Preconditions that facilitate cannulation in arteriovenous fistula: A mixed-methods study

Abstract

Background

Nurses have a great responsibility in the daily care of arteriovenous fistulae, which entails the potential to affect patency. However, good cannulation technique involves more than placing a needle in the vessel and relies on different skills to facilitate needling.

Objectives

To describe the preconditions for cannulation in arteriovenous fistulas.

Design

Descriptive statistics and qualitative content analysis were used in a mixed-methods design.

Participants

Haemodialysis units in Sweden.

Measurements

Local guidelines regarding arteriovenous fistula cannulation were analysed in parallel with responses to a questionnaire that contained open-ended and closed-ended questions on cannulation technique.

Results

Preconditions that facilitate cannulation fall into five stages, each with relevant factors in relation to the cannulation, as follows: planning cannulation—maturation and planning the cannulation, patient record, education and experience, and patient information; precannulation—physical examination, hygiene routines, arm position, tourniquet, choosing the cannulation site, and preventing pain; during cannulation—how to needle, type of needle, angle during cannulation, fixation, and adjusting; evaluating cannulation—blood flow rate and arterial and venous pressure; and postcannulation—needle withdrawal and haemostasis. The majority of dialysis units identified implementation of most of these preconditions, but the units handle several practical aspects differently.

Conclusions

Tracing the chain of cannulation led to identification of necessary preconditions for facilitating good cannulation technique. The findings also show the need for a better understanding of how different preconditions affect arteriovenous fistula and patency.