Fistula Puncture Research Articles

RETRACTION: Effect of two different techniques of arteriovenous fistula puncture on wound infection in haemodialysis patients.

Retraction: Y. Yao, H. Mao, Z. Du, and J. Liu, "Effect of Two Different Techniques of Arteriovenous Fistula Puncture on Wound Infection in Haemodialysis Patients," International Wound Journal 21, no. 3 (2024): e14659, https://doi.org/10.1111/iwj.14659. The above article, published online on 26 February 2024, in Wiley Online Library (http://onlinelibrary.wiley.com/), has been retracted by agreement between the journal Editor in Chief, Professor Keith Harding; and John Wiley & Sons, Ltd. It came to the publisher's attention from a third party that a number of articles shared concerning similarities in format and structure. Following an investigation by the publisher, the retraction has been agreed on as the peer review and publishing process for this article were found to be manipulated. The authors did not respond to the notice of retraction.

The effect of virtual reality distraction on haemodialysis patients' pain and anxiety during arteriovenous fistula puncture: a randomised controlled trial.

Pain and anxiety during arteriovenous fistula (AVF) puncture are crucial factors affecting haemodialysis (HD) patients' quality of life. The aim of this study is to assess the effect of virtual reality (VR) distraction on pain, anxiety, satisfaction and haemodynamics during AVF puncture. This randomised controlled trial study was conducted in a Haemodialysis unit at Mansoura University Hospital. Ninety-six patients were randomly divided into the intervention (n = 48) and control (n = 48) groups. Six minutes prior to the puncture, patients in the intervention group used VR glasses to experience a 360° 'Relax River VR tour', whereas patients in the control group received no intervention. Following the intervention, pain, anxiety, systolic blood pressure and heart rate were significantly lower, and satisfaction scores were significantly higher in the intervention group than in the control group (p < 0.05). VR distraction may help alleviate pain, anxiety and increase satisfaction. It may be considered a safe and cost-effective non-pharmacological therapy for HD patients undergoing AVF puncture.

Commentary: The effect of virtual reality distraction on haemodialysis patients' pain and anxiety during arteriovenous fistula puncture: a randomised controlled trial.

Commentary: The effect of virtual reality distraction on haemodialysis patients' pain and anxiety during arteriovenous fistula puncture: a randomised controlled trial.

To assess the effectiveness of cryotherapy on pain level related to AV fistula puncture among haemodialysis patients at selected hospital of Kalaburagi

To assess the effectiveness of cryotherapy on pain level related to AV fistula puncture among haemodialysis patients at selected hospital of Kalaburagi

Pengaruh Kombinasi Slow Deep Breathing dan Cryotherapy terhadap Nyeri Akibat Tusukan Fistula Arteriovenosa Pada Pasien Hemodialisis: Case Report

A problem often experienced by hemodialysis patients is pain when puncturing an arteriovenous fistula. Hemodialysis patients with AVFs experience an average of ten AVF punctures every month, lasting their entire lives. Persistent pain can negatively affect a patient's health, functional ability, and quality of life. This research uses a Case Report approach with nursing care. The intervention was carried out on a scale with structured data collection using the Numeric Scale Rating. The aim of this study was to examine the effect of a combination of slow deep breathing and cryotherapy on arteriovenous fistula puncture. This case study carried out data collection through interviews, intervention, evaluation and documentation. The results of this case study showed that the combination of Slow Deep Breathing and Cryotherapy was effective in reducing pain due to AV fistula puncture in hemodialysis patients. Before the intervention was carried out, the pain scale for both respondents was 6 (moderate pain), but after the intervention with Slow Deep Breathing and Cryotherapy for 4 sessions for 15 minutes, the pain scale decreased to 2 (mild pain).

Using cryotherapy, EMLA (eutectic lidocaine/prilocaine) cream, or lidocaine spray to reduce pain during arteriovenous fistula puncture: A randomized controlled trial.

