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Nefroloji Düşük Klirens Polikliniğinde Arteriovenöz Fistülü Hazır Hemodiyalize Başlamayan Hastalarda Arteriovenöz Fistül Eğitimlerinin Değerlendirilmesi: Pilot Çalışma/ Evaluation of Arteriovenous Fistula Training of Follow-Up Patients in Nephrology Low Clirens Outpatient Clinic who Do Not Undergo Hemodialysis with Proper Working Arteriovenous Fistula: A Pilot Study

Yıl 2021, Cilt: 16 Sayı: 1, 10 - 18, 31.01.2021
https://doi.org/10.47565/ndthdt.2021.28

Öz

Amaç: Kronik böbrek hastalığı, önemli bir halk sağlığı sorunudur. Hastaların kronik böbrek hastalığı progresyonları ve komplikasyonlarından
korunması açısından düşük klirens poliklinikleri önemlidir. Renal replasman tedavilerinden hemodiyalize girmeye karar veren hastaların
arteriyovenöz fistüllerinin hazır olarak diyalize geçmeleri hastaları kateter komplikasyonlarından korur. Bu çalışma; düşük klirens polikliniğinde
arteriyovenöz fistülü hazır, hemodiyalize girmeyen hastalara verilen arteriyovenöz fistül bakım eğitimlerini değerlendirmek, eğitim eksiklerini
tespit edip; takip ve eğitimlerinin yeniden düzenlenmesi amacıyla planlandı.  Gereç-Yöntem: Bu çalışmaya Antalya’da bir üniversite hastanesinin

nefroloji düşük klirens polikliniğinde kronik böbrek hastalığı nedeniyletakipte olan ve renal replasman tedavi kararı olarak hemodiyalizi seçmiş,
hemodiyalize girmeyen ve arteriyovenöz fistülü hazır bekleyen; 1-30Haziran 2019 tarihleri arasında kontrole gelen 23 hastadan çalışmaya
katılmaya gönüllü olan toplam 20 hasta dahil edildi.Bulgular: Çalışmaya dahil edilen hastaların %80’i erkek cinsiyette idi.
Evre 5 takip süreleri ortancası 16 ay (min:2-max:156), arteriyovenöz fistül takip süreleri ortancası 11 ay (min:2 max:156) ve arteriyovenöz
fistül açtırma kararı verildiğinde glomerüler filtrasyon hızı ortancası 10,90 ml/dk (min:7-max:15,90) olduğu
tespit edildi. Arteriyovenöz fistül, iki hastada aktif kullandığı kolda olup; bu hastalarda, ikinci kez arteriyovenöz
fistül açılmıştı. Hastaların fistüllerinin kontrolü ve korunması konularında yapması gereken davranışları yeterli
bulundu. Isı değişimlerinin ve hipotansiyon durumunun fistülü etkilemesi ile ilgili bilgi düzeyleri ise yetersiz
bulundu.
Sonuç: Henüz hemodiyalize girmeyen hastalar, açılan arteriyovenöz fistülün öneminin farkında olmayabilirler.
Bu hasta grubunda; arteriyovenöz fistül bakımı ile korunması hakkında eğitim verilip, basılı eğitim broşürleri ile
bu eğitimler pekiştirilmelidir. Arteriyovenöz fistülü açılmış hazır şekilde takip edilen hastaların her ay rutin
muayeneleri yapılmalı, muayene sırasında arteriyovenöz fistülü kontrol edilmeli ve arteriyovenöz fistülün
korunması için eğitim kontrol formlarının oluşturulması önerilir.

