Variables associated with successful vascular access cannulation in hemodialysis patients: a prospective cohort study
Variables associated with successful vascular access cannulation in hemodialysis patients: a prospective cohort study
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DOI：
10.1186/s12882-019-1373-3
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发表时间：
2019-05-31
期刊：
影响因子：
2.3
通讯作者：
Rickard, Claire M.
中科院分区：
文献类型：
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作者：
Coventry, Linda L.;Hosking, Jon M.;Rickard, Claire M.
背景：成功的血管通路(VA)插管对于提供足够的透析是不可或缺的，这突显了确保血液透析(HD)患者动静脉通路生存能力的重要性。VA插管失误可能导致感染、渗透、血肿或动脉瘤形成，导致需要重新插管、放置中心静脉导管(CVC)或永久性丧失VA。插管相关的并发症也会对患者的透析体验和生活质量产生负面影响。本研究旨在确定与VA插管失败相关的患者、VA和护士因素。方法：对来自三个HD单元的永久性VA的HD患者进行前瞻性队列研究。每一次插管都收集了患者、VA和护士的特征以及插管技术的数据。用一般估计方程进行重复测量Logistic回归分析，以确定插管成功的几率。结果：我们收集了由63名护士参与的149例患者的1946次插管(83.9%)。插管方式有止血带(62.9%)、超声(4.1%)、绳梯插管(73.8%)或区域插管(24.7%)。插管率为4.4%(n=85)，其中1/3的患者(n=47)至少有一次插管失误。渗出(n=17，0.9%)和使用现有的CVC(n=6，0.6%)很少见。成功插管的多变量特征包括与移植物相比瘘管[OR 4.38；95%CI，1.89-10.1]；年龄较大[OR 1.68；95%CI，1.32-2.14]；没有支架[OR 3.37；95%CI，1.39-8.19]；没有超声波[OR 13.7；95%CI，6.52-28.6]；没有止血带[OR 2.32；95%CI，1.15-4.66]；以及缺乏肾脏护理研究生证书[OR 2.27；95%可信区间1.31-3.93]。结论：本研究显示插管失败率低。超声引导插管还需要进一步的研究。识别与成功插管相关的变量可用于开发VA插管复杂性仪器，该仪器可用于与能力评估护士的插管技能相匹配，从而将遗漏插管和创伤的风险降至最低。
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.