In hemodialysis patients, pain associated with needle insertion into an arteriovenous fistula is a physical and psychological problem. The aim of this study was to assess the effectiveness of pre-puncture application of an ice pack, EMLA cream, or lidocaine spray to reduce pain associated with access puncture. This was a multicenter study done in nine hemodialysis centers in Iraq. The study utilized a randomized, parallel-group design, in which patients being dialyzed using an arteriovenous access were allocated into one of four groups. Access puncture was preceded by nothing (control group), by use of ice pack cooling at the puncture site, by application of EMLA cream, or by application of lidocaine spray. Pain after access puncture was assessed during a single treatment for each patient. Pain was quantified using a Visual Analogue Scale. A total of 1548 patients agreed to participate, and 1041 patients were included in the data analysis. Use of an ice pack, EMLA cream, or lidocaine spray each was associated with a lower pain score on access puncture compared with no pretreatment. The mean Visual Analogue Scores in the four groups were: 69.7 ± 15.7 in the controls, 39.8 ± 13.2 in the ice pack group, 45 ± 18.4 in the EMLA group, and 52.9 ± 15.2 in lidocaine group. Ranking of the pain severity scores suggested that ice pack use was associated with the least pain, followed by use of EMLA cream and use of lidocaine spray (severity score ranking, from lowest to highest, being 1.62, 2.18, and 2.63, respectively). Application of an ice pack prior to vascular access puncture is a fast and inexpensive technique to limit pain associated with this procedure.

Impacts of continuous quality improvement on wound pain in the puncture site of arteriovenous fistula in haemodialysis patient.

This study analyses the effects of a continuous quality improvement nursing model on wound pain at the arteriovenous fistula (AVF) puncture site in patients undergoing haemodialysis. Forty haemodialysis patients from the First Affiliated Hospital of Chongqing Medical University, from September 2020 to December 2022, were selected as study subjects. They were randomly divided into an observation group and a control group. The control group received conventional nursing care, while the observation group was treated with a continuous quality improvement nursing model. The study compared the impact of these nursing approaches on pain intensity post-AVF puncture, wound visual analogue scale scores, self-rating anxiety scale, self-rating depression scale, quality of life scores and patient satisfaction with nursing care. In the observation group, the proportion of patients experiencing moderate to severe pain during AVF puncture was lower than that in the control group, whereas the proportion of patients with no pain or mild pain was higher (P = 0.008). After nursing, the observation group exhibited significantly lower wound visual analogue scale scores, self-rating anxiety scale scores, and self-rating depression scale scores compared to the control group (P < 0.001), with a significantly higher quality of life score (P < 0.05). The nursing satisfaction rate was 95.00% in the observation group, significantly higher than the 65.00% in the control group (P = 0.018). The continuous quality improvement nursing model significantly reduces wound pain at the AVF puncture site in haemodialysis patients, alleviates negative emotions, enhances the quality of life, and achieves high patient satisfaction. It is thus a highly recommendable approach in nursing practice.

Effect of two different techniques of arteriovenous fistula puncture on wound infection in haemodialysis patients.

Safe and effective arteriovenous fistula (AVF) puncture is very important to reduce the wound complications of haemodialysis (HD). For AVF puncture in dialysis patients, there is a lack of clarity and consistency regarding the relative advantage of buttonhole (BH) over rope-ladder (RL) cannulae in terms of wound complications. The study was published in several scientific databases including Cochrane Library, PubMed and Embase by October 2023. Data from all controlled trials looking at the effect of BH and RL on wound complications in haemodialysis patients were included. The articles were written in English, and they were about adult who had AVF while on dialysis. Studies with or without BH or RL treatment were excluded from the analysis. The data was analysed with RevMan5.3 software. Out of 215 trials, 9 were chosen for the final analysis. The study publication dates were between 2000 and 2023. Of these, 17 326 patients received AVF therapy. Among them, there were 3070 BH and 14 256 RL. In 9 studies, RL had a lower risk of postoperative wound infection compared to BH (OR, 3.38; 95% CI, 3.06, 3.73 p < 0.0001); In all 3 studies, there were no statistically significant differences in the risk of post operative bleeding in RL versus BH(OR, 0.76; 95% CI, 0.25, 2.33 p = 0.63). Our studies have demonstrated that RL trocars are superior to BH trocars in the prevention of wound infection.

