BACKGROUND:Arteriovenous fistula-related self-care behaviors, self-care agency and health literacy are important for vascular access patency, which is vital in the continuation of hemodialysis treatment. The purpose of this study was to determine the arteriovenous fistula-related self-care behaviors of patients receiving chronic hemodialysis treatment and the relationship between these behaviors and their health literacy and self-care agency levels. METHODS:In this descriptive correlational study, the data were collected from 216 chronic hemodialysis patients. RESULTS:The rate of the patients who had good self-care behaviors levels was 83.96%. The sociodemographic variables that were significantly related to AVF-related self-care behaviors were education, employment status and age. It was found that the patients who had had AVF for a longer time had better self-care behaviors regarding their management of symptoms and findings ( < 0.05). As the self-care agency of the patients ( = 0.612,  < 0.001) and their health literacy ( = 0.421,  < 0.001) increased, their AVF-related self-care behaviors also increased. CONCLUSION:Age, education status, health literacy and self-care agency were identified to affect AVF-related self-care behaviors.

OBJECTIVE:To evaluate the role of preoperative peripheral blood neutrophil-to-lymphocyte ratio in predicting early arteriovenous fistula failure. The impact of postoperative neutrophil-to-lymphocyte ratio on arteriovenous fistula failure was also investigated. METHODS:Medical records from 470 patients who underwent first-time arteriovenous fistula creation were studied. Demographic, clinical, and laboratory data were obtained. Receiver operating characteristic curves were constructed to determine the optimal cutoff values of preoperative and postoperative neutrophil-to-lymphocyte ratios for predicting early arteriovenous fistula failure. Univariate and multivariate analyses were performed to evaluate whether the neutrophil-to-lymphocyte ratio parameters were prognostic indicators for arteriovenous fistula failure. RESULTS:Complete data from 396 patients were studied. The prevalence of early arteriovenous fistula failure was 30.6%. The optimal cutoff values of preoperative and postoperative neutrophil-to-lymphocyte ratios for predicting early arteriovenous fistula failure were 2.7 (82.6% sensitivity and 52.0% specificity) and 2.9 (78.5% sensitivity and 73.1% specificity), respectively. By univariate and multivariate analyses, high preoperative and postoperative neutrophil-to-lymphocyte ratios were significantly associated with early arteriovenous fistula failure. The adjusted odds ratios were 5.46 (95% confidence interval: 3.15-9.48) and 7.19 (95% confidence interval: 4.12-12.55), respectively. CONCLUSIONS:High preoperative and postoperative neutrophil-to-lymphocyte ratios significantly predict early arteriovenous fistula failure.

BACKGROUND:The use of autologous arteriovenous fistulae (AVF) for hemodialysis (HD) is the gold standard; however, for many patients at tertiary referral centers, this is not an option. METHODS:We conducted a four year retrospective cohort study to evaluate HD access outcomes with AVF, bovine carotid artery (BCA), and polytetrafluoroethylene arteriovenous graft (PTFE). RESULTS:The study contained 416 AVF, 175 BCA, and 58 PTFE, N = 649. There was statistical difference between rates of infection (AVF 3.4%, BCA 2.9%, PTFE 11.9%), P = 0.02. Maturation failed in 7.5% of AVF but in none of the BCA or PTFE (P = 0.001). Accesses were abandoned with AVF (1.9%), BCA (1.5%), and PTFE (9.5%), P = 0.01. CONCLUSION:Bovine carotid artery can be an effective alternative form of HD access with lower infection, abandonment, and failure to maturation rates when autologous arteriovenous fistula is not an option.

