血液透析患者疑难自体动静脉内瘘扣眼穿刺管理方案的设计与临床实证研究

doi:10.3761/j.issn.1672-9234.2024.09.017

Abstract

Abstract:

Objective To establish a management program for difficult autologous arteriovenous fistula buttonhole puncture and to explore its application effect in hemodialysis patients. Methods Based on literature review and expert consultation，a management program for difficult autologous arteriovenous fistula buttonhole puncture was developed. A buttonhole puncture information handover sheet and a buttonhole puncture diagram were designed. A total of 77 hemodialysis patients with difficult autologous arteriovenous fistula treated in the blood purification center of a tertiary hospital in Zhejiang Province from September 2020 to January 2022 were selected as the study subjects. They were randomly divided into the experimental group（n=38） and the control group（n=39） using a random number table. The experimental group received the management program for difficult autologous arteriovenous fistula buttonhole puncture，while the control group received the conventional buttonhole puncture program. The success rate of one-time blunt needle insertion，arteriovenous fistula infection rate，vascular intimal hyperplasia at the buttonhole puncture site，and buttonhole with a service life of ≥12 months rate were compared between the two groups. Results The success rate of one-time blunt needle insertion in the experimental group was higher than that in the control group，the degree of vascular intimal hyperplasia at the buttonhole puncture site was lower than that in the control group，and the buttonhole with a service life of ≥12 months rate was higher than that in the control group （P<0.05）. There was no significant difference in the arteriovenous fistula infection rate between the two groups（P>0.999）. Conclusion The application of the management program for difficult autologous arteriovenous fistula buttonhole puncture in hemodialysis patients can improve the success rate of one-time blunt needle insertion，delay vascular intimal hyperplasia at the buttonhole puncture site，and prolong the service life of arteriovenous fistula buttonholes，which is worthy of promotion and application.

Key words: Hemodialysis, Difficult arteriovenous fistula, Buttonhole puncture, Randomized Controlled Trails, Nursing

CHAI Jianli, WU Chunyan, YUAN Aiqin, LUO Puying, FENG Jian, LU Mingxi. Application of the buttonhole puncture management program for difficult autologous arteriovenous fistula in hemodialysis patients[J].Chinese Journal of Nursing Education, 2024, 21(9): 1132-1140.

