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Specifics of the nursing care of patients with arteriovenous fistulas in a standard departement
NIEDERMEIEROVÁ, Michaela
Theoretical basis: My bachelor thesis briefly explains the reason for establishing this vascular access, describes the types of dialysis and discusses different types of vascular accesses. It analyses the process of haemodialysis including the role of the nurse during this procedure. Finally, it provides an outline of the life of a patient, who needs to attend dialysis regularly as well as to manage to take care of the fistula at home. This shunt is the only patient's connection to the dialysis during the renal failure and therefore it requires a specific nursing care. In order to preserve the function of the fistula the longest time possible, the patient himself also needs to follow the principles of a good care. The aim of the thesis: One aimsare set in the empirical part. Aim 1 should check whether nurses know the specifics of care of patients with arteriovenous fistula. In order to acquire these aims one research question were set: what nurses know the specifics of care of patients with arteriovenous fistula. Methodology: In the empirical part of the thesis, the qualitative research method with the help of semi-structured interview was used for the research. Respondents consisted of general nurses from surgical and medical ward of selected hospital in the South Bohemian Region. The data collection took place after consultation with the senior nurse and ward sisters during March this year. Before starting the empirical investigation, the reason and intention of interviews, which took place on a voluntary basis and were electronically recorded, was explained to the respondents. The questions in the interview were prepared in advance. Obtained data were processed into categorization groups, which were further analysed. The interview was divided into 5 areas: identifying issues, preoperative preparation, postoperative care, nursing care for fistula, patients' awareness. The research part of the thesis was also consulted with the ward sister of the hemodialysis center of the selected hospital of the South Bohemian Region. Results: The results of the empirical survey shows what specifics of nursing care of patients with arteriovenous fistulas nurses know. After analysing the research, we found that nurses know the basic nursing care of the vascular access. Nurses know that this vascular access is used only for purposes of hemodialysis. They do not measure the pressure on a limb with fistula, draw blood from it or insert a permanent venous catheter into it. They know that the skin around the fistula should be observed carefully and each day. They monitor the limb with fistula mainly for signs of infection and ischemia. In case of necessity of the provision of information for the patient about the care of an arteriovenous fistula, nurses are able to complete the missing information or arrange for a consultation with a specialist. However, the research also revealed weaknesses. Nurses are not sure how long fistula matures, do not really prepare patients for hemodialysis and don't know exactly when to remove the bandage from a patient after dialysis. In case of bleeding from the fistula, they do not know whether to use a pressure bandage.
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Permanent Vascular Access in Dialysis Patients from the viewpoint of Nurses and Patients.
ŠVÁBOVÁ, Veronika
The issue of chronic renal failure and cannulation of permanent venous accesses in patients treated at haemodialysis centres is a topical and widespread problem of these days. According to generally accessible resources the incidence of terminal stage of renal failure, and thus the necessity to treat a patient by means of elimination methods, is very high, it reaches four individuals per thousand inhabitants according to the statistics. It is obviously a widespread nursing problem. The theoretical part of the thesis is divided into a summary and description of the present situation in chronic renal failure, particularly a brief insight into the chronic renal failure and its causes and syndromes. It also deals with the topic of the present treatment possibilities with stress on patient treatment at nephrologic outpatient clinics and in haemodialysis centres. The next chapter of the thesis describes the development from haemodialysis history up to the present advanced elimination methods. The present elimination methods bring the necessity of functional provision of venous access, particularly cannulation of AV fistulas, it is a very frequent nursing operation provided by nurses treating chronically affected patients at haemodialysis centres. This chapter is concluded by general knowledge of the techniques of cannulation of permanent venous accesses, possible occurrence of complications during the cannula penetration itself in relation to the physical phase of nursing treatment about patients with chronic renal failure. The practical part of the thesis was aimed at discovering or possible confirmation of the hypotheses discussed in the theoretical part. The practical research was based on searching for problems among dialyzed patients related to the permanent venous access, on finding the approach of nurses working at dialysis centres to cannulation of permanent accesses and on mapping the access of patients with permanent venous access to nurses with short time experience at a dialysis centre. Research questions were determined for this purpose and were processed within qualitative research into case reports upon depth interviews with nurses working at the dialysis centres of České Budějovice Hospital, Český Krumlov Hospital and Písek Hospital and their patients. The research data were processed into charts, where responses from patients and those from nurses were assessed separately. Occurrence frequency of the individual answers was particularly monitored in the individual output tables, however the responses were not processed by means of standard statistic methods because of the chosen methodology and thus a low number of respondents, but the output data served for drawing conclusions and preparing recommendations for application of nursing methods. The thesis conclusion summarizes the obtained knowledge and recommends possible procedures of solving the problems of cannulation of permanent venous accesses in patients with chronic renal failure treated at haemodialysis centres.
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