Clinical Epidemiology & Public Health
Public health | Online ISSN 3068-4587
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Volume 1 Number 1 2023
REVIEWS (Open Access)
Clinical Assessment and Nursing Management of Arteriovenous Fistula Complications in Hemodialysis Patients: A Systematic Review
Happy Akter 1*, Mohammed Shahidul Karim 2
Clinical Epidemiology & Public Health 1 (1) 1-19 https://doi.org/10.25163/health.1110865
Submitted: 27 June 2023 Revised: 12 August 2023 Accepted: 23 August 2023 Published: 25 August 2023
Abstract
Arteriovenous fistula (AVF) complications remain a persistent challenge in long-term hemodialysis care, despite advances in vascular access management and dialysis technology. This systematic review and meta-analysis evaluated the role of nursing-led assessment, surveillance strategies, cannulation techniques, and patient self-care interventions in reducing AVF-related complications among hemodialysis patients. Electronic databases including PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar were systematically searched following PRISMA 2020 guidelines. Fourteen studies were ultimately included in the quantitative synthesis (n = 14), comprising randomized controlled trials, retrospective cohort studies, and observational investigations. The pooled findings generally favored intervention-based nursing management approaches over routine care. Predictive nursing, individualized surveillance, integrated management, and structured patient education were consistently associated with lower rates of thrombosis, AVF dysfunction, hematoma formation, and overall vascular access complications. The random-effects meta-analysis demonstrated an overall pooled risk ratio of approximately 0.38, suggesting a meaningful reduction in adverse AVF outcomes among intervention groups. Evidence also indicated that rope-ladder cannulation may carry lower hematoma and infection risks compared with buttonhole techniques in certain clinical settings. Furthermore, patient self-care education appeared to improve treatment adherence and vascular access preservation. Overall, the findings suggest that systematic nursing assessment, proactive surveillance, and patient-centered vascular access education may substantially improve AVF longevity and reduce preventable hemodialysis complications. These strategies may represent practical and cost-effective approaches for optimizing long-term vascular access outcomes in chronic hemodialysis populations.
Keywords: Arteriovenous fistula; Hemodialysis nursing; Vascular access complications; Cannulation techniques; Nursing surveillance; Thrombosis prevention; Systematic review
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