Hemodialysis vascular access coordinator: Three-level model for access management.

Management of vascular access is a challenge for the dialysis team, particularly to keep the arteriovenous access working. The vascular access coordinator can positively contribute to increase the number of arteriovenous fistulas and reduce central venous catheters. In this article, we introduce a new approach to vascular access management centered on (the results of setting up) the role of vascular access coordinator. We described the three-level model (3Level_M) for vascular access management organized in three levels: vascular access nurse manager, vascular access coordinator, and vascular access consultant. We defined the instrumental skills and training required to be developed by each element and clarify the articulation between the model and all members of the dialysis team related to vascular access.

Use of a Paclitaxel Drug-Eluting Stent for the Treatment of Hemodialysis Access Outflow Stenosis.

PURPOSE: To evaluate the outcomes and durability of drug-eluting stents (DESs) for the treatment of hemodialysis access outflow stenosis. MATERIAL AND METHODS: A single-center retrospective analysis was conducted of all patients with hemodialysis vascular access outflow stenosis treated with a paclitaxel-coated DES (Eluvia; Boston Scientific, Marlborough, Massachusetts) between January 2020 and July 2022. A total of 34 DESs were implanted to treat outflow stenosis in 32 patients. Primary target lesion patency after stent deployment was the main outcome. Comparison between the time interval free from target lesion reintervention (TLR) after previous plain balloon angioplasty (PBA) and that after stent deployment for the same target lesion was considered a secondary outcome. RESULTS: The primary patency at 6, 12, and 18 months was 63.1%, 47.6%, and 41.7%, respectively. The secondary patency rate was 100% at 18 months. The median time interval free from TLR increased from 4.1 to 11.9 months (P < .001). No adverse events were observed during the median follow-up period of 387 days. CONCLUSIONS: The patency rates after use of DES for hemodialysis access outflow stenosis were comparable with results for drug-coated balloons and stent grafts, addressing recoil and minimizing the risk of jailing by a covered stent.

Construção e validação de um modelo de decisão para a canulação da fistula arteriovenosa em hemodiálise / Arteriovenous fistula cannulation in hemodialysis: Constructing and validating a decision-making model / Construcción y validación de un modelo de decisión para la canulación de fístulas arteriovenosas en hemodiálisis

Resumo Enquadramento: A fístula arteriovenosa é considerada como o acesso vascular de eleição para hemodiálise, a sua utilização pode ser realizada através de quatro técnicas de canulação distintas: Escada, Botoeira, MuST ou Área. Objetivo: Construir e validar um instrumento de apoio à decisão para a técnica de canulação ideal da fistula arteriovenosa em hemodiálise. Metodologia: Estudo metodológico em duas etapas mediante a realização da técnica de Delphi entre outubro 2021 e fevereiro de 2022 através de 27 juízes peritos. O instrumento de apoio ao modelo de decisão para a canulação foi segmentado em quatro blocos: avaliação física, avaliação ecográfica, esquema fotográfico com dermopigmentação e observações. Para análise, utilizou-se o índice de validade de conteúdo ≥ 0,90. Resultados: Obteve-se consenso final de juízes através de uma concordância unânime na estrutura do instrumento e um índice de validade de conteúdo global de 0,94. Conclusão: O instrumento em estudo revelou-se válido em aparência e conteúdo para aplicação em consulta de enfermagem.

Abstract Background: The arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis. Four different cannulation techniques can be used: Rope Ladder (RL), Buttonhole (BH), Multiple Single cannulation Technique (MuST), or Area Puncture (AP). Objective: To build and validate a decision-making instrument for the optimal AVF cannulation technique in hemodialysis. Methodology: This two-stage methodological study using the Delphi method was conducted between October 2021 and February 2022 with 27 experts. The decision-making instrument for choosing the cannulation technique was divided into four blocks: physical assessment, ultrasound assessment, vascular access graphical representation, and observations. The content validity index ≥ 0.90 was used in the analysis. Results: The instrument's structure obtained the unanimous agreement of the experts and an overall content validity index of 0.94. Conclusion: The instrument under analysis proved to have the face and content validity for nursing consultations.