Kaynakça

  • 1. Süleymanlar G. Chronic Kidney Disease and Failure: Definition, Stages and Epidemiology. Turkiye Klinikleri J Int Med Sci 2007;3(38):1-7.
  • 2. Sijpkens YW, Berkhout-Byrne NC, Rabelink TJ. Optimal predialysis care. NDT Plus 2008;1(suppl_4):iv7-iv13. doi: 10.1093/ndtplus/sfn117
  • 3. Jemcov, T. K., & Van Biesen, W. (2017). Optimal timing for vascular access creation. The Journal of Vascular Access 2017;18.1_suppl: S29-S33. doi: 10.5301/jva.5000685
  • 4. Jindal K, Chan CT, Deziel C, Hirsch D, Soroka SD, Tonelli M, Culleton BF. Hemodialysis clinical practice guidelines for the Canadian Society of Nephrology. Journal of the American Society of Nephrology: JASN 2006;17.3 Suppl 1: S1- 27. doi: 10.1681/asn.2005121372
  • 5. Besarab A. Clinical practice guideline for vascular access. Am J Kidney Dis, 2006, 48: s176-s247.
  • 6. Nesrallah GE, Mustafa RA, Clark WF, Bass A, Barnieh L, Hemmelgarn BR., et al. Canadian Society of Nephrology 2014 clinical practice guideline for timing the initiation of chronic dialysis. CMAJ 2014;186(2):112-7.
  • 7. Dember LM, Beck GJ, Allon M, Delmez JA, Dixon BS, et al. Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis: a randomized controlled trial. Jama 2008;299(18): 2164-71.
  • 8. Beathard GA. An algorithm for the physical examination of early fistula failure. Seminars in dialysis. Oxford, UK: Blackwell Science Inc 2005;18(4):331-5. doi: 10.1111/j.1525‐139X.2005.18314.x
  • 9. Robbin ML, Chamberlain NE, Lockhart ME, Gallichio MH, Young CJ, et al. Hemodialysis arteriovenous fistula maturity: US evaluation. Radiology 2002;225(1):59-64.
  • 10. Third NKF-K. "Clinical practice guidelines for vascular access: update 2000." Am. J. Kidney. Dis. 2001;37(1): S137- S181.
  • 11. Lee HS, Song YR, Kim JK, Joo N, Kim C, et al. Outcomes of vascular access in hemodialysis patients: Analysis based on the Korean National Health Insurance Database from 2008 to 2016. Kidney Research and Clinical Practice 2019;38(3): 391.
  • 12. Arhuidese IJ, Orandi BJ, Nejim B, Malas M. Utilization, patency, and complications associated with vascular access for hemodialysis in the United States." Journal of Vascular Surgery 2018;68(4): 1166-74.
  • 13. Quinn RR, Oliver MJ, Devoe D, Poinen K, Kabani R, et al. The effect of predialysis fistula attempt on risk of all-cause and access-related death. Journal of the American Society of Nephrology 2017;28(2): 613-20.
  • 14. Feddersen MA, Simon DR. Arteriovenous fistula surveillance: everyone s responsibility. Portuguese Journal of Nephrology & Hypertension 2012;26(4): 255-65.
  • 15. Süleymanlar G. Kronik Böbrek Hastalığı ve Yetmezliği. Arık N, Ateş K, Süleymanlar G, Tonbul HZ, Türk S, ve ark. eds. Hekimler İçin Hemodiyaliz Kaynak Kitabı. 1. Baskı. Ankara: Güneş Tıp Kitabevi; 2009
  • 16. Prevention A, Tokars M, & Andrus M. Electronic reporting of infections associated with hemodialysis." Nephrology news & issues June 2005:37-43. Retrieved from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.467. 3904&rep=rep1&type=pdf
  • 17. Astor BC, Eustace JA, Powe NR, Klag MJ, Fink NE, et al. Type of vascular access and survival among incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study. Journal of the American Society of Nephrology 2005;16(5): 1449-55.
  • 18. Brunori G, Ravani P, Mandolfo S, Imbasciati E, Malberti F, et al. Fistula maturation: doesn't time matter at all?. Nephrology Dialysis Transplantation 2005;20(4):684-87.
  • 19. Dhingra RK, Young EW, Hulbert-Shearon TE, Leavey SF, Port FK, et al. Type of vascular access and mortality in US hemodialysis patients. Kidney international 2001;60 (4):1443-51.
  • 20. Klang B, Björvell H, Clyne N. Predialysis education helps patients choose dialysis modality and increases disease‐specific knowledge. Journal of Advanced Nursing 1999;29(4): 869-76.
  • 21. Asar E, Bora F, Erol A, Şanlı T, Bozkurt N, Çetı̇nkaya R, Sarı F, Ersoy F, Süleymanlar G. Nefroloji Düşük Klirens Polikliniğinde Hasta Eğitim Süreci: Olgu Sunumu . Nefroloji Hemşireliği Dergisi 2019;14(1):33-43.
  • 22. Tattersall J, Dekker F, Heimbürger O, Jager KJ, Lameire N, et al. When to Start Dialysis: Updated Guidance Following Publication of the Initiating Dialysis Early and Late (Ideal) Study. Nephrol Dial Transpl 2011;26(7): 2082-86.
  • 23. Piccoli G. The Canadian Society of Nephrology 2014 clinical practice guideline for timing the initiation of chronic dialysis: a paradigm shift and the return of the clinical nephrologist. Giornale italiano di nefrologia: organo ufficiale della Societa italiana di nefrologia 2014;31.3.
  • 24. Stevens PE, Levin A. Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and Management of Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2012 Clinical Practice Guideline. Ann Intern Med. 2013; 158(11): 825-30.
  • 25. Watanabe Y, Yamagata K, Nishi S, Hirakata H, Hanafusa N, et al. Japanese Society For Dialysis Therapy Clinical Guideline For "Hemodialysis İnitiation For Maintenance Hemodialysis"; Ther Apher Dial 2015;19: 93-107.
  • 26. Asar E, Bora F, Şanlı T, Bozkurt N, Çetinkaya R, Sarı F, Ersoy F.F, Süleymanlar G. Düşük Klirens Polikliniğinde Renal Replasman Tedavilerine Geçiş Süreci; Akdeniz Üniversitesi Örneği 29. Ulusal Nefroloji Hemşireliği Kongresi Bildiri Özet Kitabı, 2019, Antalya.
  • 27. Pessoa NRC, Linhares FMP. Hemodialysis patients with arteriovenous fistula: knowledge, attitude and practice. Escola Anna Nery, 2015;19(1):73-79.
  • 28. Aktaş B. Hemodiyaliz Tedavisi Gören Hastaların Fistül Bakımı ve Korunması ile ilgili Bilgi Düzeylerinin Değerlendirilmesi, Yüksek Lisans Tezi, Haliç Üniversitesi Sağlık Bilimleri Enstitüsü, İstanbul, 2008
  • 29. Ovayolu N. Hemodiyaliz hastalarının fistül bakımına ilişkin uygulamaları. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi 2007;16 (4):151
  • 30. Arslan DE, Akca NK. Pain following needle insertion into a hemodialysis fistula and influencing factors. International Journal of Caring Sciences 2018;11(3):1662-1670.

