The Hemodialysis Access: Preferences and Concerns of Patients, Dialysis Nurses and Technicians, and Physicians

Abstract

One hundred twenty-eight hemodialysis patients and 64 medical personnel consisting of dialysis nurses and technicians, hemodialysis access surgeons and nephrologists were surveyed about their preferences and concerns in regard to the hemodialysis vascular access. The access preferred by physicians was the A-V fistula in the lower arm. In contrast, the access preferred by dialysis nurses and technicians was the polytetrafluoroethylene (PTFE) graft in the lower arm. Patients desired a superficial access in the forearm which was easy to cannulate, had minimal effect on their appearance, provided quick hemostasis after dialysis and enabled arm comfort during dialysis. Physicians felt the most significant concerns about the access were thrombosis and infection. Nurses and technicians ranked difficult cannulation and insufficient access blood flows that prohibited dialysis adequacy as their major problems. For patients the most common problem was pain during needle insertion. This survey concluded that the A-V fistula remains the access of choice. However, appropriate maturation of the fistula must occur before needle insertion is attempted. An immature fistula is difficult to cannulate, has fragile veins resulting in blood leakage around the needle infiltrating the subcutaneous tissues and has inadequate blood flows for successful dialysis. Patients who are introduced to dialysis with inadequate access function or access failure from either an A-V fistula or a PTFE graft have increased morbidity, inadequate dialysis and enhanced anxiety about dialysis treatments. To increase the success and acceptance of A-V fistulas in hemodialysis patients it is incumbent upon the nephrologist to protect the future access arm from damage to the vasculature and to allow for fistula maturation before cannulation. Surgical protocols must improve the appropriate selection of a fistula or PTFE graft for various age groups and disease categories. Better patient preparation and selection of the proper access type for each patient will enhance early access function and subsequent access survival.

The add-on effect of the Mutsu-Senshi® skin cooling device for needle insertion pain in hemodialysis patients: a multicenter prospective study

“…We also found that those using needles with larger diameter tended to rate Mutsu-Senshi® more favorably, and this factor was significant even in the multivariate regression analysis. Needle insertion pain is a considerable stress for patients receiving HD [4,5]. It may be associated with depressive symptoms and lower quality of life in patients with HD [19].…”

“…In fact, pain during needle insertion is the most common patient complaint regarding hemodialysis access [5]. Several approaches have been developed to minimize needle insertion pain, including buttonhole cannulation technique [6,7], lidocaine-containing local anesthetic cream/ patches [8,9], and lavender essential oil [10,11].…”

The relationship between malnutrition-inflammation and cannulation pain in hemodialysis patients

“…12 Diyaliz sırasında kanülasyon sırasında oluşan ağrı diyaliz vasküler yolda en sık rastlanan sorundur. 13 Kanülasyon işlemi sırasındaki ağrı diyaliz ekibi tarafından çözülememiş bir konudur. Haftanın belirli gün ve saatinde diyalize giren hastalarda ağrının yineleyici ancak kronik olmadığı göz ardı edilmemelidir.…”

Use of Catheters for Vascular Access among Hemodialysis Patients: A Single Center's Experience

“…Bazı hastalar (ciddi kardiyak yetersizlik, kronik respiratuar yetersizlik), kalp yetmezliği riski nedeniyle, AVF oluşturulması bakımından bir kontrendikasyona sahip olabilirler (10). Çalma sendromu nedeniyle elinde ciddi ağrı bulunan ve periferik iskemiye yol açan veya iğne sokma işleminde güçlükler yaşanan hastalar da kalıcı bir SVK'den yararlanabilirler (11). Kateterler, HD için hemen damar yolu sağlar ve birkaç ay veya yıl süreyle kullanılabilir.…”