Resumen Marco contextual: La fístula arteriovenosa se considera el acceso vascular de preferencia para la hemodiálisis y puede realizarse mediante cuatro técnicas de canulación diferentes, escalera, ojal, MuST o área. Objetivo: Construir y validar una herramienta de apoyo a la decisión para la técnica ideal de canulación de la fístula arteriovenosa en hemodiálisis. Metodología: Estudio metodológico en dos etapas mediante la técnica Delphi entre octubre de 2021 y febrero de 2022 con 27 jueces expertos. El instrumento de apoyo al modelo de decisión para la canulación se segmentó en cuatro bloques: evaluación física, evaluación ecográfica, esquema fotográfico con dermopigmentación y observaciones. Para el análisis, se utilizó el índice de validez de contenido ≥ 0,90. Resultados: El consenso final de los jueces se obtuvo mediante un acuerdo unánime sobre la estructura del instrumento y un índice de validez de contenido global de 0,94. Conclusión: El instrumento estudiado demostró ser válido en apariencia y contenido para aplicarlo en la consulta de enfermería.

Skin pigmentation as landmark for arteriovenous fistula cannulation in hemodialysis.

BACKGROUND: The cannulation of the arteriovenous fistula (AVF) for hemodialysis (HD) has traditionally depended on the nurse's tactile sensation, which has been associated with suboptimal needle placement and detrimental effects on vascular access (VA) longevity. While the introduction of ultrasound (US) has proven beneficial in mapping the AVF outflow vein and assisting in cannulation planning, aneurysmal deformations remain a common occurrence resulting from various factors, including inadequate cannulation techniques. Within this context, the utilization of skin pigmentation as a clinical landmark has emerged as a potential approach to enhance cannulation planning in HD. METHODS: A prospective longitudinal study was undertaken to investigate the correlation between the occurrence of venous morphological deformations and the cannulation technique guided by skin pigmentation after a 2-month period of implementation. RESULTS: Thirty patients were enrolled in the study with 433 cannulations being described within the first 2 months of AVF use. The overall rate of cannulation-related adverse events was 21.9%. Comparative analysis demonstrated a statistically significant relationship (p < 0.001) between aneurysmal deformation and non-compliance with the proposed cannulation technique, resulting in cannulation outside the designated points. Non-compliance was primarily attributed to nurse's decision (57.1%). CONCLUSION: The integration of US mapping of the AVF outflow vein and the utilization of skin pigmentation as a guiding tool have shown promising results in enhancing cannulation planning over time. Consistent adherence to a cannulation technique other than the area technique has been found to reduce the risk of AVF morphological deformation. These findings underscore the potential benefits of incorporating skin pigmentation as a clinical landmark in cannulation practices, highlighting its ability to impact positively cannulation outcomes.

Outflow Rescue of Elbow-Blockade Forearm Arteriovenous Fistulas: Outcomes of Open Surgical Techniques.