Evaluation of Arteriovenous Fistula Training of Follow-Up Patients in Nephrology Low Clirens Outpatient Clinic who Do Not Undergo Hemodialysis with Proper Working Arteriovenous Fistula: A Pilot Study

Yıl 2021, Cilt: 16 Sayı: 1, 10 - 18, 31.01.2021
https://doi.org/10.47565/ndthdt.2021.28

Öz

Objective: Chronic kidney disease is an important public health problem. Low clearance polyclinics are
important for protecting patients from chronic kidney disease progression and complications. The readiness of
arteriovenous fistulas of patients who decide to undergo hemodialysis for renal replacement therapies protects
patients from catheter complications. This study was planned to evaluate the arteriovenous fistula care training
of patients with proper working arteriovenous fistula and who did not undergo hemodialysis in the low clearance
outpatient clinic and to rearrange their follow-up and training.
Method: In this study, a total of 23 of 20 patients who accepted to enter the study and who came for control visit
between 1 - 30 June 2019 were included. They were followed up in the nephrology low clearance polyclinic of a
university hospital in Antalya due to chronic kidney disease and chose hemodialysis as the decision of renal
replacement treatment, did not undergo hemodialysis and had a proper working arteriovenous fistula.
Results: 80% of the patients included in the study were male. The median of the stage 5 chronic kidney disease
follow-up time was 16 months (min: 2-max: 156), the median of the follow-up time with arteriovenous fistula
was 11 months (min: 2 max: 156), and the median of the glomerular filtration rate was 10.90 ml/min (min: 7 -
max: 15.90). Four (20%) of the arteriovenous fistulas were formed for the second time. The arteriovenous fistula
was in the active arm in two patients, these patients were those who had a second-time arteriovenous fistula. The
patients' actions to control and protect their fistulas were found to be sufficient but knowledge about the effects
of temperature changes and low blood pressure on the fistula was inadequate.
Conclusion: The patients who have not yet undergone hemodialysis may not be aware of the importance of
properly working arteriovenous fistula. In these patients group; these pieces of training should be reinforced with
printed educational brochures for providing training on the care and protection of arteriovenous fistula. Patients
whose arteriovenous fistulas have been formulated before and are followed up ready should be routinely
examined every month, their arteriovenous fistulas should be checked during the examination and training
control forms should be created for arteriovenous fistula protection.

