A randomised control trial protocol of MuST for vascular access cannulation in hemodialysis patients (MuST Study): contributions for a safe nursing intervention.

BACKGROUND: The vascular access preservation and the maintenance of a complication-free fistula remains an Achilles' heel of hemodialysis in chronic kidney patients due to its substantial contribution to the morbidity and mortality. Systematic studies in the area of examining cannulation practices, achieving complication-free cannulation, and strategies to improve fistula survival are needed. For this reason, we consider it essential to create and investigate new methodologies for approaching fistula in patients on regular HD. The Multiple Single Cannulation Technique (MuST) is based on the association between the rope-ladder (RL) using the arteriovenous vessel through progressive rotation, and the buttonhole (BH) since there are three specific cannulation sites for each cannulation day during the week. The MuST is simple to implement and seems to be a very promising technique in terms of patient safety. Previous studies already showed an arteriovenous fistula survival similar to RL but significantly higher than BH. METHODS: This MuST study is a multicenter, prospective, non-blind, parallel-group, randomized controlled trial with the intervention group submitted to MuST and a control group undergoing the rope-ladder, up to 100 subjects for each group. Patients will be randomized 1:1 to one of two cannulation technique (CT), and the follow-up period of this study will be 12 months. Primary outcome is to evaluate the arteriovenous fistula survival rate at 12 months determined by the percentage of fistulas in use from the beginning of the study to the date of the first clinical intervention by angioplasty or vascular surgery, to maintain or restore patency (unassisted patency). Secondary outcome is to evaluate arteriovenous fistula survival rate at 12 month determined by the percentage of fistulas in use from the study start to the date of access abandonment due to dysfunction, patient abandonment, or death, treatment change modality or study end. We will also evaluate the assisted primary patency and include the following secondary outcomes associated with the cannulation technique: Infection, Hematoma, Aneurysm development, and pain. DISCUSSION: The study will investigate whether fistula survival can be improved when using cannulation by MuST compared to the RL. MuST study will provide important information on fistula survival when cannulated by MuST but also information related to its use in fistulas previously cannulated by other CTs. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT05081648 registered on 18 October 2021.

Cannulation Technique of Vascular Access in Hemodialysis and the Impact on the Arteriovenous Fistula Survival: Systematic Review and Meta-Analysis.

Adequate cannulation technique (CT) methods and successful puncture are essential for hemodialysis (HD) and arteriovenous fistula (AVF) maintenance. This systematic review and meta-analysis was designed to identify which CT allows better AVF primary patency and lower rates of complications in HD patients. The search was carried out on the CINAHL, MEDLINE, Cochrane Library, and Joanna Briggs Institute Library databases to identify all randomized controlled trials (RCTs) and observational studies comparing clinical outcomes of buttonhole (BH) versus rope ladder cannulation (RL) from 2010 to 2022. The Risk-of-Bias (Rob 2) tool was used for RCTs and the ROBINS-I was used for non-randomized studies. RevMan 5.4 was used for the meta-analysis. A total of five RCTs, one quasi-randomized controlled trial, and six observational studies were included. When compared with RL cannulation, BH cannulation significantly increased bacteremia (RR, 2.76, 95% CI (1.14, 6.67), p = 0.02) but showed no differences in AVF primary patency (HR, 1.06, 95% CI (0.45, 4.21), p = 0.90). There was no thrombosis reduction (RR, 0.51, 95% CI (0.23, 1.14), p = 0.10) or intervention number reduction (RR, 0.93, 95% CI (0.49, 1.80), p = 0.84) with BH. Outcomes like pain, hematoma, and aneurism could not be merged due to a lack of data, reported as medians, as well as due to different definitions. The quality in general was poor and the heterogeneity among the studies prevented us from merging the outcomes.

Cannulation Technique of Vascular Access in Haemodialysis and the Impact on the Arteriovenous Fistula Survival: Protocol of Systematic Review.

BACKGROUND: Based on a literature review of various studies, comparisons between BH and RL are inconclusive regarding some outcomes. However, in the last 5 years, some studies have been published that may contribute to clarifying which cannulation technique (CT) allows better fistula survival. AIM: To review which cannulation technique allows better primary patency of the arteriovenous fistula in haemodialysis patients. METHODS: We will include all randomised controlled trials and observational studies that include comparisons among CTs and thus define the benefits and risks of each CT. A PRISMA-compliant systematic review and meta-analysis will be performed in accordance with the quality and homogeneity of studies. A comprehensive search strategy will be applied to the CINAHL, MEDLINE and Embase electronic databases from January 2000 to September 2021. The primary outcome is the arteriovenous fistula primary patency. To assess the risk of bias in randomised controlled trials or quasi-experimental studies, we will use the tool Revised Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2). For nonrandomised studies, the Risk of Bias In Non-Randomized Studies of Interventions (ROBINS-I) will be used. DISCUSSION: The evidence generated from this systematic review of current evidence could inform the design and implementation of continuous quality improvement programs in cannulation techniques in haemodialysis patients, as well as contributing to improving the curricula within haemodialysis courses. This protocol was registered with the National Institute for Health Research PROSPERO database prior to commencement (registration number CRD42021237050).

Self-care in Preserving the Vascular Network: Old Problem, New Challenge for the Medical Staff.

