Transitioning from central venous catheter to arteriovenous fistula : the hemodialysis patient experience

• Main Author: Romyn, Angela Michelle
• Language: English
• Published: University of British Columbia 2013
• Online Access: http://hdl.handle.net/2429/44034

An estimated 200,000 British Columbians are afflicted with some degree of chronic renal disease in which the kidneys can no longer remove toxins from the body and they need a machine to perform this function. Hemodialysis is the most common way to do this and involves the creation of an access directly into the patient’s blood stream that connects to the machine. Two types of vascular accesses are arteriovenous fistulas (AVF) and central venous catheters (CVC). There is limited research available that discusses why patients choose to dialyze with AVFs or CVCs and there is no research that could be found that addresses the transition experience of patients who have utilized both accesses. The purpose of this study was to explore the experiences of hemodialysis patients who had utilized and transitioned from a CVC to an AVF. An interpretive descriptive design was used. Eleven patients participated in semi-structured interviews. Constant comparative analysis was used to analyze the data that uncovered three main themes: Impact, Coping, and Factors influencing impact and ability to cope. Participants experienced the impact of their vascular accesses within the larger context of living with end stage renal disease (ESRD). Regardless of the access, participants’ lifestyles were significantly affected and superimposed on physical and psychosocial impacts. They coped using a variety of strategies including exercising control, focusing on the positive, and struggling to accept. Participants described several factors that influenced the impact of their vascular accesses and their ability to cope including patient education, trust in health care providers, transportation, and family. Participants’ stories of vascular access transition revealed the sense of burden vascular accesses were for self and loved ones, the threat to body Image, the all-consuming fear of the unknown, and information challenges. This study elucidates the need for further exploration of issues related to improving the patient experience of vascular access with attention to body image, fear of cannulation, access to resources and trust in health care providers and the information they provide.