BACKGROUND: Venous scarring at the elbow is a common problem that can cause early and late forearm arteriovenous fistula (AVF) dysfunction in hemodialysis patients. However, any effort to prolong the long-term patency of distal vascular accesses could benefit the patient's survival, maximizing the use of restricted venous patrimony. This study aims to report a single-center experience in the recovery of distal autologous AVF with venous outflow obstruction at the elbow using different surgical techniques. METHODS: Retrospective observational study of all patients treated at a single vascular access center from January 2011 to March 2022, with dysfunctional forearm AVFs presenting with outflow stenosis or occlusions at the elbow treated by open surgery, using 3 different surgical techniques. Demographics and clinically relevant data were collected. Evaluated endpoints included primary, assisted primary, and secondary patency rates at 1 and 2 years. RESULTS: Twenty-three patients with elbow-blocked outflow forearm AVFs have been treated with a mean age of 64 ± 15 years. The majority (96%) had a radiocephalic fistula. The median time from vascular access creation to intervention was 34.5 months (12-216 months). A total of 24 procedures have been performed using 3 different surgical techniques for bypassing the obstructed venous outflow at the elbow. Technical success was achieved in 96% of the surgically treated patients. Primary and secondary patency rates at 1 year were 67.4% and 89.4%, respectively, and 52.9% and 82.0% at 2 years, with a median follow-up of 19 months (6-92 months). CONCLUSIONS: AVFs outflow stenosis or occlusions at the elbow not amenable to endovascular therapy could lead to vascular access abandonment. Our study demonstrates multiple surgical solutions to avoid this adverse outcome. Elbow venous outflow surgical reconstruction seems effective for distal vascular access preservation. Close surveillance is essential for timely endovascular treatment of newly developed stenosis at the venous drainage.

From the first to the fourth critical period of COVID-19: what has changed in nursing practice environments in hospital settings?

BACKGROUND: The COVID-19 pandemic reinforced the need to invest in nursing practice environments and health institutions were led to implement several changes. In this sense, this study aimed to analyze the impact of the changes that occurred in nursing practice  environments between the first and fourth critical periods of the pandemic. METHODS: Quantitative, observational study, conducted in a University Hospital, with the participation of 713 registered nurses. Data were collected through a questionnaire with sociodemographic and professional characterization and the Scale for the Environments Evaluation of Professional Nursing Practice, applied at two different points in time: from 1 to 30 June 2020 and from 15 August to 15 September 2021. Data were processed using descriptive and inferential statistics. RESULTS: Overall, the pandemic had a positive impact on nursing practice environments. However, the Process component remained favourable to quality of care, while the Structure and Outcome components only moderately favourable. Nurses working in Medicine Department services showed lower scores in several dimensions of the Structure, Process and Outcome components. On the other hand, nurses working in areas caring for patients with COVID-19 showed higher scores in several dimensions of the Structure, Process and Outcome components. CONCLUSIONS: The pandemic had a positive impact on various dimensions of nursing practice environments, which denotes that regardless of the adversities and moments of crisis that may arise, investment in work environments will have positive repercussions. However, more investment is needed in Medicine Department services, which have historically been characterised by high workloads and structural conditions that make it difficult to promote positive and sustainable workplaces.

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.

Validação de conteúdo do hemodialysis safety checklist para o português brasileiro: um estudo metodológico / Content validation of the hemodialysis safety checklist for brazilian portuguese: a methodological study

OBJETIVO: Realizar adaptação transcultural e validação do conteúdo do HemodialysisSafetyChecklist para uso no Brasil. MÉTODO: Este estudo metodológico foi dividido em seis etapas: i) tradução para o português; ii) comparação e síntese; iii) retrotradução cega; iv) comparação e análise das equivalências conceituais, semânticas e de conteúdo; v) teste piloto com a população-alvo; e vi) validação de conteúdo por meio do cálculo do índice de validade de conteúdo (IVC). RESULTADOS: O processo de adaptação transcultural realizado resultou em um instrumento considerado claro pela população-alvo após a realização do teste piloto. Após duas rodadas de avaliação pelos especialistas, o instrumento foi considerado válido, obtendo um IVC por item (I-IVC) ≥ 0,88 para cada item, e um IVC da escala (S-IVC/Ave) = 0,97. CONCLUSÃO: A versão em português do Hemodialysis Safety Checklist apresenta um conteúdo válido para utilização na realidade da hemodiálise brasileira.

