Nurse-led research: identifying factors that increase the risk of problems with vascular access and exploring patients’ perspectives
Mrs Sarah McMillan, lead nurse for the Welsh Kidney Network and vascular access nurse from Cardiff and the Vale, has been awarded our first ever nurse-led fellowship award of £200,000, in collaboration with Kidney Wales and the Association of Nephrology Nurses (ANN UK), to examine the risk factors for problems with vascular access and explore patients’ perspectives.
As part of the fellowship, Sarah will study for a PhD study at Cardiff University in the School of Healthcare Sciences and Wales Kidney Research Unit, supervised by Dr Jessica Baillie (senior lecturer in adult nursing) and Mr Usman Khalid (consultant transplant surgeon).
The problem
During haemodialysis, access to the blood is needed to a dialysis machine to remove toxins from the patient’s blood and return clean blood. To establish this vascular access, a surgically created arteriovenous (AV) fistula is formed as it is the least problematic form of access.
Although AV fistulas are the best form of access, they can have complications, such as stenosis, which slows and reduces blood flow through the AV fistula. This can cause problems with the quality of dialysis, requiring repeated surgeries and may eventually lead to failure. This has a huge impact on patient wellbeing and mental health.
What is an arteriovenous fistula?
An arteriovenous fistula is a type of vascular access that is made by joining a vein onto an artery, typically in the arm, to create a large sturdy vessel that can be regularly accessed with needles for haemodialysis.
The solution
Firstly, Sarah will use healthcare information, with details that could identify an individual removed, to identify any risk factors for AV fistula stenosis.
Patients who have had stenosis or experienced vascular access loss will then be invited to take part in interviews. Their answers will be analysed to identify any themes within the previously gathered data and will help Sarah and the team to gain valuable insights into patient experiences.
What does this mean for kidney patients?
By understanding the key risk factors, and patient views, changes can be implemented to improve overall outcomes for haemodialysis patients.
“I am very thankful for this opportunity from Kidney Research UK and the other funders, as this fellowship will also allow me to develop my research skills and achieve my career goal of becoming a clinical academic. Nurses can offer unique perspectives on patient experiences and fill in evidence gaps enabling better care, I am hopeful that my project will help many patients now and in the future who require dialysis.” Sarah McMillan.
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