BACKGROUND OF THE STUDY:

Disorders related to kidney are currently the leading cause of death throughout the country. Chronic renal failure is a progressive irreversible deterioration in renal function in which the body’s ability to maintain metabolic, fluid and electrolyte balance fails, resulting in uremia which render the patient to depend up on hemodialysis for the maintenance of the internal milieu and to avoid uremia.

People with failed or damaged kidneys may have difficulty in eliminating waste and unwanted water from the blood. Dialysis is an artificial way of carrying out this process. Dialysis substitutes the natural work of the kidneys¹.

Hemodialysis is the most common and durable treatment for ESRD patients. However, this changes patient’s life completely by imposing certain constrains on their routine activities affecting the compliance to therapy, so they need assistance to continue treatment. A proper vascular access is the key for effective hemodialysis². A definite access in the form of arteriovenous fistula (AVF) is recommended in CKD patients. There are several complications associated with the use of AVF access and can be prevented by adopting a daily AVF self-care practice. For this health care team is supposed to educate them about self-care and management of AVF.³Accordingly patients are instructed to avoid wearing tight dressings, checking blood flow daily and doing manual compression exercises etc. In addition to this when AVF is matured and is being used for hemodialysis, additional care is needed like pre dialysis cleansing of AVF access site, adequate compression for hemostasis after dialysis, not checking blood pressure and avoiding blood sampling from that hand etc. Adequate knowledge of all these potential complications make preventive measures necessary for ESRD patients as it will form an attitude and will lead to the practice of good AVF self-care. Failure to follow these precautionary measures may lead to hospitalization. Since ESRD patients on maintenance hemodialysis are at increased risk of complications hence it is important to find out their care practice of AV fistula access⁴.

NEED AND SIGNIFICANCE OF THE STUDY:

The main challenges faced by health systems are aging and chronic diseases. Among these, Chronic Kidney Disease is characterized by being a debilitating disease, caused by a gradual and progressive loss of renal function, which affects the person and his surroundings. The number of people with Chronic Kidney Disease and terminal chronic renal failure continues to increase exponentially, being a public health problem that could reach severe epidemic proportions. There are several important factors for its development, such as aging, cardiovascular diseases and type II diabetes mellitus, considered to be responsible for its increasing incidence⁷.

The incidence of chronic renal failure is increased by almost 8% per year for the past 5 years. In the United State, more than 2,80000 patients with chronic renal failure (65%) are receiving hemodialysis more than 1,20,000(28%) have functioning renal transplantation. The incidence is very high in India, there are almost 1.5 Lakhs new cases with end stage kidney failure, which require dialysis and transplantations⁸. In the year 2000, in the United State alone, 30 million people were diagnosed with chronic kidney disease⁹. Chronic kidney disease is a worldwide public health problem. The hemodialysis is the most widely used treatment method, which demand adjustment in the patient life, Since it is a treatment associated with restrictions and that compromises their daily activities. AV fistulas are considered as the golden standard for hemodialysis vascular access based on their superior patency, low complication rate. The prevention of complication can be accomplished through the use of appropriate care¹⁰.

In current scenario complications and failure rate of AV fistula care is increasing. As a researcher it has become important to assess the AV fistula care practices among patient undergoing hemodialysis. This study helps to understand the weak area of AV fistula care practices. And also help in conducting further research to better understand the lapses in AVF care practices to formulate a better practice and guidance for patients to improve their AV fistula care.

In this study hemodialysis patients refers to the patients undergoing a process of purifying the blood using a dialyzer whose kidneys are not functioning normally.

STATEMENT OF THE PROBLEM:

A study to assess AV fistula care practices among patient undergoing hemodialysis in a selected tertiary care hospital in Ernakulum district.

OBJECTIVES:

1 To assess the AV fistula care practices among patient undergoing hemodialysis.

2 To study the association between AV fistula care practices and selected demographic variables.

Assumption:

The haemodialysis patients may possess some AV fistula care practices in the maintenance of healthy AV fistula.

Hypothesis:

H₁: There is a significant association between AV fistula care practices among haemodialysis patients and selected demographic variables.

MATERIAL AND METHODS:

Research approach:

The present study used quantitative research approach.

Research design:

Descriptive cross-sectional design were used in the study.

Variables:

Outcome variables: AV fistula care practice of Haemodialysis patients with AV fistula.

Demographic variables: Age, gender, educational status, occupation, religion, type of family, number of Haemodialysis, exposure to AV fistula education.

Setting of the study:

The study conducted at urology OPD and dialysis unit in a selected tertiary care hospital in Ernakulam district.

Population:

Hemodialysis patients with AV fistula in a selected tertiary care hospital in Ernakulam district.

Sample and sampling technique:

69 Hemodialysis patients with AV fistula attending urology OPD and dialysis unit

Non probability convenience sampling technique were used to select subjects

Inclusion criteria:

· Patients with AV fistula who had undergone Haemodialysis for more than 2 times

· Patients above 26 years

Exclusion criteria:

Patients who are critically ill.

RESULTS:

Section: 1 Description of subjects according to their demographic characteristics

Demographic details were described in terms of age, educational qualification, marital status, job, cast, type of family, income, number of hemodialysis underwent and exposure to AV fistula education.

