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Session 3: Concurrent 1.5
Concurrent Session
Concurrent Session
1:45 pm
13 June 2024
P9
Themes
Vascular Access
Session Description
Session Chair: Ignatius Abraham
Session Program
1:45 pm
432Q - Research Paper
Abstract
Aim:
We aimed to evaluate the effects of AVF dysfunction and repeated surgical interventions on the quality of life of haemodialysis patients, and to identify strategies that balance maintaining quality of life and prolonging life.
Method:
This project utilised patient surveys to assess the impact of AVF dysfunction and the frequency of surgical interventions on quality of life. The rationale was that these interventions could potentially address the identified problems by reducing complications and enhancing patient well-being.
Results:
The surveys revealed four main themes: the effects of dialysis, treatment priorities, consequences of frequent surgeries, and satisfaction with AVFs. Dialysis mainly impacted patients' independence. Survival was the top priority for patients, followed by a desire to reduce dialysis sessions. The major issue with repeated surgeries was the disruption of daily activities. In terms of AVF satisfaction, the main problem was its failure, and the most frequent complaint was pain during use.
Conclusion:
The findings support the notion that minimising AVF complications and the need for repeated surgeries can significantly enhance the quality of life for haemodialysis patients. This project underscores the importance of considering patient well-being alongside the extension of life. Future directions include broader implementation of less invasive techniques and ongoing evaluation of their impact on patient outcomes.
Abstract
Aim:
We aimed to evaluate the effects of AVF dysfunction and repeated surgical interventions on the quality of life of haemodialysis patients, and to identify strategies that balance maintaining quality of life and prolonging life.
Method:
This project utilised patient surveys to assess the impact of AVF dysfunction and the frequency of surgical interventions on quality of life. The rationale was that these interventions could potentially address the identified problems by reducing complications and enhancing patient well-being.
Results:
The surveys revealed four main themes: the effects of dialysis, treatment priorities, consequences of frequent surgeries, and satisfaction with AVFs. Dialysis mainly impacted patients' independence. Survival was the top priority for patients, followed by a desire to reduce dialysis sessions. The major issue with repeated surgeries was the disruption of daily activities. In terms of AVF satisfaction, the main problem was its failure, and the most frequent complaint was pain during use.
Conclusion:
The findings support the notion that minimising AVF complications and the need for repeated surgeries can significantly enhance the quality of life for haemodialysis patients. This project underscores the importance of considering patient well-being alongside the extension of life. Future directions include broader implementation of less invasive techniques and ongoing evaluation of their impact on patient outcomes.
2:00 pm
455Q - Research Paper
Abstract
Aim:
This initiative aimed to improve surveillance of AVFs, where early identification of problematic or failing AVF's, ensured intervention was timely, non-disruptive for the patient, and reduced the requirement for central venous access devices (CVAD's).
Method:
The clinical lead became an experienced USGC training provider for the team. The first statewide clinical procedure in USGC was developed and fully endorsed through quality systems. A task trainer model was used to "practice" USGC prior to cannulating patients AVF's. Logbooks of all USGC's enabled self reflection, aimed at improving skill and building confidence. Logs also provided the experience of USGC from the patients perspective. "Needle-Viz", "Bi-plane" and "Teleguidance" in POCUS have all been integrated into the USGC technologies in the unit.
Results:
Staff gained knowledge and confidence in using POCUS and USGC. Demonstrated 100% accuracy in all USGC's.
Increased number of "new" sites being cannulated reducing associated complications. Positive patient and staff feedback of their experiences with USGC.
Conclusion:
POCUS assists to improve surveillance of AVF's at a unit level, and if problems are identified early, it reduces unnecessary cost to healthcare services and inconvenience for the patient. USGC promotes longevity of AVF's with precision of cannulation, reduced number of missed cannulations, and new sites being cannulated. The limitations of this project is generalisability to larger units which may differ. The author declares no conflict of interest in regards to authorship.
