Hemodialysis patients' satisfaction and perspectives on complications associated with vascular access related interventions: are we listening?
OBJECTIVE
To understand the patient's perspective on complications associated with vascular access-related interventions.


METHODS
A multi-stage comprehensive questionnaire of over 150 items was administered to 140 in-center hemodialysis patients in a large, Toronto-based academic-based facility from May 1, 2011 until July 1, 2014. The questionnaire was divided into three domains: physical complications, disruption to routine, and infection. For each of the 12 prespecified vascular access interventions, there were 9 items about the associated complications. The level of bother associated with complications was measured using a 5-point Likert scale.


RESULTS
The mean Likert value (5 = extremely bothered) for the physical complications domain was highest for grafts at 1.92, followed closely by fistulas at 1.87, and catheters at 1.56. The mean Likert value for the "disruption of routine" domain was highest for catheters at 1.44, followed by grafts at 1.37, and fistulas at 1.33. For infectious complications of all vascular access-related interventions the mean Likert value was highest at 1.76 for catheters as compared to fistulas at 1.23 and grafts at 1.22.


CONCLUSIONS
For hemodialysis patients, the physical complications associated with needle cannulation of fistulas and grafts are a major source of dissatisfaction, while infectious complications, including catheter-related infections, are not a significant source of their concerns. Future research should focus on developing methods to effectively: (i) reduce the fear and pain associated with cannulation and (ii) educate patients about the risks associated with vascular access-related infection.
University Health Network-Toronto General Hospital, Toronto, Ontario - Canada.|Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario - Canada.
Sarah D
SD
Kosa
University Health Network-Toronto General Hospital, Toronto, Ontario - Canada.
Cynthia
C
Bhola
University Health Network-Toronto General Hospital, Toronto, Ontario - Canada.|Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario - Canada.|Faculty of Medicine, University of Toronto, Toronto, Ontario - Canada.
Charmaine E
CE
Lok
D000203:Activities of Daily Living; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000295:instrumentation / Q000523:psychology; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000523:psychology; D055499:Catheter-Related Infections / Q000382:microbiology / Q000628:therapy; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation / Q000523:psychology; D002408:Catheters, Indwelling / Q000009:adverse effects; D062905:Central Venous Catheters / Q000009:adverse effects; D003288:Contusions / Q000209:etiology; D017281:Cost of Illness; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D009864:Ontario; D010146:Pain / Q000209:etiology; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D010465:Perception; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000628:therapy; D011677:Punctures; D006435:Renal Dialysis; D012307:Risk Factors; D016896:Treatment Outcome