Evaluation of point of care ultrasound (POCUS) training on arteriovenous access assessment and cannula placement for haemodialysis

Abstract

Background: Haemodialysis requires a permanent vascular access and relies on cannulation with two large bore needles. Point Of Care Ultrasound (POCUS) is a tool that may assist nursing staff with visualising cannula placement and prevent miscannulation. This can be particularly useful in regional hospitals with limited access to vascular access specialists. Aims: To examine the impact of POCUS provision and education for nursing staff on confidence in cannulation and to understand the patient experience at three regional hospital haemodialysis units in South Australia. Methods: A POCUS machine and dedicated nursing education were provided at each of the three sites. A pre-test post-test model was used to assess the individual nurses perceived competency before and after the delivery of a series of online ultrasound education modules and face to face training. Patient reported outcome measures (PROMs) were collected to understand the use of POCUS from the client perspective. Results: There was a shift towards ‘agree’ or ‘strongly agree’ for all nursing surveys in regard to perceived competency ( n = 15). This was statistically significant ( p ⩽ 0.05) for all questions other than question 1 ‘I am confident in my ability to physically assess vascular access’ ( p = 0.06). The patients that completed the PROMs ( n = 17) overall supported the ease and use of POCUS for haemodialysis cannulation and felt that it contributed to the nursing staff competency in cannulation. Conclusion: POCUS has the potential to be a valuable tool in regional haemodialysis units to support vascular access cannulation and potentially avoid metropolitan transfer due to cannulation difficulties. The non-significant change post intervention for question 1 likely reflects the haemodialysis nurses inherent pre-existing capacity to assess vascular access without the use of POCUS using the standard process of visual inspection, the use of a stethoscope and palpation (‘look, listen and feel’).