Abstract
Aim:
This initiative aimed to improve surveillance of AVFs, where early identification of problematic or failing AVF's, ensured intervention was timely, non-disruptive for the patient, and reduced the requirement for central venous access devices (CVAD's).
Method:
The clinical lead became an experienced USGC training provider for the team. The first statewide clinical procedure in USGC was developed and fully endorsed through quality systems. A task trainer model was used to "practice" USGC prior to cannulating patients AVF's. Logbooks of all USGC's enabled self reflection, aimed at improving skill and building confidence. Logs also provided the experience of USGC from the patients perspective. "Needle-Viz", "Bi-plane" and "Teleguidance" in POCUS have all been integrated into the USGC technologies in the unit.
Results:
Staff gained knowledge and confidence in using POCUS and USGC. Demonstrated 100% accuracy in all USGC's.
Increased number of "new" sites being cannulated reducing associated complications. Positive patient and staff feedback of their experiences with USGC.
Conclusion:
POCUS assists to improve surveillance of AVF's at a unit level, and if problems are identified early, it reduces unnecessary cost to healthcare services and inconvenience for the patient. USGC promotes longevity of AVF's with precision of cannulation, reduced number of missed cannulations, and new sites being cannulated. The limitations of this project is generalisability to larger units which may differ. The author declares no conflict of interest in regards to authorship.
2:15 pm
133R - Research Paper
Abstract
Aim:
To examine the effectiveness of educational and behavioural interventions designed to improve self-management of long-term vascular access in adults receiving haemodialysis.
Method:
A systematic review ofEnglish language publicationsfrom January 2013 to May 2023 retrieved from PubMed, Embase, CINAHL, Cochrane Library, PsycINFO and Joanna Briggs Institute (JBI) databases was undertaken. Two review authors identified studies for full review, data extraction and quality assessment. Data synthesis and quality assessment followed the JBI guideline for quantitative review and JBI critical appraisal tool. The review was prospectively registered with PROSPERO (CRD42023414193).
Results:
Seven studies involving 540 participants were included; two studies were randomised control trials and five were quasi-experimental. All studies involved patient education, predominately provided by nurses, and employing a variety of teaching resources such as education booklets, practical demonstrations, videos, and other patients’ experiences. The self-management assessment tools varied among the studies. Outcomes measured included vascular access self-management behaviours, self-efficacy, and vascular access knowledge, and results revealed significant improvements post educational interventions.
Conclusion:
Educational and behavioural interventions improved self-management behaviours of patients with long-term vascular access. However, there were inconsistencies in self-management interventions. An evidence-based nurse-led self-management education intervention could lead to improvements in vascular self-management.
Abstract
Aim:
To examine the effectiveness of educational and behavioural interventions designed to improve self-management of long-term vascular access in adults receiving haemodialysis.
Method:
A systematic review ofEnglish language publicationsfrom January 2013 to May 2023 retrieved from PubMed, Embase, CINAHL, Cochrane Library, PsycINFO and Joanna Briggs Institute (JBI) databases was undertaken. Two review authors identified studies for full review, data extraction and quality assessment. Data synthesis and quality assessment followed the JBI guideline for quantitative review and JBI critical appraisal tool. The review was prospectively registered with PROSPERO (CRD42023414193).
Results:
Seven studies involving 540 participants were included; two studies were randomised control trials and five were quasi-experimental. All studies involved patient education, predominately provided by nurses, and employing a variety of teaching resources such as education booklets, practical demonstrations, videos, and other patients’ experiences. The self-management assessment tools varied among the studies. Outcomes measured included vascular access self-management behaviours, self-efficacy, and vascular access knowledge, and results revealed significant improvements post educational interventions.
Conclusion:
Educational and behavioural interventions improved self-management behaviours of patients with long-term vascular access. However, there were inconsistencies in self-management interventions. An evidence-based nurse-led self-management education intervention could lead to improvements in vascular self-management.
2:30 pm
477C - Research Paper
Abstract
Case Description:
84 female presented to emergency department with left BB AVF swelling, pain, hematoma, unable to have dialysis.Day of presentation patient attended regular HD treatment at satellite unit, experienced acute pain and left breast swelling on venous needle insertion, unable to progress cannulation and haemodialysis.Patient transferred to acute tertiary hospital for management and treatment.
