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BACKGROUND: Dialysis nurses play a pivotal role in the management of vascular access (VA), physician-patient liaison, and patient education for hemodialysis patients. This multicenter study aims to review the dialysis nurses' knowledge, attitude, practice, and self-efficacy toward providing care for patients' VA. METHODS: A multi-centered study was conducted using a self-administered survey. Nurses from 47 Singapore dialysis centers (five hospital-based and 42 community-based) providing hemodialysis were invited to participate on a voluntary and anonymous basis from April to November 2022. The survey consists of nurses' knowledge on VA (10 items), attitude on VA care (six items), usual practices (seven items), and self-efficacy in VA cannulation and management (six items). The total scores for the knowledge, attitude, and self-efficacy components were 50, 30, and 30 respectively. The instrument has been validated in a pilot study. RESULTS: In total, five hundred sixteen dialysis nurses participated the survey. The mean (±SD) knowledge score of the participants toward VA care was 30.0 (±8.1) over a total score of 50. The means (±SD) of their attitude and self-efficacy scores were 24.4 (±4.1) and 24.2 (±3.1) over 30 respectively. The majority of the nurses (84.1% in hospital-based centers and 98.9% in community-based centers) conducted patient education in some aspects of VA care. The percentage of nurses indicated need for referral to access specialists due to various abnormalities varied significantly between the hospital-based and community-based settings. In the multivariable linear regression analysis, longer working experience was a significant factor for higher knowledge score (B = 0.26; p = 0.001), attitude score (B = 0.08; p = 0.01), and self-efficacy score (B = 0.34; p < 0.001). CONCLUSION: Dialysis nurses in Singapore have satisfactory knowledge, practice, and self-efficacy on VA care. The majority of them expressed positive opinions toward the VA-related training they received, new technologies, and communications. The identified knowledge and practice gaps could be incorporated into the future training programs.
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INTRODUCTION: Cannulation of complex arteriovenous fistula (AVF) or graft (AVG) frequently poses challenges to renal nursing practice. Ultrasound (US) guidance on visualizing central and peripheral venous access has been widely adopted in nephrology, reducing vascular intervention complications. Renal nurses could acquire this point-of-care technique to increase the successful cannulation rate while facilitating confidence build-up during practice. We aim to evaluate the use of handheld US on difficult AVF/AVG cannulation in a hospital-based dialysis unit. METHODS: We conducted a single-center randomized controlled trial from January 2021 to January 2022. Ten renal nurses were trained by an interventional nephrologist before patient recruitment and had completed a pre- and posttraining questionnaire on their confidence level. Fifty hemodialysis patients with complex AVF were randomized to US-guided or conventional cannulation. The total time spent on cannulation and patients' pain scores were also collected. FINDINGS: Renal nurses increased their confidence level after training (pretraining score 26.6 ± 6.9 vs. posttraining score 36.4 ± 3.0; p = 0.014). There was a higher success rate (only one cannulation attempt required) for US-guided (96%) versus conventional (72.0%) cannulation (p = 0.049). US-guided cannulation had a lower pain score than the conventional method (1.48 ± 0.73 vs. 2.13 ± 0.95, p = 0.012). The pre-cannulation assessment time and time spent on cannulation were comparable between the two groups. DISCUSSION: Our study showed that US-guided cannulation increased renal nurses' confidence level in difficult cannulation and improved success rate. Larger scale studies are required to further assess the applications of handheld US in AVF cannulation, particularly in different clinical settings (e.g., chronic dialysis centers).