Compliance with good practice guidelines for the prevention of vascular access infections: the multi-centre PHYDEL survey in French haemodialysis units

French guidelines for the prevention of vascular access infections in a haemodialysis setting were released in 2005. Compliance with these guidelines is currently unknown. The aim of this study was to assess compliance with the guidelines for vascular access infection prevention in French haemodialysis units, and to describe the difficulties reported. A cross-sectional survey was conducted between March and December 2019 in 200 haemodialysis units in France, selected at random. Data were collected via questionnaire, completed by telephone interview with an infection control practitioner. A practice was deemed compliant when >85% of units declared that they always complied with the guidelines. In total, 103 units (51.5%) agreed to participate. Most practices complied with the guidelines; however, some practices did not reach the 85% compliance threshold for working in pairs when connecting central venous catheter (CVC) lines, performing hand hygiene before disconnecting lines, rinsing antiseptic soap before painting CVC exit site or arteriovenous fistula (AVF) puncture site, allowing antiseptic paint to dry, handling CVC branches with antiseptic impregnated gauze, performing hand hygiene after AVF compression with gloves, wearing protective eyewear when connecting/disconnecting CVC or when puncturing AVF, and wearing a gown when puncturing AVF. The most frequently reported difficulties were understaffing, difficulties with skin preparation because of exit site skin damage, and lack of buttonhole technical expertise. Despite good overall compliance, this survey highlights some shortcomings in compliance with infection prevention guidelines, which could be associated with either higher risk of vascular access infection or increased blood-borne virus transmission.

Evaluation of Pain Intensity Related to Arteriovenous Fistula Puncture among Hemodialysis Patients

Background: Pain associated with arteriovenous fistula puncture is a significant problem among hemodialysis patients. The process of needle insertion often causes considerable physical and psychological discomfort, leading to a decrease in perceived quality of life. Study Objective : Evaluate the level of pain experienced by hemodialysis patients due to arteriovenous fistula puncture. Methods and Materials: A cross-sectional study design was used, with a sample size of 40 patients under hemodialysis. The intensity of pain was measured for these patients during the needle insertion by means of a rating analogies scale. The selection of the study sample was done through a purposive sample from a hospital setting. Data collection was conducted using the rating analogies scale. Descriptive statistics were used to analyze the data on pain intensity. Results: The results showed that the intensity of pain ranged from moderate to severe. The discussion of the results focused on the implications of the findings for clinical practice and the need for further research in the area. The study highlighted the importance of considering the intensity of pain related to arteriovenous fistula puncture among hemodialysis patients, and the need for further research into interventions that can reduce the associated pain. Conclusion and Recommendations : Based on the results of the study, it can be concluded that arteriovenous fistula puncture causes moderate to severe pain in hemodialysis patients. Therefore, it is recommended that healthcare providers should take necessary measures to reduce the intensity of pain during the procedure. These measures may include the use of pain-relieving medications and other methods such as distraction , relaxation techniques and cryotherapy.

Impact of simulation-based training in addition to theoretical training versus theoretical training of nurses alone in the occurrence of adverse events related to arteriovenous fistula puncture in chronic hemodialysis patients: study for a cluster randomized controlled trial (SIMFAV2)

BackgroundThe technique of arteriovenous fistula (AVF) puncture is currently taught by colleagues within hemodialysis units. Even if the main principles of the technique are well known and common to all hemodialysis units, strong rationales are still missing to standardize fine practices such as the relative position of the needles, the angle of the needle at puncture, and the position of the bevel at the time of puncture and after the needle is in the vascular lumen.MethodsWe are conducting a prospective, comparative, center-randomized, multicenter study involving 8 hemodialysis centers. The primary objective is to compare the number of adverse events related to AVF puncture between a group receiving theoretical training plus simulation-based training (4 centers) and a group receiving only theoretical training (4 centers). The study will include all adult patients who are scheduled to have an AVF puncture performed by a hemodialysis-trained nurse during a scheduled chronic dialysis session.DiscussionWe hypothesize that a training program for nurses on the AVF approach in procedural simulation versus theoretical input alone would decrease the adverse events related to AVF punctures and would be beneficial for the patient. This study is innovative for several reasons. First, simulation-based training in continuing education among professionals is not widely used. Furthermore, training allows for the standardization of practices within the team, both technically and relationally.Trial registrationClinicalTrials.gov NCT05302505. Registered on March 17, 2022.

