Improving vascular access outcomes: attributes of arteriovenous fistula cannulation success

Classified as probably not a substantial claim. May combine two claims.

The arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis (HD) and is advocated in clinical practice guidelines.

“The arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis (HD) and is advocated in clinical practice guidelines [1–4].”

• cites [1] sourceNot checked — no full text of the source
• cites [2] Thomas, 2006, Clinical educators network nursing recommendations for management of vascular access in hemodialysis patients, CANNT JNot checked yet

  Not checked in the free run.

• cites [3] sourceNot checked — no full text of the source
• cites [4] Vanholder, 2010, Diagnosis, prevention and treatment of haemodialysis catheter-related bloodstream infections (CRBSI): a position statement of European renal best practice (ERBP), Nephrol Dial Transplant sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

EI is an important competency in physician and nurse leadership.

“EI is an important competency in physician [26, 27] and nurse [28] leadership.”

• cites [26] Hammerly, 2014, Good to great: using 360 degree feedback to improve physician EI, J Healthc Manag sourceNot checked — no full text of the source
• cites [27] sourceSupported
• cites [28] sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Performing a thorough assessment is vital for AVF cannulation.

“Performing a thorough assessment is vital for AVF cannulation”

May combine two claims.

Participants are motivated and expressed an ability to focus on the task despite performing the task in the busy environment of a dialysis unit.

“They are motivated and expressed an ability to focus on the task despite performing the task in the busy environment of a dialysis unit.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In addition to auscultation and inspection of the AVF, the most important component of the assessment was palpation.

“In addition to auscultation and inspection of the AVF, the most important component of the assessment was palpation.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Nurses in this study completed an assessment prior to cannulation, believing that initial success with needle placement would save time later by avoiding miscannulations.

“This group of nurses completed an assessment prior to cannulation, believing that initial success with needle placement would save time later as a result of miscannulations.”

May combine two claims.

At times, the nurse would discuss the issue with the patient and negotiate care, while at other times, the nurse believed having someone else cannulate would put the patient more at ease and diffuse the situation.

“At times, the nurse would discuss the issue with the patient and negotiate care, while at other times, the nurse believed having someone else cannulate would put the patient more at ease and diffuse the situation.”

May combine two claims.

The nurses were attuned to the patients' emotional reactions, and if the nurse was nervous they did not want to transfer this to the patient and increase their anxiety.

“The nurses were attuned to the patients' emotional reactions, and if the nurse was nervous they did not want to transfer this to the patient and increase their anxiety.”

Probably not a substantial claim: may not pass S3 (load-bearing).

One nurse reported that if she had not cannulated a fistula recently, she would seek out an assignment change or volunteer to cannulate.

“Only one nurse commented that if she had not cannulated a fistula recently, she would seek out an assignment change or volunteer to cannulate”

May combine two claims.

Successful cannulation involved preparing the patient properly, making sure they know what is being done, taking time and getting everything ready.

“Successful cannulation involved … ‘Just preparing the patient properly, making sure they know what I am doing, taking my time and getting everything ready and cannulate them’ (7).”

May combine two claims.

There was variation from nurse to nurse in how they assisted their colleagues; some waited to be asked, some volunteered help and some mentored their colleagues.

“There was variation from nurse to nurse in how they assisted their colleagues; some waited to be asked, some volunteered help and some mentored their colleagues.”

May combine two claims.

Aspects commonly reported by participants included acknowledgment of the emotional reaction that AVF cannulation can evoke in the patient, listening and hearing about the patient's experience, education and involving and negotiating with patients regarding their AVF care.

“Aspects of this theme commonly reported by participants included acknowledgment of the emotional reaction that AVF cannulation can evoke in the patient, listening and hearing about the patient's experience, education and involving and negotiating with patients regarding their AVF care.”

May combine two claims.

Nurses reported there were times patients requested specific nurses to cannulate, based on patient concerns that were acknowledged by nurses to be real or perceived; some were based on past cannulations and others not.