Discussion:
On arrival to emergency department, urgent chest x-ray, left BB AVF USS performed – demonstrated large hematoma and stent fracture. Angio fistuloplasty intervention demonstrated blown fistula psuedoaneurym on stent site.Fistuloplasty intervention with sedation, Wrapsody covered stent was successfully performed, with needling location sites marked. Patient had haemodialysis treatment following intervention, and inpatient admission post dialysis.
Conclusion:
This case demonstrates the high risk involved with cannulating a vascular access where multiple interventions including stenting have been performed. The importance of AVF assessment, site selection, US guidance for cannulation and resources available in and after hours for immediacy of patient care & intervention when things don’t go to plan.
Abstract
Case Description:
84 female presented to emergency department with left BB AVF swelling, pain, hematoma, unable to have dialysis.Day of presentation patient attended regular HD treatment at satellite unit, experienced acute pain and left breast swelling on venous needle insertion, unable to progress cannulation and haemodialysis.Patient transferred to acute tertiary hospital for management and treatment.
Discussion:
On arrival to emergency department, urgent chest x-ray, left BB AVF USS performed – demonstrated large hematoma and stent fracture. Angio fistuloplasty intervention demonstrated blown fistula psuedoaneurym on stent site.Fistuloplasty intervention with sedation, Wrapsody covered stent was successfully performed, with needling location sites marked. Patient had haemodialysis treatment following intervention, and inpatient admission post dialysis.
Conclusion:
This case demonstrates the high risk involved with cannulating a vascular access where multiple interventions including stenting have been performed. The importance of AVF assessment, site selection, US guidance for cannulation and resources available in and after hours for immediacy of patient care & intervention when things don’t go to plan.
431Q - Research Paper
Abstract
Aim:
We aimed to evaluate the impact of various VA options on the outcomes of elderly patients undergoing HD, focusing on identifying the most effective and safe VA methods.
Method:
This study employed a comprehensive evaluation of elderly HD patients' outcomes following different VA interventions, including arteriovenous grafts (AVG) and central venous catheters (CVC), as alternatives to fistula creation. The rationale behind these interventions was the high risk of fistula failure and the potential for non-use due to patient mortality before dialysis initiation.
Result:
The findings indicated an understanding of VA efficacy in elderly HD patients, showing that while traditional fistula creation remains a gold standard, alternative VA methods like AVGs or CVCs can offer viable solutions for patients with significant comorbidities or those at a higher risk of not utilising a fistula. These alternatives demonstrated varying degrees of success.
Conclusion:
While arteriovenous fistula creation should not be disregarded for elderly patients, individualised assessments are crucial to determining the most appropriate VA option. This tailored approach could significantly enhance treatment outcomes and quality of life for elderly HD patients.
Abstract
Aim:
We aimed to evaluate the impact of various VA options on the outcomes of elderly patients undergoing HD, focusing on identifying the most effective and safe VA methods.
Method:
This study employed a comprehensive evaluation of elderly HD patients' outcomes following different VA interventions, including arteriovenous grafts (AVG) and central venous catheters (CVC), as alternatives to fistula creation. The rationale behind these interventions was the high risk of fistula failure and the potential for non-use due to patient mortality before dialysis initiation.
Result:
The findings indicated an understanding of VA efficacy in elderly HD patients, showing that while traditional fistula creation remains a gold standard, alternative VA methods like AVGs or CVCs can offer viable solutions for patients with significant comorbidities or those at a higher risk of not utilising a fistula. These alternatives demonstrated varying degrees of success.
Conclusion:
While arteriovenous fistula creation should not be disregarded for elderly patients, individualised assessments are crucial to determining the most appropriate VA option. This tailored approach could significantly enhance treatment outcomes and quality of life for elderly HD patients.
3:00 pm
Speaker: Kay McLaughlin
Presenter: Amanda Luke