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Management of vascular access is a challenge for the dialysis team, particularly to keep the arteriovenous access working. The vascular access coordinator can positively contribute to increase the number of arteriovenous fistulas and reduce central venous catheters. In this article, we introduce a new approach to vascular access management centered on (the results of setting up) the role of vascular access coordinator. We described the three‐level model (3Level_M) for vascular access management organized in three levels: vascular access nurse manager, vascular access coordinator, and vascular access consultant. We defined the instrumental skills and training required to be developed by each element and clarify the articulation between the model and all members of the dialysis team related to vascular access. [ABSTRACT FROM AUTHOR]

The cannulation technique is important for the survival of the arteriovenous access. Choosing the appropriate technique is a complex decision. Such choice must be customized to patients, considering their characteristics, the type of arteriovenous access and the experience of the hemodialysis team. We describe seven items that can help nurses to identify the appropriate cannulation technique: type of arteriovenous access; drainage vein; hygienic self‐care profile; experience of the nursing staff in the cannulation technique and nurse‐to‐patient ratio; hemodialysis treatment method; patient's condition; and patient's decision. Such items can help nurses in decision‐making on the "ideal" cannulation technique for each patient. [ABSTRACT FROM AUTHOR]

The distal arteriovenous fistula (AVF) has less complications and better patency than the proximal fistula, when it works properly. The complications of outflow of the fistula are complex, and it is necessary to analyze all solutions to solve the problem. We introduce a novel approach to solve outflow problems of a radio‐cephalic AVF by straightening of the forearm cephalic vein with drainage into the median basilic vein. [ABSTRACT FROM AUTHOR]

Introduction: Hemodialysis (HD) patients should be trained to develop self‐care behaviors in order to prevent and preserve their arteriovenous fistula (AVF). The aim of this study was identifying the factors that affect the levels of self‐care behavior with AVF by HD patients. Methods: A cross‐sectional study was conducted involving 89 patients. Results: Self‐care levels were negatively affected by patients' location (Azores) and positively affected by marital status, education, employment, AVF duration, and absence of complications with the AVF. Concerning the management of signs and symptoms, self‐care levels were negatively affected by patients' location. Regarding prevention of complications, self‐care levels were negatively affected by age and marital status and positively affected by marital status, employment, chronic kidney disease etiology, AVF duration, and previous AVF. Conclusion: Further studies are required in order to confirm whether the considered factors affect levels of self‐care behaviors with AVF, or whether other factors are needed as well. [ABSTRACT FROM AUTHOR]

Aim: To analyse the impact of COVID‐19 on professional nursing practice environments and patient safety culture. Background: The relationship between work environments and patient safety has been internationally recognized. In 2020, the pandemic imposed enormous challenges, yet the impact on these variables remains unknown. Method: This is a quantitative observational study, conducted in a Portuguese hospital, with 403 registered nurses. A self‐completion questionnaire was used. Results: The impact on the Structure and Outcome components of nursing professional practice environments was positive. Although the Process component remained favourable to quality of care, a negative trend was confirmed in almost all dimensions. The results regarding safety culture showed weaknesses; 'teamwork within units' was the only dimension that maintained a positive culture. Conclusion: Positive responses regarding patient safety were significantly associated with the quality of the nursing professional practice environment. The need to invest in all dimensions of safety culture emerges to promote positive professional environments. Implications for nursing management: Improving professional nursing practice environments can be achieved through managers' investment in the participation and involvement of nurses in the policies and functioning of institutions, as well as promoting an open, fair and participatory safety culture that encourages reporting events and provides adequate support for professionals. [ABSTRACT FROM AUTHOR]

We present the case of a male patient on hemodialysis with a ruptured pseudoaneurysm in a brachiocephalic arteriovenous fistula (AVF) and with edema and pain in the right arm attended to in the emergency department. An ultrasonographic scan identified a ruptured pseudoaneurysm with hemorrhagic infiltration of the arm muscular tissues. We performed a percutaneous ultrasound‐guided thrombin injection with an angioplasty balloon inflated in the lumen of the AVF achieving the pseudoaneurysm thrombosis. After 6 months of follow‐up, the patient's arteriovenous access remains functional. Percutaneous ultrasound‐guided thrombin injection assisted by an angioplasty balloon may be a good alternative to surgical intervention in the treatment of symptomatic growing pseudoaneurysms of the arteriovenous fistula with the benefit of preserving the vascular access. [ABSTRACT FROM AUTHOR]

Background: Several guidelines recommend that patients with chronic kidney disease treated by haemodialysis (HD) take care of their own arteriovenous fistula (AVF). The dialysis nurse plays an important role in the development of such self‐care behaviours. A very small number of instruments are available to assess self‐care behaviours with AVF in Turkey. Objective: Cultural adaptation and psychometric testing of the Turkish version of the scale of assessment of self‐care behaviours with arteriovenous fistula in haemodialysis (ASBHD‐AVF) patients. Design: Cross‐sectional validation study. Participants and Measurements: This study was conducted involving 160 patients in the Bolu region in Turkey. The guidelines provided by Sousa and Rojjanasrirat were taken into account in the scale translation, adaptation and validation process. Validity was analysed through content validity and construct validity. The latter was measured through principal component analysis with varimax rotation, considering only factor loadings of 0.30 or larger. Reliability analysis was based on internal consistency measured by Cronbach's α. Results: A two‐factor structure was extracted explaining 59.01% of the total variance. Cronbach's α was 0.91, 0.85 and 0.84 for the overall scale, the self‐care in prevention of complications subscale and the self‐care in management of signs and symptoms subscale, respectively. Conclusions: The Turkish version of the scale of ASBHD‐AVF patients is a reliable and valid instrument and can therefore be used. [ABSTRACT FROM AUTHOR]

