Patients’ experiences of cannulation of arteriovenous access for haemodialysis: A qualitative systematic review

Abstract

Introduction: Cannulation is an essential part of haemodialysis with arteriovenous access. Patients’ experiences of cannulation for haemodialysis are problematic but poorly understood. This review aims to synthesise findings related to patients’ experiences of cannulation for haemodialysis from qualitative studies, providing a fuller description of this phenomenon. Methods: Eligibility criteria defined the inclusion of studies with a population of patients with end-stage kidney disease on haemodialysis. The phenomena of interest was findings related to patients’ experiences of cannulation for haemodialysis and the context was both in-centre and home haemodialysis. MedLine, CINAHL, EMBASE, EMCARE, BNI, PsycInfo and PubMed were last searched between 20/05/2019 and 23/05/2019. The quality of studies was assessed using the using Joanna Briggs Critical Appraisal Checklist for Qualitative Research. Meta-aggregation was used to synthesise findings and CERQual to assess the strength of accumulated findings. Results: This review included 26 studies. The subject of included studies covered cannulation, pain, experiences of vascular access, experiences of haemodialysis and a research priority setting exercise. From these studies, three themes were meta-aggregated: (1) Cannulation for haemodialysis is an unpleasant, abnormal and unique procedure associated with pain, abnormal appearance, vulnerability and dependency. (2) The necessity of cannulation for haemodialysis emphasises the unpleasantness of the procedure. Success had multiple meanings for patients and patients worry about whether the needle insertion will be successful. (3) Patients survive unpleasant, necessary and repetitive cannulation by learning to tolerate cannulation and exerting control over the procedure. Feeling safe can help them tolerate cannulation better and the cannulator can invoke feeling safe. However, some patients still avoid cannulation, due to its unpleasantness. Conclusions: Cannulation is a pervasive procedure that impacts on patients’ experiences of haemodialysis. This review illuminates further patients’ experiences of cannulation for haemodialysis, indicating how improvements can be made to cannulation. Registration: PROSPERO (CRD42019134583).

Perspectives and Experiences Regarding the Creation of Arteriovenous Fistulas for Hemodialysis Access: A Rapid Qualitative Review

“…The included studies also reported that patients weigh multiple factors when deciding whether to undergo procedures to create AVFs� Patients were more likely to undergo procedures to create AVFs if a provider they trusted recommended them� However, patients often weighed the nature of past experiences with vascular access more heavily than health care providers' recommendations� Furthermore, both patients and their health care providers considered surgical procedures to create AVFs to be invasive� Patients' fears of being cut or experiencing pain or complications from these procedures could hinder their desire to engage in them� Patients also considered the anticipated outcomes of these procedures when deciding whether to undergo them� Concerns about an AVF not maturing or being easily maintained and worries about anticipated needlerelated pain could prevent patients from wanting AVFs� Additional concerns hindering patients' engagement in procedures to create AVFs included those regarding the perceived risk of bleeding, infiltrations, and aneurysms, and the anticipated impact an AVF would have on their physical appearance� The relative risk of infection between AVFs and CVLs was of lesser concern to patients� These findings corroborate those detailed in the extant literature. 15,18,38 Considering these concerns, decisionmakers would benefit from considering research investigating whether:…”

Dialysis Needle-Related Distress: Patient Perspectives on Identification, Prevention, and Management

“…Insertion of needles into a large blood vessel is a necessary but invasive and unpleasant experience for many patients receiving hemodialysis through an arteriovenous fistula. 1 Most must undergo the insertion and removal of at least 6 large-bore needles per week, totaling more than 300 needling procedures per year. Needle-related distress influences kidney replacement therapy and vascular access choices, including preferences for and reluctance to remove dialysis catheters.…”

“…Needle-related distress influences kidney replacement therapy and vascular access choices, including preferences for and reluctance to remove dialysis catheters. 1 , 2 , 3 , 4 , 5 Needle-related distress is likely underreported by patients, who accept it as the price for remaining alive with dialysis. 1 , 6 Needle fear has been reported by 25% to 47% of adults receiving dialysis.…”

“… 1 , 2 , 3 , 4 , 5 Needle-related distress is likely underreported by patients, who accept it as the price for remaining alive with dialysis. 1 , 6 Needle fear has been reported by 25% to 47% of adults receiving dialysis. 7 It is not routinely assessed in care and represents a psychological burden for patients and challenge for dialysis nurses to manage.…”

Características sociodemográficas e clínicas de pacientes em terapia hemodialítica

“…19,20 A equipe de enfermagem, em especial o enfermeiro, são os profissionais que possuem maior contato e vivência com o paciente hemodialítico, reconhecendo suas necessidades de saúde e no tratamento da doença. São também responsáveis por promover ações de educação em saúde junto ao paciente, as quais envolve o cuidado do acesso vascular.…”