title: Improving vascular access outcomes: attributes of arteriovenous fistula cannulation success.
abstract: BACKGROUND
  Arteriovenous fistulas (AVFs) are the preferred access for hemodialysis (HD) yet they are underutilized. Cannulation of the fistula is a procedure requiring significant skill development and refinement and if not done well can have negative consequences for patients. The nurses' approach, attitude and skill with cannulation impacts greatly on the patient experience. Complications from miscannulation or an inability to needle fistulas can result in the increased use of central venous catheters. Some nurses remain in a state of a 'perpetual novice' resulting in a viscous cycle of negative patient consequences (bruising, pain), further influencing patients' decisions not to pursue a fistula or abandon cannulation.
  
  
  METHODS
  This qualitative study used organizational development theory (appreciative inquiry) and research method to determine what attributes/activities contribute to successful cannulation. This can be applied to interventions to promote change and skill development in staff members who have not advanced their proficiency. Eighteen HD nurses who self-identified with performing successful cannulation participated in audio-recorded interviews. The recordings were transcribed verbatim. The data were analyzed using content analysis.
  
  
  RESULTS
  Four common themes, including patient-centered care, teamwork, opportunity and skill and nurse self-awareness, represented successful fistula cannulation. Successful cannulation is more than a learned technique to correctly insert a needle, but rather represents contextual influences and interplay between the practice environment and personal attributes.
  
  
  CONCLUSIONS
  Practice changes based on these results may improve cannulation, decrease complications and result in better outcomes for patients. Efforts to nurture positive patient experiences around cannulation may influence patient decision-making regarding fistula use.
authors.affiliation: Adam Linton Hemodialysis Unit, London Health Sciences Centre, London, ON, Canada; Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.
authors.forename: Lori E
authors.initials: LE
authors.lastname: Harwood
authors.affiliation: Adam Linton Hemodialysis Unit, London Health Sciences Centre, London, ON, Canada; Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Wilson
authors.affiliation: Arthur Labatt Family School of Nursing , Western University , London, ON , Canada.
authors.forename: Abe
authors.initials: A
authors.lastname: Oudshoorn
keywords: AV fistula; appreciative inquiry; emotional intelligence; hemodialysis