Aim: Testing the validity and reliability of the Scale for the Environments Evaluation of Professional Nursing Practice (SEE‐Nursing Practice). Background: The environment of professional nursing practice is key to achieve better results for clients, nurses and institutions. Therefore, instruments enabling the assessment of all its attributes are required. Method: Cross‐sectional methodological study. The SEE‐Nursing Practice, based on a previous qualitative study and literature review, was applied as a questionnaire. Exploratory and confirmatory factor analyses were used to assess construct validity. Results: A total of 752 nurses participated in the study. Exploratory factor analysis of the SEE‐Nursing Practice led to a factor solution with 93 items and three subscales. The Structure, Process and Outcome subscales, respectively, have 43, 37 and 13 items, loaded in 6 factors, 6 factors and 2 factors and explaining 62.6%, 59.2% and 67.4% of the total variance. Cronbach's alpha of the overall scale and of the 3 subscales was greater than 0.90. Confirmatory factor analysis showed a good fit. Conclusion: SEE‐Nursing Practice is a good valid and reliable instrument. Implications for nursing management: The SEE‐Nursing Practice enables assessing practice environments and is a tool for nursing managers in the definition of strategies ensuring favourable environments for nursing care quality. [ABSTRACT FROM AUTHOR]

Radial-cephalic fistula recovered with graft interposition from the brachial artery into the cephalic vein - Patient with two arteriovenous fistulas Dear Editor, The radio-cephalic arteriovenous fistula (RC-AVF) is considered the best access for patients requiring hemodialysis (HD) treatment.1-3 RC-AVF has fewer complications, especially steal syndrome, higher fistula flow, and venous hypertension syndrome, when compared to proximal fistulas.4 However, this fistula type has a high rate of primary failure and maturation problems. The brachiocephalic fistula (composed of a graft segment) had an anastomosis connection with a 3.2 mm size, a patent graft segment with no thrombus and a 5.8 mm diameter, a graft-cephalic vein anastomosis with a 2.5 mm size (with peak systolic velocity > 300 cm/s) and an arm cephalic vein with diameter between 5.5 and 6.0 mm. The patient had two AVFs - a distal fistula (RC-AVF) and a proximal fistula (brachiocephalic fistula with graft segment). [Extracted from the article]

Vascular access dysfunction is a serious problem in dialysis units. Some patients have complex dysfunctions that are difficult to resolve. In this article, we report the case a of two patients with radiocephalic arteriovenous fistulae (RC‐AVF) who had stenosis/occlusion of the forearm median vein and where we used the basilic vein of the forearm as a solution. We reviewed the use of this surgical solution in RC‐AVF. Two male patients on hemodialysis exhibited stenosis/occlusion of the forearm median vein. The forearm basilic vein was isolated and rotated toward the forearm median vein in order to solve RC‐AVF problems. One patient had fistula thrombosis 5 months after the procedure, while for the other patient, the fistula continues to work without problems. Literature describes only a few cases using the forearm basilic vein or the brachial vein for fistula recovery. This procedure increased the patency of fistulas. This approach has been proven to be a good solution for solving outflow problems using the superficial or deep veins, increasing fistula patency and avoiding the need to place a central venous catheter and all the related complications. [ABSTRACT FROM AUTHOR]

Abstract: Teaching/educating patients with end stage renal disease (ESRD) and identifying their self‐care behaviors for vascular network preservation are very important. However, the self‐care behaviors regularly performed by patients are still unknown. We compared self‐care behaviors for vascular network preservation performed by patients who are/are not followed‐up by the nephrologist. The study design was a prospective, observational and comparative study. Inclusion criteria were as follows: ESRD patients (at stages 4 or 5); at least 18 years old; in pre‐dialysis with at least a 6‐month follow‐up period by the nephrologist or who started dialysis in emergency and were not followed‐up by the nephrologist; with no memory problems; and medically stable. Primary outcome was the frequency of self‐care behaviors for vascular network preservation. Secondary outcome was the comparison between self‐care behaviors by ESRD patients who were/were not followed‐up by the nephrologist. The study involved 145 patients, 64.1% were female, the mean age was 69.5 years and the self‐care behaviors mean score was 36.8% (with a SD of 39.8%). The number of patients followed‐up and not followed‐up by the nephrologist was 109 (group 1) and 36 (group 2), respectively. Social characteristics were similar in the two groups (P > 0.05). The mean self‐care behaviors were 29.4% and 59.2% in groups 1 and 2, respectively (P = 0.000). Patients performed self‐care behaviors for vascular network preservation with a relatively low frequency (the mean score was 36.8% only). Patients not followed by the nephrologist performed self‐care behaviors more often than those who were followed (59.2% vs. 29.4% respectively, P = 0.000). [ABSTRACT FROM AUTHOR]

