-125) in the delayed follow-up group vs. 39 days (IQR 36-47) in the early follow-up group, (p<0.0001). The maturation rate was 87% in the delayed follow-up group vs. 81% in the early follow-up group, (p=0.1) and both groups had similar rates of interventions to assist maturation (66% vs. 57%, p=0.2). The early follow-up group had a significantly shorter median time to first cannulation (50 vs. 88 days, p<0.0001) and shorter time to catheter-free HD (75 vs. 118 days, <0.0001). At 4 months after AVF creation, the incidence of first cannulation was 74% in the early follow-up group vs 63% in the delayed follow-up group (p=0.001). Similarly, the incidence of catheter-free dialysis was 65% in the early follow-up group vs. 50% in the delayed follow-up group at 4 months postoperatively, (p = 0.036). Early post-operative follow up for evaluation of fistula maturation with is associated with reduced time to first successful cannulation of AVF for hemodialysis, and reduced time to catheter-free dialysis.

High-Grade Staphylococcus lugdunensis Bacteremia in a Patient on Home Hemodialysis.

Staphylococcus lugdunensis (S lugdunensis) is a species of coagulase-negative Staphylococcus and a constituent of human skin flora. S lugdunensis has gained notoriety for its virulence, which resembles Staphylococcus aureus (S aureus). S lugdunensis is now recognized as an important nosocomial pathogen and cause of prosthetic device infections, including vascular catheter infections. A 60-year-old man with a history of uncontrolled type 2 diabetes mellitus and end-stage renal disease on home hemodialysis via arteriovenous fistula (AVF) presented to the emergency department for evaluation of subacute progressive low back pain. Initial laboratory tests were notable for elevated inflammatory markers. Magnetic resonance imaging with contrast of the thoracic and lumbar spine revealed abnormal marrow edema in the T11-T12 vertebrae with abnormal fluid signal in the T11-T12 disc space. Cultures grew methicillin-sensitive S lugdunensis. The patient's antibiotic regimen was narrowed to IV oxacillin. He was transitioned to IV cefazolin dosed 3 times weekly after hemodialysis and an outpatient dialysis center. Treatment of bacteremia caused by S lugdunensis or S aureus should be managed with prompt initiation of IV antistaphylococcal therapy, a thorough evaluation for the source of bacteremia as well as metastatic complications, and consultation with an infectious disease specialist. This case highlights AVF as a potential source for infection even without localized signs of infection. The buttonhole method of AVF cannulation was thought to be a major contributor to the development and persistence of our patient's bacteremia. This risk should be discussed with patients using a shared decision-making approach when developing a dialysis treatment plan.

The effect of using vapocoolant spray for pain reduction in arteriovenous fistula cannulation among patients undergoing hemodialysis: A randomized control trial

AimThe aim of this study was to assess the effects of alkane vapocoolant spray in reducing pain during arteriovenous access cannulation in adult patients undergoing hemodialysis. BackgroundDeveloping and applying various approaches for pain relief remain important responsibility for nurses. MethodsThis study was designed as an experimental study with a cross-over design. Thirty-eight patients on hemodialysis volunteered to undergo cannulation of their arteriovenous access, after the application of vapocoolant or placebo spray or no intervention. Subjective and objective pain levels were assessed, along with various physiological parameters pre- and post-cannulation. ResultsStatistically significant between-group differences were observed in subjective pain at the venous (F = 4.97, p = 0.009) and arterial (F = 6.91, p = 0.001) puncture sites. The mean arterial site subjective pain scores were 4.45 ± 1.31 (no treatment), 4.04 ± 1.82 (placebo), and 2.98 ± 1.53 (vapocoolant spray). Significant between-group differences were observed in objective pain scores during arteriovenous fistula puncture (F = 5.13, p = 0.007). The mean objective pain scores after arteriovenous fistula puncture were 3.25 ± 2.66 (no treatment), 2.17 ± 1.76 (placebo), and 1.78 ± 1.66 (vapocoolant spray). Post-hoc test results indicated vapocoolant spray application was associated with significantly lower pain scores than no treatment or placebo. Patient blood pressure and heart rate recordings did not differ among the interventions. ConclusionVapocoolant application was significantly more effective than the placebo or no treatment in reducing the pain of cannulation in adult patients undergoing hemodialysis.