title: [A Project to Reduce the Occlusion Rate in Hemodialysis Arteriovenous Access].
abstract: OBJECTIVE
  Vascular occlusions in patients frequently necessitate that duty nurses work overtime to manage related vascular problems. For patients, vascular occlusions require invasive treatments that are painful, take time to heal, and increase anxiety. Furthermore, vascular occlusions seriously influence the effectiveness of hemodialysis.
  
  
  OBJECTIVE
  This project worked to reduce the rates of occlusion from 18.6% to < 15% for hemodialysis arteriovenous grafts (AVGs) and from 5.2% to < 2.6% for arteriovenous fistulas (AVFs).
  
  
  METHODS
  This project was conducted between September 1st, 2012 and July 31th, 2013. Our approach used a retrospective study, literature review, meeting discussions, and data compilation. The four main problems identified as associated with occlusion were: (1) low blood pressure during hemodialysis; (2) successive fistula puncture sites were located too close to one another; (3) abnormal blood flow; and (4) poor moisture control. Our solutions included: 1) adjusting and creating forms; 2) adjusting related nursing procedures; and 3) organizing a related lecture for our department.
  
  
  RESULTS
  The occlusion rates of AVG and AVF decreased from 18.6% to 7.4% and 5.2% to 0.9%, respectively.
  
  
  CONCLUSIONS
  We significantly reduced AVG and AVF occlusion rates by using simple methods such as using a tourniquet ruler, designing big-print, illustrated patient instruction sheets on preventing low blood pressure, creating a simplified fistula puncture site series chart, creating a moisture control card, and scheduling follow-up visits for patients with abnormal blood flow at the OPD. This project provides a reference for other hemodialysis departments.
authors.affiliation: Department of Nursing, Mennonite Christian Hospital, Taiwan, ROC. key118@mch.org.tw.
authors.forename: Jia-Ling
authors.initials: JL
authors.lastname: Huang
authors.affiliation: Department of Nursing, Mennonite Christian Hospital, Taiwan, ROC.
authors.forename: Jeng-Fong
authors.initials: JF
authors.lastname: Jang
authors.affiliation: Hemodialysis Room, Mennonite Christian Hospital, Taiwan, ROC.
authors.forename: Kun-Feng
authors.initials: KF
authors.lastname: Lee
authors.affiliation: Hemodialysis Room, Mennonite Christian Hospital, Taiwan, ROC.
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Shie
authors.affiliation: Hemodialysis Room, Mennonite Christian Hospital, Taiwan, ROC.
authors.forename: Mei-Hua
authors.initials: MH
authors.lastname: Jin
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D006083:Graft Occlusion, Vascular / Q000517:prevention & control*; D006801:Humans; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies
keywords: arteriovenous fistula; arteriovenous graft; hemodialysis; occlusion rate