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      Variables associated with successful vascular access cannulation in hemodialysis patients: a prospective cohort study

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          Abstract

          Background

          Successful vascular access (VA) cannulation is integral to the delivery of adequate dialysis, highlighting the importance of ensuring the viability of arteriovenous access in hemodialysis (HD) patients. Missed VA cannulation can lead to infection, infiltration, hematoma or aneurysm formation resulting in the need for access revision, central venous catheter (CVC) placement, or permanent loss of VA. Cannulation-related complications can also negatively impact on a patient’s dialysis experience and quality of life. This study aimed to identify patient, VA and nurse factors associated with unsuccessful VA cannulations.

          Methods

          A prospective cohort study was conducted in HD patients with a permanent VA from three HD units. Data on patient, VA and nurse characteristics, plus, cannulation technique were collected for each episode of cannulation. General Estimating Equation was used to fit a repeated measures logistic regression to determine the odds of cannulation success.

          Results

          We collected data on 1946 episodes of cannulation (83.9% fistula) in 149 patients by 63 nurses. Cannulation included use of tourniquet (62.9%), ultrasound (4.1%) and was by rope ladder (73.8%) or area (24.7%) technique. The miscannulation rate was 4.4% ( n = 85) with a third of patients ( n = 47) having at least one episode of miscannulation. Extravasation ( n = 17, 0.9%) and use of an existing CVC ( n = 6, 0.6%) were rare. Multivariable characteristics of successful cannulation included fistula compared with graft [OR 4.38; 95%CI, 1.89–10.1]; older access [OR 1.68; 95%CI, 1.32–2.14]; absence of stent [OR 3.37; 95%CI, 1.39–8.19]; no ultrasound [OR 13.7; 95%CI, 6.52–28.6]; no tourniquet [OR 2.32; 95%CI, 1.15–4.66]; and lack of post graduate certificate in renal nursing [OR 2.27; 95%CI, 1.31–3.93].

          Conclusion

          This study demonstrated a low rate of miscannulation. Further research is required on ultrasound-guided cannulation. Identifying variables associated with successful cannulation may be used to develop a VA cannulation complexity instrument that could be utilised to match to the cannulation skill of a competency-assessed nurse, thereby minimising the risk of missed cannulation and trauma.

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          Most cited references 23

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          2005 Annual Report: ESRD Clinical Performance Measures Project.

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            Cumulative patency of contemporary fistulas versus grafts (2000-2010).

            Comparisons of fistulas and grafts often overlook the high primary failure rate of fistulas. This study compared cumulative patency (time from access creation to permanent failure) of fistulas and grafts.
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              Outcomes of arteriovenous fistula creation after the Fistula First Initiative.

              The arteriovenous fistula (AVF) is the preferred hemodialysis access, but AVF-failure rate is high, and complications from AVF placement are rarely reported. There is no clear consensus on predictors of AVF patency. This study determined AVF outcomes and patency predictors at Mayo Clinic Rochester following the Fistula First Initiative. A retrospective cohort study of AVFs placed at Mayo Clinic from January 2006 through December 2008 was performed. The AVF placement-associated primary and secondary failure rates, complications, interventions, and hospitalizations were examined. Kaplan-Meier survival curves and Cox proportional hazard models were used to determine primary and secondary patency and associated predictors. During this time frame, 317 AVFs were placed in 293 individual patients. The primary failure rate was 37.1% after excluding patients not initiated on hemodialysis during follow-up (n = 38) or those with indeterminate outcome (37 lost to follow-up; six died; two transplanted). Of usable AVFs, 11.4% later failed. AVF creation incurred complications and hospitalization in 21.2% and 12.3% of patients, respectively. The risk for reduced primary patency was increased by diabetes (HR, 1.54; 95% CI, 1.14 to 2.07); the risk for reduced primary and secondary patency was decreased with larger arteries (HR, 0.83; 95% CI, 0.73 to 0.94; and HR, 0.69; 95% CI, 0.56 to 0.84, respectively). Primary failure remains a major issue in the post-Fistula First era. Complications from AVF placement must be considered when planning AVF placement. Our data demonstrate that artery size is the main predictor of AVF patency.
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                Author and article information

                Contributors
                l.coventry@ecu.edu.au
                jon.hosking@bbraun.com
                doris.chan@health.wa.gov.au
                evelyn.coral@health.wa.gov.au
                wai.lim@health.wa.gov.au
                a.towell-barnard@ecu.edu.au
                d.twigg@ecu.edu
                c.rickard@griffith.edu.au
                Journal
                BMC Nephrol
                BMC Nephrol
                BMC Nephrology
                BioMed Central (London )
                1471-2369
                31 May 2019
                31 May 2019
                2019
                : 20
                Affiliations
                [1 ]ISNI 0000 0004 0437 5942, GRID grid.3521.5, Centre for Nursing Research, , Sir Charles Gairdner Hospital, ; Hospital Avenue, Nedlands, Western Australia 6009
                [2 ]ISNI 0000 0004 0389 4302, GRID grid.1038.a, School of Nursing & Midwifery, , Edith Cowan University, ; 270 Joondalup Drive, Joondalup, Western Australia 6027
                [3 ]Diaverum Toto Ora Dialysis Clinic, 10 Waddon Place, Mangere, New Zealand
                [4 ]ISNI 0000 0004 0437 5942, GRID grid.3521.5, Department of Renal Medicine, , Sir Charles Gairdner Hospital, ; Hospital Avenue, Nedlands, Western Australia 6009
                [5 ]ISNI 0000 0004 0437 5432, GRID grid.1022.1, Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and School of Nursing and Midwifery, , Griffith University, ; Nathan Campus, 170 Kessels Road, Nathan, Queensland 4111 Australia
                Article
                1373
                10.1186/s12882-019-1373-3
                6544962
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001798, Edith Cowan University;
                Award ID: G1002171
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

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