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Abstract
Learning outcomes:
On completion of this continuing professional development activity, participants will be able to:
* Discuss basic ultrasound principles;
* Define the roles and responsibilities of the nurse in point of care ultrasound;
* Identify strategies to utilise ultrasound to provide quality cannulation practice;
* Identify anatomic structures on an ultrasound picture;
* Identify anomalies in the anatomy such as thrombus, stenosis, aneurysm and pseudoaneurysm;
* Describe the advantages and disadvantages of using ultrasound for assessment and cannulation;
* Enable staff to reflect on their current approaches to assessment and cannulation.
Keywords
Vascular, ultrasound, access, haemodialysis, education.
Introduction
Cannulation of arteriovenous fistulae (AVF) and grafts (AVG) has long been a practice that has had its disadvantages. Placement of rigid metal needles into new arteriovenous fistulae can prove challenging in the presence of soft vessels with smál diameters. These variables can lead to increased risk of vessel extravasation and haematoma formation. This then perpetuates the problem of cannulation for the next nurse can nu latin g through haematoma and dots. This situation may lead to the patient being sent home without dialysis, single-needle dialysis or, in worst-case scenarios, the insertion of a central venous catheter (CVC) (Lee, Barker & Allon, 2006). The use of point of care (POC) ultrasound for cannulation has the potential to decrease cannulation-related adverse events (van Hooland, Donck, Ameye& Aerden, 2010; Schoch & Smith, 2012; Marticorena et ai. 2014).
Ultrasound use in vascular puncture is not a new concept. It has been used in general vascular practice for over 30 years, particularly in vessel identification in CVC insertion to avoid accidental arterial puncture where vessels are in close proximity (Lamperti et ai. 2012). Ultrasound is utilised in emergency department peripheral cannula insertion, usually via basilic vein puncture (Blaivas & Lyon, 2006). A meta-analysis conducted in this area concluded that POC ultrasound increased the cannulation success and had no effect on cannulation time or the number of cannulations. However, with wide variation in cannulation and ultrasound practices within the studies analysed, further research is required in all areas that use POC ultrasound as studies are limited on this topic (Stolz et ai. 2015).
Ultrasound use in renal vascular access is growing globally. This is largely due to the development...