RDPLF 2022 annual report: Profile of home hemodialysis patients in Belgium and Francel (synthetic raw results)

We present primary descriptive data in the form of tables and graphs for patients treated with home hemodialysis in France and French-speaking Belgium in 2022. These data were recorded in the database of the French-speaking Register of Peritoneal Dialysis and Home Hemodialysis (RDPLF).&#x0D; The average age of the patients is similar in both countries: 52.7 years in France and 54.7 years in Belgium. The percentage of patients with diabetes is 25.6% in Belgium and 18.5% in France.&#x0D; The majority of patients undergo daily hemodialysis 5 to 7 times per week.&#x0D; Of the patients, 11% have received peritoneal dialysis in the past. Of these, 23.5% transitioned to home hemodialysis less than 3 months after stopping peritoneal dialysis, while 23.6% transitioned after 2 years of center-based or self-administered hemodialysis.&#x0D; Practices differ between Belgium and France. In Belgium, a central catheter is used in 57.5% of cases, compared to 8.5% in France. For arteriovenous fistula puncture, the buttonhole technique is used in 91% of cases in Belgium and 47.8% of cases in France.&#x0D; In Belgium, 70% of patients dialyze independently, while in France, 71% of patients dialyze in the presence of a family member.&#x0D; The main cause of treatment discontinuation is transplantation (44% of technical dropout).

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.

Effect of aromatherapy on quality of life in maintenance hemodialysis patients: a systematic review and meta-analysis

Objective Aromatherapy has been used for patients on maintenance hemodialysis (MHD), but the outcomes are still controversial. Thus, we conducted this study to systematically evaluate the effect of aromatherapy on the quality of life of patients on MHD. Methods We searched the PubMed, Embays, Scopus, Web of Science, and CNKI databases for randomized controlled trials that evaluated the use of aromatherapy in dialysis patients and reported at least one outcome of interest. Results Twenty-two relevant studies were included in the meta-analysis. The meta-analysis revealed that aromatherapy significantly increased subjective sleep quality (a lower score indicates better sleep quality) [standardized mean difference (SMD) = −1.52, 95% CI (−2.38, −0.67), p < 0.01] and reduced fatigue [SMD = −1.14, 95% CI (−1.95, −0.33), p = 0.01], anxiety [SMD = −1.38, 95% CI (−2.09, −0.67), p < 0.01], symptoms of restless legs syndrome [RLS; SMD = −1.71, 95% CI (−2.09, −1.33), p < 0.01], and arteriovenous fistula puncture pain [SMD= −1.56, 95% CI (−2.60, −0.52), p < 0.01]. Conclusions Aromatherapy may be used as a novel complementary and alternative therapy to improve sleep quality and reduce fatigue, anxiety, symptoms of RLS, and arteriovenous fistula puncture pain in patients on MHD.

Procedural simulation for nursing education

Simulation is an educational tool that allows, in initial and continuing education, the acquisition of gestures and procedures. The management of the vascular approach concerning the arteriovenous fistula is not yet standardized. Thus, the standardization of the fistula puncture technique, approached through simulation, could be part of an approach to optimizing practices and continuous improvement of care.

Knowledge of vascular access among hemodialysis unit nurses and its influencing factors: a cross-sectional study.