“Nurses reported there were times patients requested specific nurses to cannulate. This was based on patient concerns, which were acknowledged by nurses to be real or perceived; some were based on past cannulations and others not.”

May combine two claims.

Having opportunities is essential for practicing the skill of cannulation, but this was difficult in HD units with limited numbers of AVFs.

“First, having opportunities is essential for ‘practicing the skill’ of cannulation, but this was difficult in HD units with limited numbers of AVFs.”

May combine two claims.

The nurses' ultimate goal was to be successful with the cannulation, and if that meant finding a different nurse to cannulate they did so.

“Their ultimate goal was to be successful with the cannulation, and if that meant finding a different nurse to cannulate they did so.”

May combine two claims.

Participants were aware of the emotional response that patients have to cannulation and were also aware of their own reactions to cannulation.

“They not only were aware of the emotional response that patients have to cannulation but were also aware of their own reactions to cannulation.”

Classified as probably not a substantial claim. May combine two claims.

Nurses believed that having more accessibility to fistulas meant more opportunity to consolidate their skills and reduce any feelings they had of being nervous with skill performance.

“They believed that having more accessibility to fistulas meant more opportunity to consolidate their skills and reduce any feelings they had of being nervous with skill performance.”

Classified as probably not a substantial claim.

The orientation period was viewed to be a crucial period in which to develop cannulation skills.

“The orientation period was viewed to be a crucial period in which to develop cannulation skills.”

May combine two claims.

Participants approached cannulation with a plan and established self-rules regarding how many unsuccessful attempts they would allow themselves, including 'knowing their limits'.

“They approached cannulation with a plan and also established self-rules regarding how many unsuccessful attempts they would allow themselves.”

• Also stated in: § Nurse self-awareness · plain

  “They expressed the importance of ‘know your limits’ (10).”

• Also stated in: § Discussion · hedged

  “Participants indicated that they are able to self-regulate by doing a thorough assessment, visualizing the fistula, having a plan prior to cannulation and ‘knowing their limits’.”

May combine two claims.

The skill of cannulation can conjure up emotional reactions within the nurse, including acknowledgement of the pressure of being successful, causing pain to patients, and how an unsuccessful attempt affects their confidence with the skill.

“The skill of cannulation can conjure up emotional reactions within the nurse, which includes an acknowledgement of the pressure of being successful, causing pain to patients and how an unsuccessful attempt affects their confidence with the skill.”

May combine two claims.

Nurses engaged in patient education on the benefits of AVFs and self-care, anatomy of the fistula, the cannulation procedure and how to manage unfortunate complications such as bruising.

“Nurses engaged in patient education on the benefits of AVFs and self-care, anatomy of the fistula, the cannulation procedure and how to manage unfortunate complications such as bruising.”

May combine two claims.

Nurses are sought out who are known to be an 'expert' with cannulation for a particular patient or who are considered to be expert regardless of which AVF is being cannulated.

“Nurses are sought out who are known to be an ‘expert’ with cannulation for a particular patient or who are considered to be expert regardless of which AVF is being cannulated.”

May combine two claims.

Nurses kept their skills up to date by attending education sessions, calling vascular access experts, and watching other nurses they believed to be expert cannulate.

“Participants discussed keeping their skills up to date by attending education sessions, calling experts in vascular access such as the vascular access nurses and watching other nurses cannulate they believed to be expert.”

Classified as probably not a substantial claim.

The approach was to practice and do the procedure many times until the nurse was confident in his/her skills.

“The approach was to practice and do the procedure many times until the nurse was confident in his/her skills.”

May combine two claims.

There is a policy in the HD unit with a recommended number of total attempts, but the nurses followed 'rules' that were consistent with their own beliefs about the process.

“There is a policy in the HD unit with a recommended number of total attempts, however, the nurses followed ‘rules’ that were consistent with their own beliefs about the process.”

May combine two claims.

The nurses provided examples where staff not comfortable with cannulation of AVFs would avoid cannulation, which further impedes their skill development.

“The nurses provided examples where staff not comfortable with cannulation of AVFs would avoid cannulation, which further impedes their skill development.”

May combine two claims.