Teaching/educating patients with end stage renal disease (ESRD) and identifying their self-care behaviors for vascular network preservation are very important. However, the self-care behaviors regularly performed by patients are still unknown. We compared self-care behaviors for vascular network preservation performed by patients who are/are not followed-up by the nephrologist. The study design was a prospective, observational and comparative study. Inclusion criteria were as follows: ESRD patients (at stages 4 or 5); at least 18 years old; in pre-dialysis with at least a 6-month follow-up period by the nephrologist or who started dialysis in emergency and were not followed-up by the nephrologist; with no memory problems; and medically stable. Primary outcome was the frequency of self-care behaviors for vascular network preservation. Secondary outcome was the comparison between self-care behaviors by ESRD patients who were/were not followed-up by the nephrologist. The study involved 145 patients, 64.1% were female, the mean age was 69.5 years and the self-care behaviors mean score was 36.8% (with a SD of 39.8%). The number of patients followed-up and not followed-up by the nephrologist was 109 (group 1) and 36 (group 2), respectively. Social characteristics were similar in the two groups (P > 0.05). The mean self-care behaviors were 29.4% and 59.2% in groups 1 and 2, respectively (P = 0.000). Patients performed self-care behaviors for vascular network preservation with a relatively low frequency (the mean score was 36.8% only). Patients not followed by the nephrologist performed self-care behaviors more often than those who were followed (59.2% vs. 29.4% respectively, P = 0.000).

Fluid and dietary restriction's efficacy on chronic kidney disease patients in hemodialysis.

OBJECTIVE: to identify self-care measures to manage fluid and dietary restrictions and assess their effectiveness. METHOD: descriptive-correlational study and cluster analysis with 254 chronic renal failure patients on regular hemodialysis program, handled by hemodiafiltration. We evaluated the effectiveness of self-care by interdialytic weight gain (IWG) and by potassium and phosphorus serum pre-dialysis serum levels. RESULTS: several self-care measures were significantly correlated with a lower IWG and a lower level of pre-dialysis phosphorus. Patients most often use measures to reduce salt consumption than measures to restrict potassium and dietary phosphorus. The spouse provides important support dietary management. Subjects who use more often the self-care measure are mostly female, are older, less IWG and have a higher Kt/V. CONCLUSION: these results can contribute to the nursing educational support.

Eficácia das restrições hídrica e dietética em pacientes renais crônicos em hemodiálise / Eficacia de las restricciones de agua y de la dieta en pacientes renales crónicos en hemodiálisis / Fluid and dietary restrictions efficacy on chronic kidney disease patients in hemodialysis

RESUMO Objetivo: identificar as medidas de autocuidado usadas na restrição hídrica e dietética e para avaliar a eficácia do autocuidado. Método: estudo descritivo-correlacional e análise de clusters com 254 pacientes renais crônicos tratados por hemodiafiltração. A eficácia do autocuidado foi avaliada pelo ganho de peso interdialítico (GPI) e pelos níveis de potássio e de fósforo pré-diálise. Resultados: várias medidas de autocuidado estavam significativamente correlacionadas com o menor GPI e um nível baixo de fósforo. Os sujeitos usam mais vezes as medidas para reduzir o consumo de sal do que as medidas para restringir o potássio e o fósforo da dieta. O cônjuge presta importante apoio na gestão da dieta. Os sujeitos que usam mais vezes as medidas de autocuidado são maioritariamente do sexo feminino, têm mais idade, menor GPI e maior Kt/V. Conclusão: estes resultados podem contribuir para o aconselhamento de enfermagem.

RESUMEN Objetivo: identificar medidas de autocuidado utilizados para gestionar restricciones de líquidos y dietéticas y evaluar la eficacia del autocuidado. Método: estudio descriptivo-correlacional e análisis de clustrers, con 254 pacientes con insuficiencia renal crónica tratados en hemodiafiltración. Se evaluó la efectividad del autocuidado por la ganancia de peso interdiálisis (GPI) y niveles séricos de potasio y fósforo pre diálisis. Resultados: varias medidas de autocuidado se correlacionaron significativamente con la menor GPI y el menor nivel de fósforo pre diálisis. Los pacientes utilizan más veces medidas para reducir la sal, que medidas para reducir el potasio y el fósforo en la dieta. Se evidencia la importancia del cónyuge en la gestión de la dieta. Los sujetos que utilizan con más frecuencia las medidas de autocuidado son en su mayoría mujeres, más viejos, tienen menor GPI y mayor Kt/V. Conclusión: estos resultados pueden contribuir a un mejor asesoramiento de enfermería.

ABSTRACT Objective: to identify self-care measures to manage fluid and dietary restrictions and assess their effectiveness. Method: descriptive-correlational study and cluster analysis with 254 chronic renal failure patients on regular hemodialysis program, handled by hemodiafiltration. We evaluated the effectiveness of self-care by interdialytic weight gain (IWG) and by potassium and phosphorus serum pre-dialysis serum levels. Results: several self-care measures were significantly correlated with a lower IWG and a lower level of pre-dialysis phosphorus. Patients most often use measures to reduce salt consumption than measures to restrict potassium and dietary phosphorus. The spouse provides important support dietary management. Subjects who use more often the self-care measure are mostly female, are older, less IWG and have a higher Kt/V. Conclusion: these results can contribute to the nursing educational support.