Nurses in hemodialysis (HD) units are the main performers in the maintenance and management of HD patients' vascular access, and the cognition degree of their specialized knowledge of vascular access directly affects the quality of vascular access management. However, most of the investigations on the cognition of vascular access knowledge take HD patients as the research subjects, while there are few studies on nurses in HD units as the research subjects. Herein, we explored the knowledge of vascular access among HD unit nurses and its influencing factors, aiming to inform the training of HD unit nurses on vascular access management. By using a convenience sampling method, we investigated the knowledge of vascular access in terms of basic knowledge, vascular access assessment and arteriovenous fistula (AVF) puncture technique knowledge of dialysis unit nurses who volunteered to engage in hemodialysis clinical nursing for more than 6 months in HD units in Sichuan Province from March 2022 to May 2022. Data were collected on demographic characteristics, hospital nature, the city and region where the hospital is located, the working time of hemodialysis. Analysis of variance was used to analyze the score of vascular access specialist knowledge of HD unit nurses, and multiple linear regression was used to explore the influencing factors of vascular access specialist knowledge of HD unit nurses. A total of 222 nurses in HD units were included. The total score of the knowledge of vascular access was 87.52±13.71 points, of which the basic knowledge scored 3.88±0.60 points, the vascular access assessment scored 3.62±0.65 points, and the AVF puncture techniques scored 3.22±0.71 points. Multiple linear regression analysis showed that longer working years [beta: 0.381, 95% confidence interval (CI): 3.064-7.188, P=0.000], more advanced training [beta: 0.206, 95% CI: 2.817-10.672, P=0.001], and public hospital [beta: 0.138, 95% CI: 0.839-12.342, P=0.025] positively predicted higher knowledge of vascular access scores among HD unit nurses (all P<0.05). The cognitive degree of vascular access specialized knowledge of hemodialysis nurses is affected by different working years, training experience and the nature of the hospital. Nursing managers can develop different training and assessment programs for vascular access specialized knowledge according to different influencing factors.

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.

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.

Evaluation of the pain scale during arteriovenous fistula puncture with and without lidocaine gel 2% in patients undergoing haemodialysis in Kosovo

Aimthis study aims to evaluate the pain scale during Arteriovenous fistula (AVF) puncture in patients undergoing regular haemodialysis sessions with and without Lidocaine gel 2%. MethodsThe study is Cross-Sectional, conducted at the University Clinical Centre of Kosovo - Clinic of Nephrology and Haemodialysis in Pristina, Regional Haemodialysis Centre in Prizren, Regional Haemodialysis Centre in Gjilan and Regional Haemodialysis Centre in Mitrovica, all in Kosovo. In this research, 616 patients were surveyed during AVF puncture and the other group of 232 patients in whom 2% Lidocaine gel was applied before puncture at the fistula puncture site. ResultsIn the above mentioned centres, the total number of patients who are on dialysis through AVF is 632, of which 324 men and 308 women. 560 patients had created AVF on the left arm and 72 patients on the right arm. In our research, 616 patients were surveyed, of which 312 men and 304 women. The most affected age group was between 60 and 69. The pain scale reported during AVF punctuation was moderate in 304 (49%) patients, severe in 176 patients (29%) and mild in 136 (22%) patients. After the applying of Lidocaine gel 2%, the puncture of AVF was performed, so from the total number of 232 participants, 64 (28%) of them reported moderate pain and 168 (72%) of research participants reported mild pain during puncture of AVF. In order to compare results from both groups, we have chosen a random sample from the first group during AVF punctuation without Lidocaine gel 2% (234 in total from 616 patients) and compared the result with the second group during AVF puncture with Lidocaine gel 2% (232 in total). ConclusionsThe average pain scale during AVF puncture without Lidocaine gel 2% was 5.04 while the average pain scale after applied Lidocaine gel 2% was 2.61.

Effect of Immersive Virtual Reality during Arteriovenous Fistula Puncture on Pain Intensity among Children Undergoing Hemodialysis in El Beheira Governorate

Effect of Immersive Virtual Reality during Arteriovenous Fistula Puncture on Pain Intensity among Children Undergoing Hemodialysis in El Beheira Governorate

Effect of Educational Guidelines on Nurses’ Performance related to Care of Arteriovenous Fistula Puncture for Children undergoing Hemodialysis

Effect of Educational Guidelines on Nurses’ Performance related to Care of Arteriovenous Fistula Puncture for Children undergoing Hemodialysis