How to choose the appropriate cannulation technique for vascular access in hemodialysis patients.

The cannulation technique is important for the survival of the arteriovenous access. Choosing the appropriate technique is a complex decision. Such choice must be customized to patients, considering their characteristics, the type of arteriovenous access and the experience of the hemodialysis team. We describe seven items that can help nurses to identify the appropriate cannulation technique: type of arteriovenous access; drainage vein; hygienic self-care profile; experience of the nursing staff in the cannulation technique and nurse-to-patient ratio; hemodialysis treatment method; patient's condition; and patient's decision. Such items can help nurses in decision-making on the "ideal" cannulation technique for each patient.

Measuring Cannulation Skills for Hemodialysis: Objective Versus Subjective Assessment.

Lack of cannulation skill during hemodialysis treatments results in poor clinical outcomes due to infiltration and other cannulation-related trauma. Unfortunately, training of patient care technicians and nurses, specifically on the "technical" aspects of cannulation, has traditionally not received much attention. Simulators have been successfully deployed in many medical specialties for assessment and training of clinical skills. However, simulators have not been as widely used in nursing, especially in the context of training clinical personnel in the dialysis unit. We designed a state-of-the-art simulator for quantifying skill for hemodialysis cannulation. In this study, 52 nurses and patient care technicians with varying levels of clinical experience performed 16 cannulations on the simulator with different fistula properties. We formulated a composite metric for objectively measuring overall success of cannulation and compared this metric with subjective assessment by experts. In addition, we examined if years of clinical experience correlated with objective and subjective scores for cannulation skill. Results indicated that, while subjective and objective metrics generally correlated with each other, the objective metric was more precise and better suited for quantifying cannulation skill. Further, the simulator-based objective metric provides several advantages over subjective ratings, including providing fine-grained assessment of skill, consistency in measurement unaffected by subjective biases, and basing assessment on a more complete evaluation of performance. Years of clinical experience, however, demonstrated little correlation with either method of skill assessment. The methods presented for cannulation skill assessment in this study, if widely applied, could result in improved cannulation skill among our PCTs and nurses, which could positively impact patient outcomes in a tangible way.

Extracting Subtask-specific Metrics Toward Objective Assessment of Needle Insertion Skill for Hemodialysis Cannulation.

About 80% of all in-hospital patients require vascular access cannulation for treatments. However, there is a high rate of failure for vascular access cannulation, with several studies estimating up to a 50% failure rate for these procedures. Hemodialysis cannulation (HDC) is arguably one of the most difficult of these procedures with a steep learning curve and an extremely high failure rate. In light of this, there is a critical need that clinicians performing HDC have requisite skills. In this work, we present a method that combines the strengths of simulator-based objective skill quantification and task segmentation for needle insertion skill assessment at the subtask level. The results from our experimental study with seven novice nursing students on the cannulation simulator demonstrate that the simulator was able to segment needle insertion into subtask phases. In addition, most metrics were significantly different between the two phases, indicating that there may be value in evaluating participants' behavior at the subtask level. Further, the outcome metric (risk of infiltrating the simulated blood vessel) was successfully predicted by the process metrics in both phases. The implications of these results for skill assessment and training are discussed, which could potentially lead to improved patient outcomes if more extensive validation is pursued.