Table: 1 Frequency and percentage distribution of subject according to their demographic variables. n=69

Sl no	Demographic variables	Category	Frequency (f)	Percentage (%)
1	Age of the subject	26-30	2	2.89
		31-35	2	2.89
		>35	65	94.2
2	Educational qualification	Illiterate	16	23.1
		SSLC	28	40.5
		Higher Secondary	10	14.4
		Degree	15	21.7
3	Marital status	Married	67	97.1
3	Marital status	Unmarried	2	2.8
4	Job	Sedentary	4	5.79
		Moderate	26	37.6
		Heavy	4	5.79
		Not working	35	50.7
5	Cast	Christian	46	66.6
		Hindu	20	28.9
		Muslim	3	4.34
6	Family	Joint	17	24.6
6	Family	Nuclear	52	75.3
7	Income	<5000	27	39.1
		5001-10000	18	26.08
		10001-30000	18	26.08
		>30000	6	8.69
8	Number of HD underwent	10	1	1.44
		11-50	22	31.8
		>50	46	66.6
9	Exposure	Yes	2	2.89
9	Exposure	No	67	97.1

Table 1: shows that majority of the subjects (94.2%) were above 35years of age, most of the subjects (40.5%) were educated up to SSLC and only 23.1% were illiterate. Result showed most of the subjects (97.1%) were married. Majority of the subjects (50.7%) were not working and 37.6% were having moderate job. About 66.6% of respondents were Christians, 28.9% were Hindus followed by 4.34% were Muslims. Majority 75.3% of the subjects belonged to nuclear family, 39.1% of the subjects had a monthly income less than 5000, 26.08% had monthly income between Rs. 5001- Rs.30,000 and only 8.69% of the subjects had monthly income more than 30,000. More than half of the subjects (66.6%) underwent hemodialysis more than 50 times and (97.1%) never had any exposure to AV fistula education.

Objective 1: To assess the AV fistula care practices among patients undergoing hemodialysis.

Description of subjects according to AV fistula care practices

Variable	Mean	Standard deviation
Level of AV fistula care practice	30.22	3.23

Figure 1: Level of AV fistula care practices.

Table 2: Frequency and percentage distribution of subjects according to their level of AV fistula care practices.

Level of AV fistula care practices	Frequency (f)	Percentage (%)
Poor(<20)	0	0
Good ( 20-30)	28	40.6
Very good ( 30-36)	41	59.4

The above table depicts that majority of subjects (59.4%) had very good AV fistula care practices and merely 40.6% had good care practices. None of the subjects had poor AV fistula care practices.

Item wise analysis:

Majority of subject 49% had poor AV fistula care practices in checking AV fistula thrill or pulse daily and 40% subjects had less practice in washing hands before and after touching AVF site.

Objective 2: To study the association between AV fistula care practices and selected demographic variables.

Association between AV fistula care practices and demographic variables.

Table 3: Association between AV fistula care practice and selected demographic variables. n =69

SL No	Demographic variables		AV fistula care practices		Chi square/Fishers exact value	P value
			Good	v. good
1.	Age	26-30	0	2	1.356	-
		31-35	1	1
		>35	27	38
2.	Education	SSLC	7	21	5.461	.141
		Degree	8	7
		H second	6	4
		Illiterate	7	9
3.	Marital	Married	27	40	.393	-
		Unmarried	1	1
4.	Occupation	Heavy	0	4	3.132	-
		Moderate	10	16
		Sedentary	2	2
		Not working	16	19

Table 3 continued

SL No	Demographic variables		AV fistula care practices		Chi square/Fishers exact value	P value
			Good	v. good
5.	Religion	Christian	20	26	1.815	-
		Hindu	8	12
		Muslim	0	3
6.	Family	Joint	4	13	2.720	.099
		Nuclear	24	28
7.	Income	<5000	12	15	4.176	-
		5001-10000	7	11
		10001-30000	5	13
		>30000	4	2
8.	Number	<10	1	0	2.213	-
		11-50	7	15
		>50	20	26
9.	Exposure	Yes	0	2	-	-
		No	28	39

Level of significance at < 0.05 level

The above table shows that no significant association were found between AV fistula care practice and selected demographic variables such as, age, education, marital status, occupation, religion, type of family, income, no. of hemodialysis underwent, exposure to AV fistula education.

DISCUSSION:

The present study was intended to assess the AV fistula care practices among patient undergoing hemodialysis. The findings of the present study have been discussed in relation to the observation made by other studies which the investigator had reviewed.

The present study results showed that the AV fistula care practices among patient undergoing hemodialysis was very good (59.4%). A similar study was conducted on the knowledge attitude and practices among ESRD patients on hemodialysis at in Lahore general hospital also showed has positive practice towards AV fistula care.

On contrary^17,28, a study conducted on knowledge, attitude and practice among in Barao de Lucena Hospital showed 97.7% patients have inadequate fistula care practices. A study to assess the care practice on AV fistula among patients undergoing haemodialysis in selected tertiary hospital at kelambakkam showed patients having adequate AVF practice 47(81.2%).

The current study showed that there is no significant association between AV fistula care practices and selected demographic variables. On contrary a study²⁸ was conducted to assess the care practice on AV fistula among haemodialysis patients showed there is a significant association between demographic variables and AVF care practices. No study could be received to support the above findings.

ACKNOWLEDGEMENTS:

Accomplishment of this study owes to the encouragement and guidance given by many individuals. The researchers would like to thank all individuals who participated in the current study.

CONFLICT OF INTEREST:

The authors declare no conflict of interest in the study

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Received on 22.10.2019 Modified on 16.11.2019

Asian J. Nursing Education and Research. 2020; 10(1):103-106.

DOI: 10.5958/2349-2996.2020.00023.3