Kaynakça

  • 1. Süleymanlar G. Chronic Kidney Disease and Failure: Definition, Stages and Epidemiology. Turkiye Klinikleri J Int Med Sci 2007;3(38):1-7.
  • 2. Sijpkens YW, Berkhout-Byrne NC, Rabelink TJ. Optimal predialysis care. NDT Plus 2008;1(suppl_4):iv7-iv13. doi: 10.1093/ndtplus/sfn117
  • 3. Jemcov, T. K., & Van Biesen, W. (2017). Optimal timing for vascular access creation. The Journal of Vascular Access 2017;18.1_suppl: S29-S33. doi: 10.5301/jva.5000685
  • 4. Jindal K, Chan CT, Deziel C, Hirsch D, Soroka SD, Tonelli M, Culleton BF. Hemodialysis clinical practice guidelines for the Canadian Society of Nephrology. Journal of the American Society of Nephrology: JASN 2006;17.3 Suppl 1: S1- 27. doi: 10.1681/asn.2005121372
  • 5. Besarab A. Clinical practice guideline for vascular access. Am J Kidney Dis, 2006, 48: s176-s247.
  • 6. Nesrallah GE, Mustafa RA, Clark WF, Bass A, Barnieh L, Hemmelgarn BR., et al. Canadian Society of Nephrology 2014 clinical practice guideline for timing the initiation of chronic dialysis. CMAJ 2014;186(2):112-7.
  • 7. Dember LM, Beck GJ, Allon M, Delmez JA, Dixon BS, et al. Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis: a randomized controlled trial. Jama 2008;299(18): 2164-71.
  • 8. Beathard GA. An algorithm for the physical examination of early fistula failure. Seminars in dialysis. Oxford, UK: Blackwell Science Inc 2005;18(4):331-5. doi: 10.1111/j.1525‐139X.2005.18314.x
  • 9. Robbin ML, Chamberlain NE, Lockhart ME, Gallichio MH, Young CJ, et al. Hemodialysis arteriovenous fistula maturity: US evaluation. Radiology 2002;225(1):59-64.
  • 10. Third NKF-K. "Clinical practice guidelines for vascular access: update 2000." Am. J. Kidney. Dis. 2001;37(1): S137- S181.
  • 11. Lee HS, Song YR, Kim JK, Joo N, Kim C, et al. Outcomes of vascular access in hemodialysis patients: Analysis based on the Korean National Health Insurance Database from 2008 to 2016. Kidney Research and Clinical Practice 2019;38(3): 391.
  • 12. Arhuidese IJ, Orandi BJ, Nejim B, Malas M. Utilization, patency, and complications associated with vascular access for hemodialysis in the United States." Journal of Vascular Surgery 2018;68(4): 1166-74.
  • 13. Quinn RR, Oliver MJ, Devoe D, Poinen K, Kabani R, et al. The effect of predialysis fistula attempt on risk of all-cause and access-related death. Journal of the American Society of Nephrology 2017;28(2): 613-20.
  • 14. Feddersen MA, Simon DR. Arteriovenous fistula surveillance: everyone s responsibility. Portuguese Journal of Nephrology & Hypertension 2012;26(4): 255-65.
  • 15. Süleymanlar G. Kronik Böbrek Hastalığı ve Yetmezliği. Arık N, Ateş K, Süleymanlar G, Tonbul HZ, Türk S, ve ark. eds. Hekimler İçin Hemodiyaliz Kaynak Kitabı. 1. Baskı. Ankara: Güneş Tıp Kitabevi; 2009
  • 16. Prevention A, Tokars M, & Andrus M. Electronic reporting of infections associated with hemodialysis." Nephrology news & issues June 2005:37-43. Retrieved from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.467. 3904&rep=rep1&type=pdf
  • 17. Astor BC, Eustace JA, Powe NR, Klag MJ, Fink NE, et al. Type of vascular access and survival among incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study. Journal of the American Society of Nephrology 2005;16(5): 1449-55.
  • 18. Brunori G, Ravani P, Mandolfo S, Imbasciati E, Malberti F, et al. Fistula maturation: doesn't time matter at all?. Nephrology Dialysis Transplantation 2005;20(4):684-87.
