Hemodialysis, Difficult Vascular Access Cannulation
Conditions
Keywords
Ultrasound Vascular Mapping, Handgrip Exercise, Local Cryotherapy, Cannulation Pain, First-Attempt Cannulation Success
Brief summary
This pilot randomized controlled trial evaluated a multicomponent intervention for adult maintenance hemodialysis patients with difficult vascular access cannulation. Participants were randomly assigned to an intervention group or a usual-care control group. The intervention included pre-cannulation ultrasound vascular mapping, handgrip exercise, and local cryotherapy before vascular access cannulation. The study assessed visual analog scale pain, first-attempt cannulation success, perceived pain, anxiety, comfort, and overall care satisfaction. Participants in the intervention group also evaluated the acceptability of the intervention.
Interventions
OTHERPre-Cannulation Ultrasound Vascular Mapping
Pre-cannulation ultrasound vascular mapping was performed before vascular access cannulation to assess vessel course, depth, blood flow, and suitable cannulation areas. The vascular map was provided as a reference for the cannulating nurse when selecting the cannulation site. Routine visual inspection and palpation were also performed before cannulation.
BEHAVIORALHandgrip Exercise
Participants performed handgrip exercise before vascular access cannulation as part of the multicomponent intervention.
OTHERLocal Cryotherapy
Local cryotherapy was applied before vascular access cannulation as part of the multicomponent intervention.
OTHERUsual Care
Participants in the control group received usual care, including routine visual inspection and palpation of the vascular access before cannulation. They did not receive pre-cannulation ultrasound vascular mapping, handgrip exercise, or local cryotherapy.
Sponsors
Chang Gung Memorial Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
20 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Aged 20 years or older. * Receiving maintenance hemodialysis for at least 3 months. * Having an arteriovenous fistula or arteriovenous graft for hemodialysis vascular access. * Having difficult vascular access cannulation, defined as requiring two or more cannulation attempts during at least one of the two most recent hemodialysis sessions. * Able to understand the study information and provide written informed consent.
Exclusion criteria
* Newly created vascular access that had not yet matured or was not clinically stable for routine cannulation. * Acute or clinically unstable medical condition. * Cognitive or language impairment that prevented completion of the study questionnaires. * Contraindication to local cryotherapy or handgrip exercise. * Previous participation in this study or in the study pretest.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| VAS Pain Score | Before cannulation and immediately after completion of arterial and venous needle insertion on the same hemodialysis session. | Pain intensity was assessed using a 0-10 visual analog scale (VAS), with higher scores indicating greater pain. VAS pain was measured before vascular access cannulation and immediately after completion of arterial and venous needle insertion. |
| First-Attempt Cannulation Success | During vascular access cannulation in the same hemodialysis session. | First-attempt cannulation success was defined as successful placement of both arterial and venous needles on the first attempt. If either needle required repeat cannulation and the total number of needle insertions exceeded two, the cannulation was classified as unsuccessful on the first attempt. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain Perception Score | Before cannulation and immediately after completion of arterial and venous needle insertion in the same hemodialysis session. | Pain perception was assessed using a 5-item questionnaire. Each item was rated on a 4-point Likert scale, with a total score ranging from 5 to 20. Higher scores indicated greater pain perception. The scale was administered before vascular access cannulation and immediately after completion of arterial and venous needle insertion. |
| Anxiety Perception Score | Before cannulation and immediately after completion of arterial and venous needle insertion in the same hemodialysis session. | Anxiety perception was assessed using a 5-item questionnaire. Each item was rated on a 4-point Likert scale, with a total score ranging from 5 to 20. Higher scores indicated greater anxiety perception. The scale was administered before vascular access cannulation and immediately after completion of arterial and venous needle insertion. |
| Comfort Score | Before cannulation and immediately after completion of arterial and venous needle insertion in the same hemodialysis session. | Comfort was assessed using a 4-item questionnaire. Each item was rated on a 4-point Likert scale, with a total score ranging from 4 to 16. Higher scores indicated greater comfort. The scale was administered before vascular access cannulation and immediately after completion of arterial and venous needle insertion. |
| Overall Care Satisfaction Score | Before cannulation and immediately after completion of arterial and venous needle insertion in the same hemodialysis session. | Overall care satisfaction was assessed using a 6-item questionnaire. Each item was rated on a 4-point Likert scale, with a total score ranging from 6 to 24. Higher scores indicated greater satisfaction with overall care. The scale was administered before vascular access cannulation and immediately after completion of arterial and venous needle insertion. |
Countries
Taiwan
Contacts
PRINCIPAL_INVESTIGATORShu-Fen Hsieh
Chang Gung Memorial Hospital
Outcome results
None listed