Smith Kyle, Ayars Candace
Dallas Nephrology Associates, AT Still University College of Graduate Health Studies, Tarleton State University College of Health Sciences, Dallas, TX, USA.
Associate Professor, A.T. Still University, College of Graduate Health Studies, Kirksville, MO, USA.
J Osteopath Med. 2025 Jan 8;125(6):321-327. doi: 10.1515/jom-2023-0262. eCollection 2025 Jun 1.
Vascular access malfunction and failure contribute to morbidity and hospitalization in hemodialysis populations. Although controversy still exists over the identification and appropriate management of access malfunction, recognition of sentinel signs during physical examination remains an efficient way to screen for access malfunction. Dialysis staff are on the front line of providing quality care to dialysis patients, often being the first ones who could detect early physical signs of access malfunction.
The study's purpose is to determine the effect of an advanced vascular access educational module presented to hemodialysis nurses and technicians, focusing on physical examination findings to identify a dialysis access at risk for malfunction.
Utilizing a quasi-experimental pretest and posttest group design with a nonequivalent comparison control group, the effect of an advanced vascular access education module to improve vascular access knowledge and skill in recognition of sentinel signs of access malfunction was studied in a group of hemodialysis nurses (registered nurses [RNs]) and certified patient care technicians (PCTs).
Knowledge post-test scores (RN, M=94.44, SD=7.05; PCT, M=90.83, SD=7.93) were significantly higher than pretest scores (RN, M79.54, SD12.47; PCT M=80.67, SD7.99) in the intervention group (p<0.001) but not in the comparison group. There were no statistically significant differences in mean skill scores between dialysis nurses (p=0.38) and PCTs (p=0.826) or between intervention and comparison groups (p=0.332).
This study exposes a critical gap in the transition of vascular access knowledge to the practical skill of access assessment. The findings suggest the need for restructuring the clinical training of dialysis nurses and PCTs in vascular access management and care. Newer active learning educational strategies in physical assessment of hemodialysis vascular access should be explored to further support dialysis nurses and PCTs in providing optimal patient care.
血管通路故障和失败会导致血液透析人群发病和住院。尽管在血管通路故障的识别和适当管理方面仍存在争议，但在体格检查过程中识别哨兵体征仍然是筛查血管通路故障的有效方法。透析工作人员处于为透析患者提供优质护理的第一线，通常是最先能够检测到血管通路故障早期体征的人。
本研究的目的是确定向血液透析护士和技术人员提供的高级血管通路教育模块的效果，重点是体格检查结果，以识别有故障风险的透析血管通路。
采用非等效比较对照组的准实验前测和后测组设计，在一组血液透析护士（注册护士[RN]）和认证患者护理技术员（PCT）中研究了高级血管通路教育模块对提高血管通路知识和识别通路故障哨兵体征技能的效果。
干预组的知识后测分数（RN，M = 94.44，SD = 7.05；PCT，M = 90.83，SD = 7.93）显著高于前测分数（RN，M = 79.54，SD = 12.47；PCT，M = 80.67，SD = 7.99）（p < 0.001），而对照组则不然。透析护士（p = 0.38）和PCT（p = 0.826）之间或干预组和对照组之间的平均技能分数没有统计学上的显著差异（p = 0.332）。
本研究揭示了血管通路知识向通路评估实践技能转化过程中的一个关键差距。研究结果表明，需要重新构建透析护士和PCT在血管通路管理和护理方面的临床培训。应探索血液透析血管通路体格评估中更新的主动学习教育策略，以进一步支持透析护士和PCT提供最佳患者护理。
