TITLE: Integrated management to reduce fistula-related long-term complications and improve the quality of life after arteriovenous fistula surgery: A retrospective cohort study.

AIM: Proper arteriovenous fistula (AVF) management is crucial to avoid AVF complications and prolong its useful life for maintenance haemodialysis (MHD).

DESIGN: Retrospective cohort study.

METHODS: Patients on MHD who underwent AVF surgery at the Wuhan Third Hospital between January 2018 and July 2018.

RESULTS: A total of 144 patients were included, with 56 in the integrated group and 88 in the routine group. There were no differences between the two groups in terms of sex (p = .61), age (p = .62) and type of primary kidney disease (p > .99). At 1 year, the integrated group had significantly fewer fistula-related complications than the routine group (3.6% versus. 23.9%, p < .001). AVF functional scores were lower in the integrated group compared with the routine group (0.1 ± 0.5 versus. 0.8 ± 0.8, p < .001). The pain scores were lower in the integrated group than in the routine group (1.2 ± 0.4 versus. 1.8 ± 0.9, p < .001).

CONCLUSION（FROM PAPER）：The integrated management based on the management of vascular access can alleviate the pain during AVF puncture and effectively monitor AVF function for early identification of complications and interventions, significantly reducing the incidence of AVF- related complications in MHD patients. Thus, such a nursing approach could have profound significance for the long- term maintenance of AVF.

SOURCE: Ning M, Luo D, Ye G, et al. Integrated management to reduce fistula-related long-term complications and improve the quality of life after arteriovenous fistula surgery: A retrospective cohort study[J]. Nurs Open, 2021, DOI: 10.1002/nop2.839.

目的：正确的动静脉内瘘（AVF）管理对于避免AVF并发症并延长其用于维持血液透析（MHD）的使用寿命至关重要。

设计：回顾性队列研究。

方法：2018年1月至2018年7月在武汉市第三医院接受AVF手术的MHD患者。

结果：共纳入144例患者，其中综合组56例，常规组88例。两组在性别（p =0.61），年龄（p =0.62）和原发性肾脏疾病类型（p>0.99）方面无差异。 1年时，整合组的瘘管相关并发症明显少于常规组（3.6％比23.9％，p <.001）。与常规组相比，综合组的AVF功能评分较低（0.1±0.5 vs. 0.8±0.8，p <.001）。综合组的疼痛评分低于常规组（1.2±0.4 vs. 1.8±0.9，p <.001）。

结论：以血管通路管理为基础的综合管理可以减轻动静脉内瘘穿刺时的疼痛，有效监测动静脉内瘘功能，及早发现并发症和给予干预措施，显著降低维持性血液透析患者动静脉内瘘相关并发症的发生率。因此，这种护理方法对动静脉内瘘的长期维持具有深远的意义。

启发：内瘘的综合管理（穿刺点规划、术后宣教、穿刺前物理检查、定期超声随访等）对患者的生命线极其重要，其重要性不亚于内瘘的建立及维护！