OBJECTIVE: To perform cross-cultural adaptation and content validation of the Hemodialysis Safety Checklist for use in Brazil. METHODS: This methodological study was divided into six stages: i) translation into Portuguese; ii) comparison and synthesis; iii) blind back-translation; iv) comparison and analysis of conceptual, semantic, and content equivalence; v) pilot testing with the target population; and vi) content validation by calculating the Content Validity Index (CVI). RESULTS: The cross-cultural adaptation process resulted in an instrument that was considered precise by the target population after the pilot test. After two rounds of evaluation by experts, the instrument was considered valid, obtaining an Item-Level Content Validity Index (I-CVI) ≥ 0.88 for each item and a Scale-Level Content Validity Index (S-CVI/Ave) = 0.97. CONCLUSION: The Portuguese version of the Hemodialysis Safety Checklist presents valid content for use in Brazilian hemodialysis.

Effects of Long-term Administration of Inhaled Lavender During Hemodialysis on Patients' Invasive Pain, Anxiety, and Comfort During Cannulation: A Single-blind Randomized Controlled Trial.

Context: Although a number of studies have shown that lavender administered via inhalation can decrease the invasive pain and anxiety experienced by hemodialysis (HD) patients during cannulation, the evaluation has mostly been on the short-term effectiveness of lavender oil. Also, no study has evaluated the effects of lavender on comfort level. Objective: The study aimed to investigate the long-term effectiveness of lavender oil, when administered via an inhaler during HD sessions, on a patient's experience of invasive pain, anxiety, and comfort during access to the fistula. Design: The research team designed a prospective, single-blind, randomized, controlled clinical trial. Setting: The study took place in an HD unit of a public hospital in Kirklareli, Turkey. Participants: Participants were 24 patients receiving HD in the unit between January and March 2021. Intervention: Participants were randomly assigned to the intervention or control group. Pure lavender essence was diluted with sweet almond oil at a ratio of 1:10. Before the cannulation procedure at 12 HD sessions, three drops of a 1:10 mixture were placed on sterile gauze and held at a distance of about 10 cm from the participant's nose to ensure its inhalation before the fistula puncture with the needle. No extra procedure was performed for the control group. Outcome Measures: Participants completed a visual analogue scale (VAS) right after puncture of the fistula during each HD session. The STAI and HD Comfort Scale were scored at baseline prior to the first HD session and postintervention at the twelfth HD session. Results: The VAS (P < .001) and state anxiety scores (P = .027) were significantly lower in the intervention group than in the control group at all time points, except at baseline. The comfort scale in the intervention group was significantly higher than that in the control group (P < .05). Conclusions: Lavender aromatherapy could be a good option for reducing the pain, anxiety, and discomfort level of HD patients.

Adaptação e validação do Kidney Transplant Understanding Tool para o contexto brasileiro / Adaptación y validación del Kidney Transplant Understanding Tool para el contexto brasileño / Adaptation and validation of the Kidney Transplant Understanding Tool for the Brazilian context

Resumo Objetivo Realizar a adaptação transcultural e validar o conteúdo do instrumento Kidney Transplant Understanding Tool para o cenário brasileiro. Métodos Estudo metodológico realizado na capital pernambucana, que executou cinco etapas de um protocolo canadense de adaptação transcultural. A versão pré-final do instrumento foi avaliada por 36 participantes em terapia renal substitutiva e sete especialistas em Nefrologia. Resultados Para cada item, atingiu-se o I-IVC ≥ 0,85; e 0,99 para a escala S-IVC/Ave em equivalência conceitual e de conteúdo. O teste binomial apresentou o p-valor ≥ 0,05 para todos os itens; e o Coeficiente de Concordância de Kappa foi de 0,90. Conclusão O instrumento adaptado foi considerado claro pelos participantes e o conteúdo foi validado pelos especialistas. O Kidney Transplant Understanding Tool (K-TUT-Br) foi validado para utilização no contexto do transplante renal no Brasil. A sua aplicação poderá instrumentalizar a enfermagem na implementação de mudanças estratégicas nas estruturas técnico-assistenciais em uso de práticas baseadas em evidências ressaltando o conhecimento e o Letramento em Saúde.