End stage renal disease (ESRD) patients should be educated to maintain and preserve the arteriovenous fistula (AVF) in the best condition. The purpose of this work was to evaluate self-care frequency and factors that influenced such frequency. A prospective study was performed in 101 hemodialysis patients. Self-care behaviors were measured with the Scale of Assessment of Self-Care Behaviours with Arteriovenous Fistula in Hemodialysis. A regression model was used to determine the relevant predictors of self-care frequency and their influence. The incidence of self-care behaviors was 71.0%. The regression model showed that self-care behaviors were positively influenced by gender (female), ESRD etiology (hypertension, polycystic kidneys and other kidney diseases), duration of AVF and negatively by the existence of previous AVF and health professional (doctor). The frequency of self-care behaviors was lower than expected and below an appropriate standard. Education programs designed to improve self-care behaviors with AVF should be further explored in a prospective randomized trial. [ABSTRACT FROM AUTHOR]

Several guidelines recommend the importance of educating the patient about the care of vascular access. Nurses have a key role in promoting the development of self-care behaviors by providing the necessary knowledge to patients, so that they develop the necessary skills to take care of the arteriovenous fistula ( AVF). This article describes the process of building a scale of assessment of self-care behaviors with arteriovenous fistula in hemodialysis ( ASBHD-AVF). This is a cross-sectional study in which the development, construction, and validation process followed the directions of the authors Streiner and Norman. This is a convenience sample, sequential, and nonprobabilistic constituted by 218 patients. The study was conducted in two stages during 2012-2014. The first phase corresponds to the scale construction process, 64 patients participated, while the second corresponds to the evaluation of metric properties and 154 patients participated. The principal component analysis revealed a two-factor structure, with factorial weights between 0.805 and 0.511 and between 0.700 and 0.369, respectively, explaining 39.12% of the total variance of the responses. The Cronbach's alpha of the subscale management of signs and symptoms is 0.797 and from the subscale prevention of complications is 0.722. The ASBHD-AVF revealed properties that allow its use to assess the self-care behaviors in the maintenance and conservation of the AVF. [ABSTRACT FROM AUTHOR]

Vascular access is one of the leading causes of mobilization of financial resources in health systems for people with chronic kidney disease on hemodialysis. Physical examination of the arteriovenous fistula ( AVF) has demonstrated its effectiveness in identifying complications. We decided to evaluate the influence of nurses' professional experience in the detection of complications of the AVF (venous stenosis and steal syndrome). The study took place in eight hemodialysis centers between May and September of 2011 in the north of Portugal. Sample was constituted by registered nurses. The nurses involved in the experiment were divided in two groups: those who had more than 5 years of experience and those who had less than 5 years of experience. Ninety-two nurses participated in the study: 34 nurses had less than 5 years of professional experience and 58 had more than 5 years of professional experience. In the practices considered by nurses in the detection of venous stenosis, there were no differences observed between the groups ( P > 0.05). In steal syndrome, there were no differences observed between the groups in the practices of the nurses in the detection of this complication of the AVF ( P > 0.05). We concluded that professional experience does not influence the detection of venous stenosis and steal syndrome. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2013; 27; 468-474 Evaluation and cross-cultural adaptation of the Hendrich II Fall Risk Model to Portuguese Background: Several tools for the assessment of the risk of falling are used commonly by clinical nurses, but none have been validated in Portuguese. Aims: To adapt and evaluate the Hendrich II Fall Risk Model (HIIFRM) for use with elderly Portuguese inpatients. Method: We conducted a prospective study of 586 older inpatients in acute care hospitals, from November 2007 to May 2010. Results: The study involved 270 men and 316 women. The most frequent risk factor on admission and at discharge was a score ≥3 on the 'Get Up and Go' test. The adapted HIIFRM showed a sensitivity of 93.2% and 75.7%, and a specificity of 35% and 46.7%, on admission and at discharge, respectively. A positive predictive value of 17.2% on admission and 17% at discharge and a negative predictive value of 97.3% and 93%, respectively, were estimated. Conclusions: The HIIFRM was shown to be a useful tool in predicting falls by patients. Nevertheless, the research model suggested that only four risk factors affected the occurrence of falls significantly on admission and two risk factors at discharge. Further research is required in Portuguese hospital settings. [ABSTRACT FROM AUTHOR]

Many time series encountered in practice are non-Gaussian. Because of the process of data collection or the practice or researchers, time series used in analysis and modelling are frequently temporal aggregates. In this paper, we study the effects of the use of aggregate time series on testing for Gaussianity. We analyse how the test statistic is affected by aggregation and how that affects the power of the test. The results show that the use of aggregate time series induces Gaussianity and that the degree of inducement increases with the order of aggregation. In fact, the use of aggregate time series reduces the power of the test, although the effect is not significant for low orders of aggregation. [ABSTRACT FROM AUTHOR]