SP506IS DIALYSIS NURSING PRACTISE ASSOCIATED WITH SUCCESSFUL CANNULATION OF NATIVE ARTERIOVENOUS FISTULAS AND GRAFTS?

Abstract

Introduction and Aims: Vascular access (VA) cannulation is an essential skill for dialysis nurses: failure to correctly repeat this operation day after day may result in serious complications for the patients. VA cannulation, even if usually considered a very simple action, is actually a procedure involving several steps. The aim of this study was to investigate if different aspects of arteriovenous fistula (AVF) and graft (AVG) cannulation have an effect on the development of acute access complications which may, in the medium to long-term, affect the survival of the vascular access. Methods: In April 2009 a cross-sectional survey was conducted in 171 dialysis units located in Europe, the Middle East and Africa to collect details on VA cannulation practices. Information on cannulation retrieved from the survey comprised fistula type and location, cannulation technique, needle size, use of disinfectants and of local anaesthesia, application of arm compression at the time of cannulation, needle and bevel direction, needle rotation, and needle fixation. Results: In total, 10,807 cannulation procedures of an equivalent number of patients were observed and included in the current evaluation. Out of all observed cannulation procedures, 367 showed some kind of complication, the most frequent (33.8%) being the need for multiple cannulations. In summary, the following were associated with a significantly higher odds ratio for acute complication: prescription of 16-17 gauge needles, of back-eye needles, the use of rope-ladder cannulation technique, the insertion of venous needle as first needle, and the rotation of the arterial needle. Table: Results of the logistic regression model evaluating nursing practice aspects in respect to the event “cannulation complication”. Conclusions: This study highlights critical steps in the process of cannulation potentially affecting the life of the vascular access, stressing the need for additional research aimed to improve cannulation practice. (Table Presented).