Dialysis Unit, Registered Nurse-Nephrology, University Hospital Center, Coimbra, Portugal.
Nursing School Porto, Porto, Portugal.
J Vasc Access. 2022 Sep;23(5):825-831. doi: 10.1177/11297298211006972. Epub 2021 Apr 30.
The cannulation of an arteriovenous fistula (AVF) by the hemodialysis (HD) nurse is challenging. Despite it being the focus of extensive research, it is still one of the majors causes of damage making it prone to failure. A considerable number of Clinical Practice Guidelines (CPGs) for the management of vascular access (VA) have been published worldwide over the past two decades. This review aimed to assess all information available in the selected CPG regarding AVF cannulation for HD providing a comprehensive analysis in order to interpret possible future cannulation approaches. A total of seven CPGs were described in a coding table separated in seven subthemes: Initiation of cannulation, preparation, technique, needle selection, surveillance, pain, and education. Our analysis outlines current CPGs for HD VA cannulation with lack of good evidence support for the majority of the recommendations, showing that, there is an urgent need for international collaboration and coordination to ensure relevant and high-quality evidence. Future CPGs must consider recommendations with better grading of evidence aiming patient-centered care and nurse decision models that can potentially represent better AVF cannulation outcomes.
对血液透析（HD）护士来说，动静脉瘘（AVF）的置管是一项具有挑战性的操作。尽管这是广泛研究的焦点，但它仍然是导致血管通路（VA）损伤和失败的主要原因之一。在过去的二十年中，全世界已经发布了相当数量的血管通路管理临床实践指南（CPG）。本综述旨在评估所选 CPG 中关于用于 HD 的 AVF 置管的所有可用信息，提供全面分析，以解释可能的未来置管方法。共有 7 项 CPG 被描述在一个编码表中，分为 7 个副标题：置管启动、准备、技术、针头选择、监测、疼痛和教育。我们的分析概述了当前用于 HDVA 置管的 CPG，其中大多数建议缺乏良好的证据支持，表明迫切需要国际合作与协调，以确保相关和高质量的证据。未来的 CPG 必须考虑具有更好证据分级的建议，以实现以患者为中心的护理和护士决策模型，这可能代表更好的 AVF 置管结果。