Use of the ultrasound machine to assist with cannulation in this study was mixed; some nurses reported it being helpful and some did not.

“Use of the ultrasound machine to assist with cannulation in this study was mixed. Some nurses reported it being helpful and some did not.”

May combine two claims.

The nurses in this study had highly developed skills and were able to focus on the task at hand, making cannulation the priority and setting aside all other issues, concerns or emotions until cannulation was successful.

“The nurses in this study had highly developed skills and were able to focus on the task at hand, making cannulation the priority and setting aside all other issues, concerns or emotions until cannulation was successful.”

May combine two claims.

There were variations in the technique the nurses described for cannulation, but many of them used the technique that they were initially taught.

“There were variations in the technique the nurses described for cannulation, but many of them used the technique that they were initially taught.”

May combine two claims.

Participants also described efforts to review the health record and often asked their peers, who had previously been successful with cannulation, for suggestions and/or advice.

“Participants also described efforts to review the health record and often asked their peers, who had previously been successful with cannulation, for suggestions and/or advice.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

Interventions that decrease infiltrates, bruising and pain and increase nurse and patient confidence in nurses' skill will result in more positive patient experiences with arteriovenous fistulas and more positive talk among patients about arteriovenous fistulas.

“Interventions that decrease infiltrates, bruising and pain and increase nurse and patient confidence in nurses’ skill will result in more positive patient experiences with AVFs and more positive talk among patients about AVFs.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Historically, the constant site needle insertion technique gained acceptance by word of mouth from patients' positive cannulation experiences.

“Historically, the constant site needle insertion technique gained acceptance by word of mouth from patients’ positive cannulation experiences [36].”

• cites [36] sourceNot checked — no full text of the source

May combine two claims.

Successful AVF cannulation encompasses much more than the technique of needle insertion into a vessel, depending rather on the contextual influences and interplay of the practice environment and the personal attributes of the nurse.

“Successful AVF cannulation encompasses much more than the technique of needle insertion into a vessel, depending rather on the contextual influences and interplay of the practice environment and the personal attributes of the nurse.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Practice changes based on these results may improve cannulation, decrease complications and result in better outcomes for patients.

“Practice changes based on these results may improve cannulation, decrease complications and result in better outcomes for patients.”

• AssumptionRests on an assumption: Improving outcomes through behavior change is more complex than providing nursing education on proper needle insertion technique and patient education on the benefits of an AVF.
• AssumptionThe authors state this as an assumption: Change can occur and the cycle can be broken by developing staff for more successful cannulation.

Probably not a substantial claim: may not pass S3 (load-bearing).

At the core of the professional practice model is patient-centered care.

“At the core of the model is patient-centered care [24]”

• cites [24] Harwood, 2013, The renal nursing professional practice model: the next generation, CANNT JNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

There are five main elements of EI: self-awareness, self-regulation, motivation, empathy and social skills.

“There are five main elements of EI: self-awareness, self-regulation, motivation, empathy and social skills [29].”

• cites [29] Goleman D . Emotional Intelligence: Why it can Matter More Than IQ. New York, NY, USA: Bantum Books, 1995Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Patient-centered care may have impacted the results of this study.

“At the core of the model is patient-centered care [24], which may have impacted the results of this study.”

May combine two claims.

A number of barriers exist in the clinical setting preventing nurses from developing beyond the perpetual novice with cannulation, including the nurse's emotional response, avoidance, patients who refuse certain nurses for cannulation, busy work environments, dialysis schedules and a lack of opportunity to gain experience with the skill.

“A number of barriers exist in the clinical setting preventing nurses from developing beyond the perpetual novice with cannulation, including the nurse's emotional response, avoidance, patients who refuse certain nurses for cannulation, busy work environments, dialysis schedules and a lack of opportunity to gain experience with the skill [11].”

• cites [11] Wilson, 2010, The culture of vascular access cannulation among nurses in a chronic hemodialysis unit, CANNT JNot checked — no full text of the source

May combine two claims.

Teamwork in the dialysis unit and knowing that one can get help from a colleague when necessary is an important factor in successful cannulation.

