الفهرس 
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Abstract
Hemodialysis requires a well-functioning vascular access (VA) that allows sufficient blood flow to achieve adequate clearance and blood dialysis. The VA offers excellent way for bacteria to invade blood stream of patients undergoing HD. One of the major problems and causes of failure in HD was represented by the lack of good VA (Canaud et al., 2019).
Arteriovenous fistula is commonly used as VA for patients who require hemodialysis. AVF complications are a serious clinical problem, and they are associated with high rates of morbidity and mortality, prolonged hospital stay, and increased medical treatment costs (Canaud et al., 2019). AVF requires fundamental care for maintenance. Health professionals need to orient each patient about self-care in the management of its new vascular access. When thinking in the care with the AVF, a range of actions to be undertaken in the preoperative period of its manufacture (Fernandes et al., 2013).
Aim of the study:
The present study was conducted to fulfill the study aim:
Assessing factors affecting AVF survival among the hemodialysis patients through the following:
1- Assess survival time of arteriovenous fistula among the hemodialysis patients.
2- Assess factors affecting survival of arteriovenous fistula among the hemodialysis patients.
Research questions:-
The current study was conducted for answering the following questions:
1- What are arteriovenous fistula survival time among the hemodialysis patients?
2- What are the factors affecting arteriovenous fistula survival among the hemodialysis patients?
Research Design
A descriptive exploratory research design was used in this study. It is a type of research that describes a population, situation, or phenomenon that is being studied. This is mainly because it is important to have a proper understanding of what a research problem is about before investigating why it exists in the first place (Fain, 2017).
Study Setting:
This study was conducted in Hemodialysis Unit at Assuit University Hospital.
Subjects:
The study subjects were included:
- A convenient sample of all available nurses ( no=30) working in hemodialysis unit at Assuit University Hospital was recruited.
- A convenient sample of adult patients (no= 230) in both gender with arteriovenous fistula for hemodialysis in the previously mentioned setting was selected.
Tools of data collection:
Three tools were used to collect the data and fulfilled the study aim.
Tool (I): Nurses’ self administered questionnaire: (Appendix I):
It self administered questionnaire sheet filled by the studied nurses it composed of three parts:
Part 1:- Nurses’ demographic characteristics: This part was used to assess the nurses’ demographic data which involved six questions included age, gender, marital status level of education, years of experiences, training course.
Part 2:- Nurses’ knowledge assessment: This part was concerned with assessing the nurses’ knowledge regarding the care of AVF among the HD patients. This part consisted of 49 closed ended questions in form of multiple choice questions (MCQs) This part was consisted of four sections :
Section I: Concerned with nurses’ basic knowledge about AVF. It included definition of AVF, indication and contraindication, advantages and disadvantages of AVF (14 questions).
Section II: Focused on nurse’s knowledge regarding complications of AVF. It included signs and symptom of AVF infection, stenosis and thrombosis (7 questions).
Section III: Concerned with of nurse’s knowledge regarding the care for AVF. It included frequency measurement of blood pressure, caring for fistula bleeding and instruction before starting session (16 questions).
Section IV: Concerned with nurse’s knowledge regarding health education about AVF. It included instruction before, during and after session of HD related AVF (12 questions).
Part 3: Other factors affecting arteriovenous fistula; these factors were assessed from the nurses’ point of view, it included nurses’ related factors (12 statements). Patients related factors (14 statements). Environmental related factors (14 statements). There were 40 statements, the response for each statement was one grade for yes and zero for no.
Tool (II): Nurses’ practice observational checklist regarding AVF: (Appendix II):
This tool was developed by researcher in English language after reviewing related literatures .It was used to assess nurses practice regarding the care of AVF among the HD patients, it included:
Section I: Pre-cannulation technique of AVF, it included (15 steps).
Section II: Cannulation technique of AVF insertion, it included (20 steps).
Section III: Post\ AVF decannulation, it included (10 steps).
Section IV: The care of AVF, it included (10 steps).
Section V: - Patients education, it included (13 steps).
Tool (III): Hemodialysis patients assessment: (Appendix III):
It included three parts:
Part 1:- Demographic characteristics and medical data:- This part used to assess patient’s demographic data and medical data which involved 12 questions included age, gender, level of education, experiences, marital status, occupation, residence, cost of treatment, diagnosis, duration of hemodialysis, weight before session, weight after session, height, medical history and family history.
Part II: AVF assessment:- This part developed by researcher based on literature review. It consisted of two sections:
Section I: Examination of fistula: it consisted of (19 items), to assess fistula location, number of fistulisation, survival time and criteria of its survival among the HD patients.
Section II: Examination of fistula for any complications: it consisted of eight complications related to AVF and manifestation for each one, the response option was either yes \took one score or no\ took zero score.
Part III : Patients’ self-care behavior assessment tool: this tool was used to assess HD patients self-care reported practice regarding the care of AVF and involved 29 statements. The response for healthy behavior took one grade and zero for unhealthy behavior.
Results: This result of the study showed that:
- The mean age of studied nurses was 33.30 ± 11.58 years, 60% of them were females. Regarding marital status, 60% of the nurses were married and regarding educational level, it was found that 56.7% of them were graduated from nursing school. Also, 50.0% of the studied nurses had more than 10 years of experience in hemodialysis unit, 63.3%of them had previous training courses regarding nursing care for HD patients and 47.4% of them took two training courses.
- 50% of the studied nurses had unsatisfactory knowledge about AVF, 76.7% of them had unsatisfactory knowledge about complications of AVF and 46.7% of them had unsatisfactory knowledge about health education while 80.0% of them had satisfactory knowledge about the care of AVF.
- 60% of the studied nurses had satisfactory knowledge regarding AVF care and 40.0 % of them had unsatisfactory knowledge.
- Most of the studied nurses 80% reported that, nurses related factors had high effect on AVF survival from their point of view followed by environmental related factors 70% and patients related factors 56.7%.
- 63.3% of the studied nurses viewed that many reported factors had high effect on AVF survival. While 36.7% of them viewed that those factors had low effect..
- The studied nurses had unsatisfactory level of practice regarding pre-cannulation of AVF, post-cannulation of AVF and about the care of AVF; 56.7%, 63.3% and70.0% respectively.
- 56.7% of studied nurses had unsatisfactory level of total practice regarding AVF care. While, 43.3% of them had satisfactory level of total practice regarding AVF.
- 32.6% of studied patients, their was age ≥ 50, 50. 4% of them were males, 87.0% of them were married, 43.5% of patient study was not read and write, 76.5% of them had no work, 69.6% of them resided in rural areas and the cost of treatment for 84.3% of them was by expense of the state.
- 51.3% of the studied patients had total satisfactory level of self care behavior regarding AVF care. While 48.7% of them had unsatisfactory level.
- There was highlly statistically significant relation between survival time AVF (years) and nurses total level of knowledge and practice among the studied patients at p. value <0.001. While, there was statistically significant relation between survival time of AVF and patients’ self-care behavior at p value < 0.05.
- There were highly statistically significant correlation between AVF survival time and nurses total level of knowledge, practice and patients’ self-care behavior at p. value <0.001. While, there was no statistically significant correlation between AVF survival time and other affecting factors; nurses, patients environmental related factors at p value > 0.05.