Implantación de la técnica del “ojal” o “buttonhole” en una unidad de hemodiálisis hospitalaria: satisfacción del paciente

Abstract

Professionals in the field of Nephrology and Dialysis have been aware of the vital importance of optimal vascular access since the first hemodialysis substitution treatment was performed in 1945. This is because the quality of vascular access (VA) conditions the efficiency and effectiveness of this technique, as well as the morbidity and quality of life of patients undergoing this therapy1. For a VA to be considered optimal, it must have several characteristics: allow a safe and continuous approach to the vascular system, provide sufficient flows to deliver the required dose of dialysis and be free of complications. However, although this type of VA does not currently exist, the one that comes closest to these requirements is internal arteriovenous fistula (IVF)1 . The scientific evidence agrees on the importance of effective nursing care of the LVAF and an appropriate puncture technique to achieve correct development and permeability, prolong survival and minimise complications related to the dysfunction (stenosis, aneurysms, thrombosis, infection, etc.). The correct use and maintenance of this vascular access (VA) will be the cornerstone related to the technical aspect of haemodialysis in which nursing can play a role. The FAVI puncture technique has been shown to cause anxiety and discomfort for the patient and, secondarily, for the nursing staff2. In addition to influencing the survival of the FAVI, given that repeated punctures end up altering the morphology and characteristics of the blood vessel3 , as already stated by Kronung in 1984 with his analysis of the consequences of multiple punctures, and the best technique for avoiding damage4 , due to the elongation of the front wall of the vessel caused by tissue displacement and the subsequent filling with a thrombus of the hole generated after needle removal.