Abstract:

Objective To establish a real-time ultrasound-guided arteriovenous fistula puncture process and to provide guidance for improving the safety and quality of nursing operations and teaching. Methods From April 2024 to June 2024，the first draft of ultrasound-guided arteriovenous fistula puncture procedure was prepared through literature review and group decision making. Delphi expert letter consultation was used to determine the final draft of ultrasound-guided arteriovenous fistula puncture process. After receiving corresponding training，nurses applied this process in clinical practice for puncture of internal venous fistulas. Results Two rounds of expert consultation were carried out. The effective recovery rate of the first round was 94%（15/16），and that of the second round was 100%（15/15）. The expert authority coefficient of the second round was 0.930， the Kendall harmony coefficient was 0.140 and the coefficient of variation was 0~0.166. In the end，an ultrasound-guided arteriovenous fistula puncture process with nine primary steps and 35 secondary steps was formed. The average importance score of each step was 4.47~5.00. Ten nurses used this procedure to perform ultrasound-guided puncture 98 times，and the success rate of one puncture was 95%. Conclusion The established process of ultrasound-guided arteriovenous fistula puncture is scientific，and its feasibility and practicability have been confirmed in the preliminary clinical application，which provides a reference for the homogenization of ultrasound-guided puncture operation of arteriovenous fistula in hemodialysis patients.

Key words: Arteriovenous fistula, Puncture, Real-time ultrasound guidance, Delphi method, Operating procedures