Rui Pinto, João Barros, Ricardo Ferreira, Pedro Alves, Rui Sousa, Liliana Oliveira, Lénia Pereira, Ana Luísa Correia, Ana Rita Silva, Andreia Henriques, Magda Guerra, Fernando Mata, Anabela Salgueiro, Isabel Fernandes, Rui Alves, Clemente Sousa
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Abstract
Background: The success of haemodialysis (HD) critically depends on the effective use of arteriovenous fistulas (AVFs). The precise needling technique is vital to minimise complications and ensure functional vascular access.
Objective: This study assesses the effectiveness of a nursing consultation protocol, which integrates physical examination (PE) with Doppler Ultrasound (DUS), in preparing patients for the first AVF needling.
Design/participants: A cross-sectional analysis at a Portuguese National Health Service Hospital engaged thirty new HD patients, four HD needling experienced nurses and one HD vascular access nurse. This study examines the accuracy of PE in assessing the matured AVF by the four nurses compared to a trained vascular access nurse encompassing systematic PE and DUS.
Measurements: The primary data incorporated AVF characteristics derived from PE (inspection, palpation, and auscultation) and DUS findings (vein depth, diameter, and blood flow). A secondary focus was evaluating the change in nurses' perceived needling complexity following the nursing consultation.
Results: The nursing consultation significantly enhanced the identification of crucial AVF features, such as accessory veins (p = 0.002), and improved the accuracy of AVF morphology assessments. This led to identifying longer needling tracks (p = 0.031) and a higher number of safe needling points (p = 0.016). Nurses reported a notable reduction in perceived complexity and potential adverse events following this method (p = 0.027).
Conclusions: Integrating structured PE with DUS in a nursing consultation framework significantly improves the preparation for AVF needling. This approach enhances the efficiency and safety of AVF needling and boosts nurse confidence and patient care in HD settings.
背景：血液透析（HD）的成功与否关键取决于动静脉瘘（AVF）的有效使用。精确的针刺技术对减少并发症和确保功能性血管通路至关重要：本研究评估了将体格检查（PE）与多普勒超声检查（DUS）相结合的护理咨询方案在帮助患者做好首次动静脉瘘针刺准备方面的有效性：在葡萄牙国家医疗服务医院进行的横断面分析中，有 30 名 HD 新患者、4 名有 HD 针刺经验的护士和 1 名 HD 血管通路护士参与。本研究考察了四名护士与一名训练有素的血管通路护士（包括系统 PE 和 DUS）相比，PE 评估成熟 AVF 的准确性：主要数据包括通过 PE（检查、触诊和听诊）和 DUS 发现（静脉深度、直径和血流量）得出的动静脉瘘特征。次要重点是评估护理咨询后护士感知到的针刺复杂性的变化：结果：护理咨询大大提高了对重要动静脉瘘特征（如附属静脉）的识别能力（p = 0.002），并提高了动静脉瘘形态评估的准确性。这有助于确定更长的针刺路径（p = 0.031）和更多的安全针刺点（p = 0.016）。护士们报告称，采用这种方法后，她们感觉到的复杂性和潜在不良事件明显减少（p = 0.027）：结论：在护理咨询框架中将结构化 PE 与 DUS 相结合，可显著改善动静脉瘘针刺的准备工作。这种方法提高了动静脉瘘针刺的效率和安全性，增强了护士的信心，加强了在 HD 环境中对患者的护理。
期刊介绍：
The Journal of Renal Care (JORC), formally EDTNA/ERCA Journal, is the official publication of the European Dialysis and Transplant Nursing Association/European Renal Care Association (EDTNA/ERCA).
The Journal of Renal Care is an international peer-reviewed journal for the multi-professional health care team caring for people with kidney disease and those who research this specialised area of health care. Kidney disease is a chronic illness with four basic treatments: haemodialysis, peritoneal dialysis conservative management and transplantation, which includes emptive transplantation, living donor & cadavaric transplantation. The continuous world-wide increase of people with chronic kidney disease (CKD) means that research and shared knowledge into the causes and treatment is vital to delay the progression of CKD and to improve treatments and the care given.
The Journal of Renal Care is an important journal for all health-care professionals working in this and associated conditions, such as diabetes and cardio-vascular disease amongst others. It covers the trajectory of the disease from the first diagnosis to palliative care and includes acute renal injury. The Journal of Renal Care accepts that kidney disease affects not only the patients but also their families and significant others and provides a forum for both the psycho-social and physiological aspects of the disease.
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