“Teamwork in the dialysis unit and knowing that one can get help from a colleague when necessary is an important factor in successful cannulation.”

Probably not a substantial claim: may not pass S2 (checkable).

Efforts to nurture positive patient experiences around cannulation may influence patient decision-making regarding fistula use.

“Efforts to nurture positive patient experiences around cannulation may influence patient decision-making regarding fistula use.”

• AssumptionThe authors state this as an assumption: Change can occur and the cycle can be broken by developing staff for more successful cannulation.

Classified as probably not a substantial claim. May combine two claims.

Purposeful sampling was used whereby investigators sought participants working in three HD units (one free-standing unit, two hospital-based) who had positive experiences with cannulation.

“Purposeful sampling was used whereby investigators sought participants working in three HD units (one free-standing unit, two hospital-based) who had positive experiences with cannulation.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The sample size was guided by data saturation, at the point where no further themes were arising.

“The sample size was guided by data saturation, at the point where no further themes were arising [19].”

• cites [19] Mayan M . Essential of qualitative inquiry. In: Morse J (eds). Qualitative Essentials. Walnut Creek, CA, USA: Left Coast Press, 2009Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

The perpetual novice state can result in cannulation misses and complications such as increased bruising, pain, fear and, if persistent, a need for insertion or reliance on a CVC.

“This can result in cannulation misses and complications such as increased bruising, pain, fear and, if this persists, a need for insertion or reliance on a CVC.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

This study was approved by the local research ethics board, and written informed consent was obtained by the research assistant.

“This study was approved by the local research ethics board, and written informed consent was obtained by the research assistant.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The investigators analyzed the data separately and then met as a group to discuss preliminary findings and agree on common themes.

“The investigators analyzed the data separately and then met as a group to discuss preliminary findings and agree on common themes.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The professional practice model has been documented to benefit nurse and patient outcomes.

“Also in the environment where the study took place is a professional practice model that provides the foundation for how nursing care is delivered and has been documented to benefit nurse and patient outcomes [22, 23].”

• cites [22] Harwood, 2007, Nurses perception of the impact of a renal nursing professional practice model on nursing outcomes, characteristics of practice environments and empowerment. Part I, CANNT JNot checked — no full text of the source
• cites [23] Harwood, 2007, Nurses perception of the impact of a renal nursing practice model on nursing outcomes, characteristics of practice environments and empowerment. Part II, CANNT JNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

Nurses who have not yet acquired these skills may be able to develop them.

“Nurses who have not yet acquired these skills may be able to develop them.”

May combine two claims.

These factors create a vicious cycle: fewer AVFs, less opportunity for skill development, more unsuccessful attempts, fewer patients wanting AVFs.

“This further contributes to the problem, creating a vicious cycle: fewer AVFs, less opportunity for skill development, more unsuccessful attempts, fewer patients wanting AVFs and so forth (see Figure 1).”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

In organizational development terms, when these situations occur, they are positive deviances from the norm and are important for organizational change.

“In organizational development terms, when these situations occur, they are positive deviances from the norm and are important for organizational change.”

Probably not a substantial claim: may not pass S2 (checkable).

Organizational development can be used to break the cycle of the perpetual novice in efforts to improve patients' cannulation experience for arteriovenous fistulas by focusing on strategies to build support and acknowledge and improve factors such as patient-centered care, teamwork, opportunities for skill development and emotional intelligence.

“Organizational development can be used to break the cycle of the perpetual novice in efforts to improve the patients’ cannulation experience for AVFs by focusing on strategies to build support and acknowledge and improve factors such as patient-centered care, teamwork, opportunities for skill development and EI.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Reliability and validity were assessed for qualitative research by using the criteria of credibility, transferability, dependability and confirmability.

“Reliability and validity were assessed for qualitative research by using the criteria of credibility, transferability, dependability and confirmability [20].”

• cites [20] Lincoln Y Guba E . Naturalistic Inquiry. Beverly Hills, CA, USA: Sage, 1985 sourceNot checked — no full text of the source