  • 19. Dhingra RK, Young EW, Hulbert-Shearon TE, Leavey SF, Port FK, et al. Type of vascular access and mortality in US hemodialysis patients. Kidney international 2001;60 (4):1443-51.
  • 20. Klang B, Björvell H, Clyne N. Predialysis education helps patients choose dialysis modality and increases disease‐specific knowledge. Journal of Advanced Nursing 1999;29(4): 869-76.
  • 21. Asar E, Bora F, Erol A, Şanlı T, Bozkurt N, Çetı̇nkaya R, Sarı F, Ersoy F, Süleymanlar G. Nefroloji Düşük Klirens Polikliniğinde Hasta Eğitim Süreci: Olgu Sunumu . Nefroloji Hemşireliği Dergisi 2019;14(1):33-43.
  • 22. Tattersall J, Dekker F, Heimbürger O, Jager KJ, Lameire N, et al. When to Start Dialysis: Updated Guidance Following Publication of the Initiating Dialysis Early and Late (Ideal) Study. Nephrol Dial Transpl 2011;26(7): 2082-86.
  • 23. Piccoli G. The Canadian Society of Nephrology 2014 clinical practice guideline for timing the initiation of chronic dialysis: a paradigm shift and the return of the clinical nephrologist. Giornale italiano di nefrologia: organo ufficiale della Societa italiana di nefrologia 2014;31.3.
  • 24. Stevens PE, Levin A. Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and Management of Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2012 Clinical Practice Guideline. Ann Intern Med. 2013; 158(11): 825-30.
  • 25. Watanabe Y, Yamagata K, Nishi S, Hirakata H, Hanafusa N, et al. Japanese Society For Dialysis Therapy Clinical Guideline For "Hemodialysis İnitiation For Maintenance Hemodialysis"; Ther Apher Dial 2015;19: 93-107.
  • 26. Asar E, Bora F, Şanlı T, Bozkurt N, Çetinkaya R, Sarı F, Ersoy F.F, Süleymanlar G. Düşük Klirens Polikliniğinde Renal Replasman Tedavilerine Geçiş Süreci; Akdeniz Üniversitesi Örneği 29. Ulusal Nefroloji Hemşireliği Kongresi Bildiri Özet Kitabı, 2019, Antalya.
  • 27. Pessoa NRC, Linhares FMP. Hemodialysis patients with arteriovenous fistula: knowledge, attitude and practice. Escola Anna Nery, 2015;19(1):73-79.
  • 28. Aktaş B. Hemodiyaliz Tedavisi Gören Hastaların Fistül Bakımı ve Korunması ile ilgili Bilgi Düzeylerinin Değerlendirilmesi, Yüksek Lisans Tezi, Haliç Üniversitesi Sağlık Bilimleri Enstitüsü, İstanbul, 2008
  • 29. Ovayolu N. Hemodiyaliz hastalarının fistül bakımına ilişkin uygulamaları. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi 2007;16 (4):151
  • 30. Arslan DE, Akca NK. Pain following needle insertion into a hemodialysis fistula and influencing factors. International Journal of Caring Sciences 2018;11(3):1662-1670.
Toplam 30 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Hemşirelik
Bölüm Makale
Yazarlar

Emine Asar

Feyza Bora Bu kişi benim

Yayımlanma Tarihi 31 Ocak 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 16 Sayı: 1

Kaynak Göster

Vancouver Asar E, Bora F. Nefroloji Düşük Klirens Polikliniğinde Arteriovenöz Fistülü Hazır Hemodiyalize Başlamayan Hastalarda Arteriovenöz Fistül Eğitimlerinin Değerlendirilmesi: Pilot Çalışma/ Evaluation of Arteriovenous Fistula Training of Follow-Up Patients in Nephrology Low Clirens Outpatient Clinic who Do Not Undergo Hemodialysis with Proper Working Arteriovenous Fistula: A Pilot Study. NefroHemDergi. 2021;16(1):10-8.

Nefroloji Hemşireliği Dergisi/ Journal of Nephrology Nursing Creative Commons Lisansı Creative Commons Atıf-GayriTicari-Türetilemez 4.0 Uluslararası Lisansı ile lisanslanmıştır.