Harwood Lori E, Wilson Barbara M, Oudshoorn Abe
Adam Linton Hemodialysis Unit, London Health Sciences Centre, London, ON, Canada; Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.
Arthur Labatt Family School of Nursing , Western University , London, ON , Canada.
Clin Kidney J. 2016 Apr;9(2):303-9. doi: 10.1093/ckj/sfv158. Epub 2016 Feb 4.
Arteriovenous fistulas (AVFs) are the preferred access for hemodialysis (HD) yet they are underutilized. Cannulation of the fistula is a procedure requiring significant skill development and refinement and if not done well can have negative consequences for patients. The nurses' approach, attitude and skill with cannulation impacts greatly on the patient experience. Complications from miscannulation or an inability to needle fistulas can result in the increased use of central venous catheters. Some nurses remain in a state of a 'perpetual novice' resulting in a viscous cycle of negative patient consequences (bruising, pain), further influencing patients' decisions not to pursue a fistula or abandon cannulation.
This qualitative study used organizational development theory (appreciative inquiry) and research method to determine what attributes/activities contribute to successful cannulation. This can be applied to interventions to promote change and skill development in staff members who have not advanced their proficiency. Eighteen HD nurses who self-identified with performing successful cannulation participated in audio-recorded interviews. The recordings were transcribed verbatim. The data were analyzed using content analysis.
Four common themes, including patient-centered care, teamwork, opportunity and skill and nurse self-awareness, represented successful fistula cannulation. Successful cannulation is more than a learned technique to correctly insert a needle, but rather represents contextual influences and interplay between the practice environment and personal attributes.
Practice changes based on these results may improve cannulation, decrease complications and result in better outcomes for patients. Efforts to nurture positive patient experiences around cannulation may influence patient decision-making regarding fistula use.
动静脉内瘘（AVF）是血液透析（HD）的首选血管通路，但目前其使用率较低。内瘘穿刺是一项需要大量技能培养和提升的操作，如果操作不当会给患者带来不良后果。护士的穿刺方法、态度和技能对患者体验有很大影响。误穿或无法穿刺内瘘导致的并发症会增加中心静脉导管的使用。一些护士一直处于“永远的新手”状态，导致患者出现负面后果（如瘀伤、疼痛）的恶性循环，进一步影响患者选择不使用内瘘或放弃穿刺的决定。
本定性研究运用组织发展理论（肯定性探究）和研究方法来确定哪些属性/活动有助于成功穿刺。这可应用于促进技能未得到提升的工作人员发生改变和技能发展的干预措施。18名自认为穿刺成功的血液透析护士参与了录音访谈。访谈录音逐字转录。采用内容分析法对数据进行分析。
成功的内瘘穿刺体现为四个共同主题，即以患者为中心的护理、团队合作、机会与技能以及护士自我意识。成功穿刺不仅仅是学会正确进针的技术，更代表了实践环境与个人属性之间的背景影响和相互作用。
基于这些结果进行的实践改变可能会改善穿刺效果，减少并发症，为患者带来更好的结局。围绕穿刺培养积极患者体验的努力可能会影响患者关于使用内瘘的决策。
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