Resumen Objetivo Realizar la adaptación transcultural y validar el contenido del instrumento Kidney Transplant Understanding Tool para el escenario brasileño. Métodos Estudio metodológico realizado en la capital del estado de Pernambuco, donde se ejecutaron cinco etapas de un protocolo canadiense de adaptación transcultural. La versión preliminar del instrumento fue evaluada por 36 participantes en terapia de reemplazo renal y siete especialistas en Nefrología. Resultados En cada ítem se alcanzó el I-IVC ≥ 0,85; y 0,99 en la escala S-IVC/Ave en equivalencia conceptual y de contenido. La prueba binominal presentó el p-valor ≥ 0,05 en todos los ítems; y el coeficiente de concordancia de Kappa fue de 0,90. Conclusión El instrumento adaptado fue considerado claro por los participantes y el contenido fue validado por los especialistas. El Kidney Transplant Understanding Tool (K-TUT-Br) fue validado para su utilización en el contexto del trasplante renal en Brasil. Su aplicación podrá servir de instrumento para enfermeros en la implementación de cambios estratégicos en las estructuras técnico-asistenciales en uso de prácticas basadas en evidencia, destacando el conocimiento y la alfabetización en salud.

Abstract Objective To perform a cross-cultural adaptation and content validation of the Kidney Transplant Understanding Tool for the Brazilian context. Methods A methodological study conducted in the city of Pernambuco, Brazil, which performed the five steps of a Canadian cross-cultural adaptation protocol. The pre-final version of the instrument was evaluated by 36 participants in renal replacement therapy and seven specialists in nephrology Results For each item, the Item Content Validity Index - I-CVI ≥ 0.85 was achieved; and 0.99 for the mean Scale Content Validity Index - S-CVI/Ave in conceptual and content equivalence. The binomial test showed a p-value ≥ 0.05 for all items; and the Kappa Coefficient of Agreement was 0.9. Conclusion The adapted instrument was found to be clear by the participants, and the content was validated by the experts. The Kidney Transplant Understanding Tool (K-TUT-Br) was validated for use in the context of kidney transplantation in Brazil. Its application may enable nurses to implement of strategic changes in technical and care structures using evidence-based practices focusing on knowledge and health literacy.

Maintaining Vascular Access Response in a Severely COVID-19 Hit Country.

INTRODUCTION: The COVID-19 pandemic has caused an unprecedented disruption in healthcare systems worldwide, and Portugal was no exception. We analyze the impact of the COVID-19 pandemic in activity of our Vascular Access Center (Grupo Estudos Vasculares - GEV). MATERIAL AND METHODS: This is a retrospective study, during March 2019 and February 2021. An analysis of surgical and appointments records in 2,495 patients from 25 hemodialysis centers followed by GEV was performed. Patients were divided into two periods: non-pandemic (NPP) (March 2019 to February 2020) and pandemic periods (PP) (March 2020 to February 2021). The number of surgeries and appointments were analyzed per month and per week. The number of thrombosis were analyzed in both periods. Normality was tested by the Shapiro-Wilk test and by the Lilliefors (Kolmogorov-Smirnov) test. Comparisons were made by the t-test (paired samples) when normality was not rejected and by the Wilcoxon test otherwise. All the variables (normal or otherwise) were described by the usual descriptive measures such as the mean, median and quartiles. No categorical data were collected. To avoid COVID-19 infection a set of measures were created: Sars-cov-2 PCR test for every patient, individual protection equipment for staff, rotating teams and schedules, and only one patient allowed in the circuit to the intervention room. A descriptive statistical analysis was performed with SPSS version28. The statistical significance was confirmed for p-value < 0.05. RESULTS: A total of 1756 surgeries and 800 appointments were made in both PP and NPP. Comparing the periods, we performed 914 (52%) interventions in the NPP and 842 (48%) in PP, 423 (53%) consultations in NPP and 377 (47%) at PP. Comparing the NPP and PP by months we observed more appointments in the NPP (p=0.004). However, the difference in the number of surgeries did not reach statistical significance (p=0.533). There were more thrombosis during the summer and fall in the NPP and PP. A total of 138 in NPP and 131 in PP thrombosis were observed in the 2 years period. There was no record of COVID-19 infections between all GEV staff (n=25). CONCLUSION: Due to timed and tight set of measures taken in the pandemic lockdown by GEV, a similar clinical and surgical activity regarding hemodialysis patients was obtained in both periods (PP and NPP). The hypothesis that the PP could diminish vascular access assessment/intervention or more thrombosis could occur was not verified at our institution. The set of measures established to deal with the COVID-19 pandemic was also effective to prevent infection in staff members.

