Authors (including presenting author) :
Chan CH(1), Au CP(1), Lee SH(1), Wong WYS(1), Ho LF(1), Zao YK(1), Tang MKC(1)
Affiliation :
(1) Medicine and Geriatrics, Princess Margaret Hospital
Introduction :
USG is an accessible and non-invasive tool to assess patient’s AVF function and assist difficult vascular access cannulation. USG can locate and quantify suspected stenosis through direct imaging of vascular structure and capturing undesirable changes of blood flow parameters at the point of care. It is a cost-effective measure for evaluation of vascular maturation, prospective vascular surveillance and early identification of complications, which may facilitate early referral for further interventions. Maintenance of well-functioning vascular access is essential for smooth continuation of HD treatment. National Kidney Foundation K/DOQI suggests early detection of vascular dysfunction and proper cannulation technique may improve longevity of vascular access.
Objectives :
-To improve successful cannulation rate in new vascular access and assist in difficult cannulation. -To early detect vascular dysfunction and provide timely care and referral. -To facilitate Nocturnal Home Hemodialysis training.
Methodology :
Since October 2017 with a new USG machine available in renal unit, renal nurses are eager to learn and to apply this advanced technology to improve patient care and renal services. USG is mainly used on patients with suspected vascular access dysfunction, assisting cannulation and monitoring of vascular access function in Nocturnal Home Hemodialysis (NHHD) patients during training. Two HD cases with positive vascular outcomes after bed-side USG application were selected for case sharing
Result & Outcome :
Case 1: Patient complained decreased thrill over AVF before HD, renal nurse performed a timely bedside assessment with USG on patient’s AVF and identified a thrombus inside the AVF. Prompt referral to Medical Officer for urgent intervention was done, and patient’s AVF was salvaged successfully.
Case 2: Multiple failures of cannulation with infiltration or double puncture were noted during NHHD training. USG-assisted cannulation improved the successful rate of cannulation on the difficult AVF. It is a good tool to improve both nurse and patient confident on cannulation. During use of USG for cannulation, a thrombus was incidentally found over venous limb of AVF. Confirmative fistulogram was arranged and confirmed moderate stenosis (50-70%); 2.5cm in length over the venous limb about 3cm from the AV anastomosis. Early and proactive angioplasty was arranged to patient with no significant residual stenosis resulted. Smartly use of USG on patient’s vascular access to early identify problems and assist cannulation can benefit to both nurse and patient. It can improve the successful cannulation of difficult AVF, and strengthen nurses’ confidence on vascular access management. Hence, renal nurses are encouraged to equip with this advanced skill of USG usage to provide high quality care in HD unit.
Co-location with:
