Dr RIZZA ANTOINETTE YAP SO-RUBIO1, Dr Vivian Imbriotis1, Ms Aphrodite Stathis1, Dr Rashmi Nair1, Dr Animesh Singla1, Dr Vikram Puttaswamy1, Dr Emma O'Lone1,2
1Royal North Shore Hospital, St Leonards, Australia, 2University of Sydney,, Camperdown, Australia
Biography:
Dr. So trained in General Nephrology at the Royal North Shore Hospital (RNSH) in 2023 as an International Society of Nephrology Fellow. In 2024, she took on the role of Unaccredited Trainee in Research, focusing on vascular access surveillance and maintenance. She worked on various research projects in the same field during this time. She has since returned to the Philippines and has applied for a staff specialist position at the National Kidney and Transplant Institute (NKTI). Dr. So is eager to apply all the knowledge and experience she gained abroad and looks forward to future collaborative work with RNSH.
Aim:
To evaluate the usefulness, acceptability, feasibility, and accuracy of a standardized vascular access (VA) assessment tool.
Background:
Clinical examination remains an easy and inexpensive way to monitor VA, critical for effective haemodialysis. We designed a standardized clinical examination tool, the Routine Access Assessment Form (RAAF), and embedded it into a surveillance program. The RAAF was designed to support education, examination, and documentation.
Methods:
A mixed-methods validation study in prevalent haemodialysis patients with arteriovenous fistulas and grafts (AVFs/AVGs) with RAAF assessments between January 2023 and June 2024. All RAAF data and VA outcomes were collected via a secure online database, RedCap. Data included thematically analysed qualitative interviews and surveys incorporating Likert scales for nursing staff and patients. RAAF as a predictor for stenosis, as determined by ultrasound, was analysed using regression models.
Results:
2,627 RAAFs were performed in 213 patients. 20 nurses and 66 patients responded to respective surveys, and 15 nurses undertook interviews. 71% of patients reported improved confidence in fistula monitoring and felt the additional examination time was worthwhile. 80% of nurses acknowledged the patient benefit, and 80% valued the tool as an educational resource. Qualitative themes were broadly divided into implementation challenges and optimizing VA outcomes. The RAAF did not predict stenosis as determined by US (p=<0.05).
Conclusions:
The RAAF tool is useful, feasible, and acceptable to staff and patients. Some challenges remain, including nursing workload and information technology barriers, but these concerns are more than offset by the positive contribution to nursing education, streamlined management of VA, and patient confidence. Further research is required to determine the long-term impact of the RAAF on access longevity.