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References 25

[1]	陈香美. 血液净化标准操作规程:2010版[M]. 北京: 人民军医出版社, 2010.
[2]	洪成波, 江瑞, 凌扣荣, 等. 疑难内瘘患者穿刺方法的改良及应用[J]. 中华护理杂志, 2020, 55(5):727-730. doi: 10.3761/j.issn.0254-1769.2020.05.0019
	Hong CB, Jiang R, Ling KR, et al. Application of zero-pressure modified puncture technique in hemodialysis patients with difficult arteriovenous fistula[J]. Chin J Nurs, 2020, 55(5):727-730. doi: 10.3761/j.issn.0254-1769.2020.05.0019
[3]	Lok CE, Huber TS, Lee T, et al. KDOQI clinical practice guide-line for vascular access:2019 update[J]. Am J Kidney Dis, 2020, 75(4Suppl 2): S1-S164.
[4]	吴春燕, 蒋欣欣, 王文娟, 等. 扣眼穿刺法在自体动静脉内瘘中的应用进展[J]. 中华护理杂志, 2013, 48(11):1033-1035.
	Wu CY, Jiang XX, Wang WJ, et al. Progress of application of buttonhole puncture in autologous arteriovenous fistula[J]. Chin J Nurs, 2013, 48(11):1033-1035.
[5]	张尧, 王霄, 杜楠楠, 等. 动静脉内瘘扣眼穿刺处内膜增生特点及停止穿刺的效果观察[J]. 中国血液净化, 2023, 22(5):396-400.
	Zhang Y, Wang X, Du NN, et al. Characteristics of intimal hyperplasia at the buttonhole puncture segments of arteriove-nous fistula and the effect of discontinuing the puncture[J]. Chin J Blood Purif, 2023, 22(5):396-400.
[6]	赵秀明, 牛洪艳, 刘金凤, 等. 血液透析行扣眼穿刺患者动静脉内瘘发生内膜增生的影响因素分析[J]. 中国血液净化, 2023, 22(9):710-714.
	Zhao XM, Niu HY, Liu JF, et al. The influencing factors for the intimal hyperplasia in arteriovenous fistula in patients with buttonhole puncture for hemodialysis[J]. Chin J Blood Purif, 2023, 22(9):710-714.
[7]	董永泽, 许秀君, 沈华娟, 等. 维持性血液透析患者动静脉血管通路穿刺管理的最佳证据总结[J]. 中华护理杂志, 2023, 58(9):1135-1141. doi: 10.3761/j.issn.0254-1769.2023.09.016
	Dong YZ, Xu XJ, Shen HJ, et al. Summary of the best evidence for the management of arteriovenous access cannula-tion in maintenance hemodialysis patients[J]. Chin J Nurs, 2023, 58(9):1135-1141. doi: 10.3761/j.issn.0254-1769.2023.09.016
[8]	傅丽丽, 黄龙. 智能掌上超声诊断仪在疑难动静脉内瘘穿刺中的应用[J]. 中国血液净化, 2018, 17(8):539-541.
	Fu LL, Huang L. The application of intelligent handheld ultra-sound diagnostic instrument for difficult puncture of arteriove-nous arteriovenous fistula[J]. Chin J Blood Purif, 2018, 17(8):539-541.
[9]	吴爱纯, 张璜, 吴磊. 彩色多普勒超声引导较深动静脉新内瘘穿刺的临床应用[J]. 中国实用护理杂志, 2020, 36(1):36-41.
[10]	王冠群, 刘苗, 肖燕. 透析用留置针在自体动静脉内瘘扣眼穿刺建立隧道中应用[J]. 中国血液净化, 2020, 19(7):500-502.
	Wang GQ, Liu M, Xiao Y. Application of indwelling needle for AVF buttonhole puncture to establish tunnel for dialysis[J]. Chin J Blood Purif, 2020, 19(7):500-502.
[11]	中国医院协会血液净化中心分会血管通路工作组. 中国血液透析用血管通路专家共识(第2版)[J]. 中国血液净化, 2019, 18(6):365-381.
	Blood Access Working Group, Branch of Blood Purification Center Management, Chinese Hospital Association. Consensus among experts on blood access used for hemodialyis in China(The 2nd edition)[J]. Chin J Blood Purif, 2019, 18(6):365-381.
[12]	Vrtovsnik F, Brunet P, Chauveau P, et al. Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults[J]. Nephrol Ther, 2020, 16(6):376-386. doi: 10.1016/j.nephro.2020.05.002 pmid: 33139227
[13]	Kukita K, Ohira S, Amano I, et al. 2011 update Japanese society for dialysis therapy guidelines of vascular access con-struction and repair for chronic hemodialysis[J]. Ther Apher Dial,2015, 19(Suppl 1):1-39.
[14]	UK Kidney Association. UK Kidney Association Clinical Practice Guideline Vascular Access for Haemodialysis[EB/OL].(2023-04-12). https://ukkidney.org/sites/renal.org/files/FINAL%20FOR-MATTED%20Vascular%20access%20for%20haemodialysis%20April%202023.pdf.
[15]	Schmidli J, Widmer MK, Basile C, et al. Editor’s choice-vascular access:2018 clinical practice guidelines of the European Society for Vascular Surgery(ESVS)[J]. Eur J Vasc Endovasc Surg,2018, 55(6):757-818.
[16]	Cheng YL, Tang HL, Tong MKL. Clinical practice guidelines for the provision of renal service in Hong Kong:Haemo-dialysis[J]. Nephrology(Carlton), 2019, 24(Suppl 1):41-59.
[17]	Wasse H, Alvarez AC, Brouwer-Maier D, et al. Patient selection,education,and cannulation of percutaneous arteriovenous fistulae:an ASDIN white paper[J]. J Vasc Access, 2020, 21(6):810-817.
[18]	Allon M, Berns JS. Overview of hemodialysis arteriovenous graft maintenance and thrombosis prevention[EB/OL].(2021-02-02). https://www.uptodate.com/contents/overview-of-hemodia-lysis-arteriovenous-graft-maintenance-and-thrombosis-prevention.
[19]	王慧, 孙秀丽, 吴红梅, 等. 新建立自体动静脉内瘘首次穿刺时间对内瘘预后影响的系统评价和Meta分析[J]. 中国血液净化, 2018, 17(2):107-113.
[20]	Vascular Access Special Interest Group. Clinical Practice Recommendations for Needling of Arteriovenous Fistulae and Grafts for Haemodialysis[EB/OL]. (2018-09-03). https://www.vasbi.org.uk/media/resources/needling_guidelines2018.pdf.
[21]	Marticorena RM, Dacouris N, Donnelly SM. Randomized pilot study to compare metal needles versus plastic cannulae in the development of complications in hemodialysis access[J]. J Vasc Access, 2018, 19(3):272-282. doi: 10.1177/1129729817747535 pmid: 29772982
[22]	Yin JM, Tian ZW, Li PQ, et al. A time-saving method of creating AVF buttonholes:indwelling trocar technique[J]. J Clin Nurs, 2022, 31(21/22):3102-3109.
[23]	陈荣荣, 俞燕, 范亚平. 动静脉内瘘血管内膜增生的细胞和分子病理机制[J]. 肾脏病与透析肾移植杂志, 2016, 25(5):475-478,455.
[24]	Rønning MI, Benschop WP, Øvrehus MA, et al. Direction- and angle-assisted buttonhole cannulation of arteriovenous fistula in hemodialysis patients:a multicenter randomized controlled trial[J]. Kidney Med, 2022, 4(2):100393.
[25]	Shigeki T. Relationship between years elapsed after initial buttonhole cannulation and frequency of vascular access-related infections[J]. Contrib Nephroly, 2015,186:57-63.

Application of the buttonhole puncture management program for difficult autologous arteriovenous fistula in hemodialysis patients

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