Jackson Victoria E, Hurst Helen, Mitra Sandip
1 Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK.
2 Devices for Dignity, National Institute for Health Research, Sheffield, UK.
J Vasc Access. 2018 May;19(3):221-229. doi: 10.1177/1129729817751867. Epub 2018 Mar 18.
Arteriovenous fistulae remain the gold standard of vascular access in haemodialysis. There is currently no consensus on standardised methods of monitoring arteriovenous fistulae. Assessment techniques and practice remain widely variable. The purpose of this study is to determine whether existing evidence supports physical assessment as an effective tool and a good predictor of arteriovenous fistulae dysfunction to allow for timely intervention and improve outcomes.
A literature search was performed using CINAHL, PubMed, Medline and BNI databases and relevant search terms. Studies included were peer-reviewed, published after 2008, in English and related to arteriovenous fistulae only. Six key papers were identified and critically analysed for validity and relevance, in relation to outcomes, assessor experience, training duration and nurses' ability to perform physical assessment.
Physical assessment has been shown to be effective in detecting arteriovenous fistulae dysfunction and comparable to technology-based surveillance. Physical assessment techniques generally adopt a 'look, listen and feel' approach to identify arteriovenous fistulae dysfunction that includes stenosis, thrombosis, ischaemia and infections. Physical assessment is a skill that can be taught with studies showing that skill-specific training is more effective than experience alone. Cost-effectiveness analysis is lacking.
The analysis of evidence demonstrates that physical assessment of arteriovenous fistulae is an effective method of detecting arteriovenous fistulae dysfunction and is a skill that can be taught. A structured physical assessment and its implementation may be significant in routine care, but research into the most effective physical assessment techniques and its impact on clinical practice in haemodialysis is required.
动静脉内瘘仍然是血液透析血管通路的金标准。目前对于动静脉内瘘的标准化监测方法尚无共识。评估技术和实践差异很大。本研究的目的是确定现有证据是否支持体格检查作为检测动静脉内瘘功能障碍的有效工具和良好预测指标，以便及时干预并改善预后。
使用CINAHL、PubMed、Medline和BNI数据库及相关检索词进行文献检索。纳入的研究需为经过同行评审、2008年后发表、英文且仅与动静脉内瘘相关。确定了六篇关键论文，并就其有效性和相关性进行了批判性分析，内容涉及结果、评估者经验、培训时长以及护士进行体格检查的能力。
体格检查已被证明在检测动静脉内瘘功能障碍方面有效，且与基于技术的监测相当。体格检查技术通常采用“视、听、触”的方法来识别包括狭窄、血栓形成、缺血和感染在内的动静脉内瘘功能障碍。体格检查是一项可以传授的技能，研究表明特定技能培训比单纯经验更有效。缺乏成本效益分析。
证据分析表明，动静脉内瘘的体格检查是检测动静脉内瘘功能障碍的有效方法，且是一项可以传授的技能。结构化的体格检查及其实施在常规护理中可能具有重要意义，但需要对最有效的体格检查技术及其对血液透析临床实践的影响进行研究。
