关键词: 血液透析；自体动静脉内瘘；人工动静脉内瘘；血管通路

Abstract: Objective: To describe the characteristics of vascular access cannulation among clinical nurses in hemodialysis centers in Beijing based on the best evidence, therefore to identify the gap between clinical practice and the best practice of vascular access cannulation, and provide evidence for future improvement. Methods: Following convenient sampling, eligible nurses from the hemodialysis centers of study hospitals were included in the current study. Using questionnaire which was designed based on the evidence-based practice, clinical guidelines and expert consensus, the characteristics and influencing factors of vascular access cannulation among clinical nurses were examined. Results: A total of 542 valid questionnaires were collected and analyzed. Among these nurses, the average score for the standardized operation was 4.64 (0.62), which was related to the nurse's professional title, position, received training on puncture and ultrasound application. Meanwhile, the score on handling puncture complications was significantly lower than the scores on both assessment before puncture and the puncture process (P<0.001). The proportion of nurses who assessed the maturity of AVF and AVG at the time of puncture according to the best evidence was 46.3% and 12.3%, and the proportion of nurses who adopted "rope-ladder cannulation", "buttonhole cannulation" and "area cannulation" in AVF/AVG were 96.5%/93.9%, 27.3%/13.5% and 26.9%/19.9%, respectively. Conclusion: There are potential needs to standardize nurses' cannulation process, especially those related to the handling of puncture complications. The time assessing maturity and cannulation of the initial arteriovenous fistula is not consistent, the cannulation methods needs to be improved. The overall nursing management of vascular access is significantly related to the standardization of nurses' cannulation in hemodialysis centers.

Key words: hemodialysis; Arteriovenous Fistula; Arteriovenous Graft; vascular access