Radio-cephalic fistula recovered with drainage to median basilic vein by straightening of the forearm cephalic vein: A case report.

The distal arteriovenous fistula (AVF) has less complications and better patency than the proximal fistula, when it works properly. The complications of outflow of the fistula are complex, and it is necessary to analyze all solutions to solve the problem. We introduce a novel approach to solve outflow problems of a radio-cephalic AVF by straightening of the forearm cephalic vein with drainage into the median basilic vein.

Impact of COVID-19 on professional nursing practice environments and patient safety culture.

AIM: To analyse the impact of COVID-19 on professional nursing practice environments and patient safety culture. BACKGROUND: The relationship between work environments and patient safety has been internationally recognized. In 2020, the pandemic imposed enormous challenges, yet the impact on these variables remains unknown. METHOD: This is a quantitative observational study, conducted in a Portuguese hospital, with 403 registered nurses. A self-completion questionnaire was used. RESULTS: The impact on the Structure and Outcome components of nursing professional practice environments was positive. Although the Process component remained favourable to quality of care, a negative trend was confirmed in almost all dimensions. The results regarding safety culture showed weaknesses; 'teamwork within units' was the only dimension that maintained a positive culture. CONCLUSION: Positive responses regarding patient safety were significantly associated with the quality of the nursing professional practice environment. The need to invest in all dimensions of safety culture emerges to promote positive professional environments. IMPLICATIONS FOR NURSING MANAGEMENT: Improving professional nursing practice environments can be achieved through managers' investment in the participation and involvement of nurses in the policies and functioning of institutions, as well as promoting an open, fair and participatory safety culture that encourages reporting events and provides adequate support for professionals.

The COVID-19 Pandemic and Professional Nursing Practice in the Context of Hospitals.

The COVID-19 pandemic has imposed challenges to health systems and institutions, which had to quickly create conditions to meet the growing health needs of the population. Thus, this study aimed to assess the impact of COVID-19 on professional nursing practice environments and to identify the variables that affected their quality. Quantitative, observational study, conducted in 16 Portuguese hospitals, with 1575 nurses. Data were collected using a questionnaire and participants responded to two different moments in time: the pre-pandemic period and after the fourth critical period of COVID-19. The pandemic had a positive impact on the Structure and Outcome components, and a negative trend in the Process component. The variables associated with the qualification of the components and their dimensions were predominantly: work context, the exercise of functions in areas of assistance to COVID-19 patients, length of professional experience and length of experience in the service. The investment in professional practice environments impacted the improvement of organizational factors, supporting the development of nurses' work towards the quality of care. However, it is necessary to invest in nurses' participation, involvement and professional qualifications, which are aspects strongly dependent on the institutions' management strategies.

Environments of professional nursing practice in the context of the COVID-19 pandemic.

