TITLE: Vascular access cannulation and haemostasis: a national observational study of French practices.

Background: We report the results of an observational study of arteriovenous fistula (AVF) cannulation and haemostasis practices in France.

Methods: The study (sponsored by Brothier Pharmaceutical Inc.) was conducted in 150 dialysis units. Data obtained from 150 supervisory nurses, 1538 nurses and 3588 patients with an AVF were analysed.

Results: The nurses reported using rope-ladder, area or buttonhole cannulation techniques in 68, 26 and 6% of cases, respectively. Metal needles were used most frequently (64%), with mainly a diameter of 15 G or 16 G. The needle was introduced with the bevel up in 56% of cases. Compression applied using dressings (in particular, pure calcium alginate dressings) was the method of choice for haemostasis of the puncture sites and was assessed as being strong by most of the nurses and very strong in cases of prolonged bleeding. Most (82%) of the patients reported the use of local anaesthetic before cannulation and 23% reported an allergic skin reaction to the anaesthetic. Bleeding of the puncture sites lasted for >10 min for 48% of the patients and it reappeared between two sessions for 29% of the patients. Whereas the nurses appeared to have a good understanding of AVF, more than half of the patients did not know how to care for it, with 55% requiring more information.

Conclusions: This study underlines the lack of national consensus concerning AVF cannulation practices. It suggests that haemostasis methods of the puncture sites can be improved and it highlights the need to improve patient knowledge.

SOURCE:  Sallée M, Mercadal L, Jean G, et al. Vascular access cannulation and haemostasis: a national observational study of French practices[J]. Clin Kidney J, 2021, 14(4):1261-1268. DOI: 10.1093/ckj/sfaa098. 

背景：我们报告了法国动静脉内瘘（AVF）穿刺和止血实践的观察性研究结果。

方法：该研究（由Brothier Pharmaceutical Inc.赞助）在150个透析单元中进行。数据来源于150名护士长，分析了1538名护士和3588名AVF患者的数据。

结果：护士报告了如下内容：分别有68、26和6％的患者使用了绳梯，区域或钮孔插管技术。使用金属针的频率最高（64％），主要直径为15G或16G。在56％的病例中，针头带有斜角。使用敷料（特别是纯海藻酸钙敷料）施加压迫是穿刺部位止血的一种选择方法，多数护士认为这种方法具有较强的止血效果，而对于长时间出血的情况则非常有效。大多数（82％）患者报告了在穿刺前使用局部麻醉剂，而23％的患者报告对麻醉剂出现皮肤过敏反应。 48％的患者的穿刺部位出血持续时间超过10分钟，并且29％的患者在两次疗程之间再次出现出血。即时护士对AVF有很好的了解，但一半以上的患者不知道如何护理，其中55％的患者需要更多信息。

结论：本研究强调了关于AVF穿刺实践的全国共识的缺乏。这表明穿刺部位的止血方法有待改善，并强调需要提高患者的知识水平。

启发：患者的内瘘自我护理有待改善，需要加强患者教育。