Arteriovenous Fistula (AVF) Self-Care: A Study at a Tertiary Care Hospital in Lahore, Pakistan

Abstract

Most complications associated with the use of arteriovenous fistula (AVF) access site for hemodialysis can be prevented by adopting a daily self-care plan for AVF access site. Therefore, the aim of this study was set to assess the knowledge, attitude and practice (KAP) about self-care of AVF access site amongst end stage renal disease (ESRD) patients who are on maintenance hemodialysis. Methods: This comparative cross sectional study with quantitative approach was carried out in hemodialysis unit of Shalamar Institute of Health Sciences, Lahore for the month of July, 2017. All patients with ESRD, on maintenance hemodialysis through an AVF access for at least last 30 days, were included in the study. Each patient was given a questionnaire comprising of 21 questions during his/her routine dialysis. Knowledge of ESRD patients was categorized into poor (<50%), average (50-70%) and good (> 70%). Results: Out of 138 patients, 94% had good knowledge about AVF self-care and 99% had good attitude about AVF access care. However a few practices like daily AVF thrill checkup, pre-hemodialysis AVF site washing and pre and post hemodialysis disinfection were not in correspondence with the level of knowledge representing a discrepancy between knowledge and practice in some aspects of the of the AVF care. Knowledge scores when compared between different age groups, greater proportion of patients between age of 45- 65 (p<0.017) possessed good knowledge as compared to age groups of 25-45, 65-85 years. Conclusion: Despite good understanding and adequate attitude, few practices were not being followed in parallel to the knowledge acquisition. Therefore, regular reminder and periodic evaluation of practical aspects of AVF care is recommended for each ESRD patient visiting for hemodialysis.

Knowledge of arteriovenous fistula care in patients with end-stage kidney disease in south Asian countries: A systematic review and meta-analysis

“…There were a total of seven studies: two from Nepal conducted in the years 2019 and 2021, 29,30 three from Pakistan conducted in the years 2013 and 2018, [31][32][33] and two from India conducted in the years 2012 and 2020. 34,35 Study designs and sampling techniques were clearly defined in all the studies except for Rashid et al, 32 who did not mention the sampling technique. Besides the two studies from India, 34,35 the authors in the other studies mentioned the duration of the study.…”

“…Around 94% of participants reported knowledge of checking AVF thrill regularly. 32 Abraham et al 35 reported that 49% of the subjects had poor knowledge and practice in checking AVF thrills. Some participants had a poor practice of checking the thrill even after having adequate knowledge of self-care.…”

“…Some participants had a poor practice of checking the thrill even after having adequate knowledge of self-care. 32,35 Knowledge regarding continuous management of AVF Shrestha et al 29 evidenced that most of the people were aware of protecting the AVF arm from injuries. The article also reported good knowledge about avoiding blood pressure measurement on the AVF arm and avoiding carrying heavy items.…”

“…Rashid et al reported good self-care knowledge in patients with compliance to AVF arm weight avoidance and needle pricking. 32 Patients reported a lack of knowledge regarding the disinfection of the AVF access site prior to cannulation and were unaware of the consequences of wearing tight clothes. Aspects of AVF care like hemostasis at the fistula site, prevention of hematoma after dialysis, and arm elevation to prevent swelling of the access site were least common in patients as reported by Iqbal et al 31 They also reported that around 37% of patients were unaware of the importance of washing the AVF arm with soap and water prior to dialysis.…”

“…Also, advice regarding follow-up was better rendered by nephrologists (55.8%) than physicians (40%). 32,33…”