Bundle of Care Promotes Arteriovenous Fistula Maturity in Patients with End-Stage Kidney Disease.

BACKGROUND: Arteriovenous fistula (AVF), as the hemodialysis access, has the advantages of safety, sufficient blood flow, and long use time. To establish an ideal AVF, patients require good vascular condition. However, many teams often neglect preoperative preparation and exercises and have no concept of specialized nursing or bundle of care, directly leading to stenosis of the outflow tract and seriously affected surgical efficacy. This study aimed to evaluate the influence of bundle of care on AVF. METHODS: A total of 260 patients with end-stage kidney disease were included from January 2019 to December 2020 at Qilu Hospital, Shandong University. Patients were divided into 2 groups, and were treated with ordinary nursing care (the control group) or bundle of care (the observation group). Maturity of AVF fistula and postoperative complications were compared between 2 groups. RESULTS: The observation group was associated with larger internal diameter of the cephalic vein (6.524 ± 0.347 vs. 6.346 ± 0.32 4 mm) and faster blood flow at the anastomosis of AVF (568.2 ± 26.8 vs. 565.7 ± 27.5 mL/min) than the control group at 2 weeks after surgery (both P < 0.05). The observation group had a higher maturity rate than the control group (93.1% vs. 81.5%, P < 0.05) at 8 weeks after surgery. There were lower incidences of fistula stenosis (4.6% vs. 10.8%) and fistula thrombosis (2.3% vs. 7.7%) in the observation group than in the control group (both P < 0.05). The secondary patency was higher in the observation group than in the control group (97.7% vs. 92.3%, P < 0.05). CONCLUSIONS: The use of bundle of care promotes AVF maturity and reduces postoperative complications in patients with end-stage kidney disease.

Comparison of arteriovenous fistulas constructed with main or internal branch of the cephalic vein: a retrospective analysis of 32 cases.

OBJECTIVE: To evaluate the effect on the maturation of arteriovenous fistulas (AVFs) when using the internal branch of the cephalic vein compared with the main branch of the cephalic vein. METHODS: The study enrolled patients with end-stage renal disease and divided them into an internal branch group (AVF constructed using the internal branch of the cephalic vein) or a main branch group (AVF constructed using the main branch of the cephalic vein). The surgical outcomes including complications were observed in these patients after 12 weeks. RESULTS: Thirty-two patients with end-stage renal disease were included in the study. There were 16 patients in each group. The demographic and clinical characteristics were not significantly different between the two groups. The diameter of the arteries and veins were not significantly different between the two groups before the operation. In the internal branch group, significantly more (n = 7) patients failed to mature or required surgical intervention compared with the main branch group (n = 1). CONCLUSION: For veins of the same diameter, these findings suggest that constructing AVFs using the main branch of the cephalic vein instead of the internal branch was more suitable for patients with end-stage renal disease requiring haemodialysis.