BACKGROUND: Although COVID-19 attracted attention to the environments of professional nursing practice, triggering a series of responses to address some of the most pressing problems, it is important to identify the size and scope of other weaknesses that have emerged. METHODS: In an observational and cross-sectional study, using the Scale for the Evaluation of the Environment of Professional Nursing Practice, 752 nurses from a Portuguese university hospital, provided socio-demographic and professional data about the components structure, process and outcome of their professional nursing environment. Data collection took place from June 1-30, 2020, immediately after the first critical period of the COVID-19 pandemic in Portugal. RESULTS: In the analysed environment of professional nursing practice, Process factors were favourable to the quality of care, while the Structure and Outcome factors had a moderately favourable effect. Structure factors related to work contexts (P < .001) and nursing functions in patient care areas with COVID-19 (P = .001). Process factors related significantly to work contexts (P < .001). A significant association was found between Outcome factors and work contexts (P < .001) and nursing functions in patient care areas with COVID-19 (P = .005). CONCLUSION: The environments of professional nursing practice in the hospital under study are moderately favourable to the quality of care. However, the need to invest in nurses' participation, involvement and professional qualification is clear. Maintenance of a sustainable nursing workforce requires attention to be given to ensuring that practice environments are conducive to the quality of care and geared to promoting professional involvement and job satisfaction among nurses.

Effects of demographic and clinical character on differences in self-care behavior levels with arteriovenous fistula by hemodialysis patients: An ordinal logistic regression approach.

INTRODUCTION: Hemodialysis (HD) patients should be trained to develop self-care behaviors in order to prevent and preserve their arteriovenous fistula (AVF). The aim of this study was identifying the factors that affect the levels of self-care behavior with AVF by HD patients. METHODS: A cross-sectional study was conducted involving 89 patients. RESULTS: Self-care levels were negatively affected by patients' location (Azores) and positively affected by marital status, education, employment, AVF duration, and absence of complications with the AVF. Concerning the management of signs and symptoms, self-care levels were negatively affected by patients' location. Regarding prevention of complications, self-care levels were negatively affected by age and marital status and positively affected by marital status, employment, chronic kidney disease etiology, AVF duration, and previous AVF. CONCLUSION: Further studies are required in order to confirm whether the considered factors affect levels of self-care behaviors with AVF, or whether other factors are needed as well.

Noise levels in the dialysis unit and its relationship with sleep quality and anxiety in patients receiving HD: A pilot study.

INTRODUCTION: HD unit is a noisy environment for patients, and noise can affect anxiety levels and sleep quality. METHODS: The aim of the study is to determine noise level, the relationship between noise levels, and sleep quality and anxiety in patients in HD unit. A descriptive and observational study design was used. Three Benetech GM1351 manual sound-level meters were used to measure noise. A patient information form, the State Anxiety Inventory, and the modified Post-Sleep Inventory were used for data collection. RESULTS: The noise range detected in the HD unit ranges from 48.40 to 72 dB(A). Our findings show that patients in the HD unit are exposed to high noise levels and the noise significantly negatively impacts quality of sleep and anxiety level of the patients. CONCLUSIONS: It is important to be aware that HD patients are constantly exposed to high levels of noise and to plan nursing interventions to reduce this noise level.

Arteriovenous fistula cannulation in hemodialysis: A vascular access clinical practice guidelines narrative review.

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.

Ruptured arteriovenous fistula pseudoaneurysm treatment by balloon-assisted direct percutaneous thrombin injection.

We present the case of a male patient on hemodialysis with a ruptured pseudoaneurysm in a brachiocephalic arteriovenous fistula (AVF) and with edema and pain in the right arm attended to in the emergency department. An ultrasonographic scan identified a ruptured pseudoaneurysm with hemorrhagic infiltration of the arm muscular tissues. We performed a percutaneous ultrasound-guided thrombin injection with an angioplasty balloon inflated in the lumen of the AVF achieving the pseudoaneurysm thrombosis. After 6 months of follow-up, the patient's arteriovenous access remains functional. Percutaneous ultrasound-guided thrombin injection assisted by an angioplasty balloon may be a good alternative to surgical intervention in the treatment of symptomatic growing pseudoaneurysms of the arteriovenous fistula with the benefit of preserving the vascular access.