Impact of Training in Procedural Simulation of Nurses in the Reduction of Complications Related to Puncture of Arterio Venous Fistula (AVF) in Chronic Hemodialysis Patients. Prospective, Comparative, Randomized Study (1090-003966) (Developmental Research Projects: Procedure (By Invitation Only))
Start time: Tuesday, February 2, 2021, 3:00 PM End time: Tuesday, February 2, 2021 Session Type: Research Study Development and Presentation Program Abstracts
The hemodialysis population consists of increasingly older patients with significant co-morbidities. The quality of arterio-venous fistula’s puncture (AVFP) impacts the quality of the extra-renal treatment. Wrong positioning of the needles in the vascular lumen, blood flow and thus the amount of blood treated may be decreased . A more severe complication of the AVFP may cause the fistula to be unusable. The technique of AVFP is passed by companionship in hemodialysis departments. While the main principles are well known and common to all hemodialysis units, there is still a lack of strong rationales for standardized practices. This technique, which is currently poorly protocolized, is not part of a process of optimizing practices and continuous improvement of care. We hypothesize that a procedural simulation training program for nurses on AVFP would reduce adverse events related to punctures and be benefic to patients.
We previously conducted a pre/post procedural simulation training pilot study (SIMFAV, RCT03680209) and observed a decrease in AVFP related iatrogeny: reduction in pain (79.9% vs 21.1%, p<0.01), decrease in hematomas (1.8% vs 0.4%, p=0.01), allowing a better longevity of the arterio-venous fistula (AVF) and an increase dialysis quality. We now propose a comparative, multicentric randomized study with 8 hemodialysis centers (600 AVFP/center). All centers will use the same materials. Experimental group will undergo 5 steps: (1) initial questionnaire on the nursing practice and hemodialysis expertise (Q-EXP); (2) procedural simulation training based on deliberate practice and rapid cycle deliberate practice[2-4]; (3) intermediate Q-EXP; (4) collection of data related to AVFP; and (5) final questionnaire Q-EXP. Control Group will undergo 2 steps: (1) questionnaire Q-EXP; (2) collection of data related to AVFP (including possible complications and undesirable effects).
We propose to compare the number of complications related to AVFP between a group with a procedural simulation training and a group without. AVFP related major complications (AVFP failure, AVF’s hematoma, AVF hematoma not allowing dialysis to continue) will be the primary outcome and will be compare in percentage between the 2 groups. AVPF related minor complications and situation descriptors (number of perdialytic bleeds, accidental needle removal, pain’s score during AVFP, difficulty of AVFP’s procedure, patients’ anxiety during AVFP, use of ultrasound, type of material used for AVFP) will be secondary outcomes and will be compare in percentage between the 2 groups.