“You know your own fistula, it becomes a part of you”—Patient perspectives on vascular access: A semistructured interview study

Abstract

The success of hemodialysis depends on functional vascular access but such an invasive, semipermanent intervention can be confronting for patients. Vascular access complications are potentially life threatening and reduce treatment satisfaction and quality of life. This study aims to describe patient perspectives on vascular access. Face-to-face, semistructured interviews were conducted with 26 adult patients receiving hemodialysis with any form of vascular access at two dialysis units in Australia. The transcripts were analyzed using thematic analysis. We identified five major themes describing patient perspectives on vascular access: developing mental fortitude for access (accepting necessity for survival, self-advocacy, experiential confidence and competency, dependency on others, gaining vascular knowledge), device intrusiveness on the body (restricting normal function, finding compensatory solutions, bodily invasion, confronting appearance), inhibiting pain (aversion to surgery, persisting needle anxieties), exposure to dire health consequences (resigning to inevitable failure, anticipating serious complications, technological skepticism, wary of medical incompetence), and imposing burdens (generating additional expenses, encumbering family members). Patients with a vascular access rely on a precarious lifeline, which is confronting, intrusive, and burdensome. Some develop mental resilience to cope with the pain and invasiveness of vascular access. The results suggest that more attention to address needle anxieties, self-advocacy, lifestyle disruption, fear of complications, and concern for caregiver burden may improve treatment satisfaction and outcomes for patients on hemodialysis.

Needle fear: A point prevalence survey of dialysis patients

“…4 The high level of needle fear observed in our study may be clinically significant, and highlights that needle fear may have implications on treatment adherence and the choice of treatment modality. 5 Although not reaching statistical significance in this survey, the finding that needle fear was higher in PD patients, may reflect needle-avoidance as part of the decision making process regarding the choice of renal replacement therapy; however, this requires further investigation. The scarcity of published interventions to decrease needle fear in dialysis patients is remarkable given the enormous number of access cannulations, vaccinations and erythropoietin stimulating agents that dialysis patients receive.…”

“…Our finding of needle fear in 36% of the cohort compares to a smaller Dutch study that observed 44% of 45 patients reported needle fear . The high level of needle fear observed in our study may be clinically significant, and highlights that needle fear may have implications on treatment adherence and the choice of treatment modality . Although not reaching statistical significance in this survey, the finding that needle fear was higher in PD patients, may reflect needle‐avoidance as part of the decision making process regarding the choice of renal replacement therapy; however, this requires further investigation.…”

How an ordeal becomes the norm: A qualitative exploration of experiences of self‐cannulation in male home haemodialysis patients

“…() and Taylor et al . () reported that some patients started self‐cannulating because they felt they knew their fistula better than nurses. For many of these patients, taking control had the physical benefit of hurting less.…”

“…In Taylor et al . (), self‐cannulation was also linked with building confidence and occurred when participants had successful experiences with cannulation. Moral support was also found to be critical to the maintenance of confidence.…”

“…Some patients had overcome blood or needle phobias stating that self‐cannulation was easy and a way of protecting the health of their fistula, while others lacked confidence, noting that even nurses experienced problems with cannulation. In a study on patients’ views of vascular access, some patients regarded being able to self‐cannulate as important in developing confidence and knowledge of their access, while for others, fears and pain related to needles prevented them from doing HHD (Taylor et al ., ). Taken together, these studies highlight the diverse and contrasting views that patients have of needles and self‐cannulation.…”