OBJECTIVES:Vascular access is a lifeline for the patients who are in need of long-term hemodialysis. Native arteriovenous fistula is the most intensively preferred vascular access method owing to its longevity and convenience of use. Therefore, in this study, we aimed to determine whether there might be a relationship between hemodialysis patients' educational levels and arteriovenous fistula patency. METHODS:A total of 349 patients who were attending in a chronic hemodialysis program between June 2018 and September 2018 at Bursa Uludağ University, Faculty of Medicine Dialysis Unit and in a private dialysis center in İstanbul were included in this study. The patients were grouped into two: those who have had arteriovenous fistula primary failure at least once and those who have never had arteriovenous fistula primary failure. Educational levels of the patients were classified according to Turkish National Education system (illiterate, primary school graduate, secondary school graduate, high school graduate, and university graduate). Mann-Whitney U and Chi-square tests were performed for statistical analyses. Risk factors were determined by applying backward binary logistic regression analysis. RESULTS:A total of 349 patients, 161 (46.1%) females and 188 (53.9%) males, were examined retrospectively. The median age of the patients was 64 years (range: 18-90 years). Educational level comparison revealed statistically significant difference in terms of fistula patency ( = 0.016). In particular, fistula patency was significantly lower in illiterate, primary, secondary, and high school graduates in comparison with university graduates ( = 0.001,  = 0.015,  = 0.003, and  = 0.018, respectively). When each group of educational level was analyzed separately in terms of fistula patency, it was observed that the higher the educational level was, the lower arteriovenous fistula primary failure rates were. CONCLUSIONS:In this study, we observed a lower rate of fistula patency in patients with a low level of education. Hence, we are of the opinion that the trainings delivered on arteriovenous fistula care in dialysis centers are required to be shaped in accordance with educational levels of patients.

PURPOSE:Atherosclerotic disease of the forearm arteries can impede the maturation of distal fistulas in diabetic patients. The goal of this study was to look at the maturity of diabetic hemodialysis patients' distal forearm (radiocephalic snuffbox or distal forearm) arteriovenous fistulas. MATERIALS AND METHODS:Patients with chronic renal failure who were candidates for distal forearm radiocephalic arteriovenous fistula implantation were evaluated in this cross-sectional study. Patients' demographic details, underlying disorders, laboratory measurements, vital signs, and information on their surgery were all noted. Patients were checked for fistula development 1 week, 1 month, 2 months, and then monthly until 6 months after surgery. Arteriovenous fistula maturation characterized by optimal blood flow, vessel dilation, and structural adaptations. RESULTS:Among 343 patients (56% male, 44% female, mean age: 57.32 ± 12.48 years), hypertension prevailed (81.9%), followed by hyperlipidemia (42.3%) and coronary artery disease history (25.9%). AVFs achieved 58.3% maturation in 64.98 ± 11.05 days; higher BP during creation correlated with successful maturation (17.02 ± 1.46 mmHg vs 13.90 ± 1.93 mmHg, < .05). No significant statistical difference found in distal forearm arteriovenous fistula maturation between males (57.8%) and females (58.9%) ( > .005). However, 41.7% of AVFs failed in 18.83 ± 17.89 days. Failed AVFs exhibited lower BP during operation and failure (11.75 ± 1.86 mmHg). Kaplan-Meier analysis depicted maturation probabilities over 90 days post-surgery. CONCLUSION:Diabetes and patient sex did not affect the maturation time of distal forearm AVFs in hemodialysis patients. Increased blood pressure during and after surgery correlated with shorter maturation time.

Objective:A retrospective case-control study was conducted to explore the risk factors of late failure of arteriovenous fistula in hemodialysis patients. Methods:A total of 95 hemodialysis patients treated in our hospital from January 2018 to January 2021 were included. The HE staining results of late failure of arteriovenous fistula in hemodialysis patients were observed. The general data and laboratory indexes of the patients were recorded by using a questionnaire survey, hospital case system, and hemodialysis record. According to the functional status of internal fistula, the patients were divided into two groups: failure group ( = 35) and patency group ( = 60). SPSS22.0 software was employed for statistical analysis, and the relevant data of the two groups were compared. The independent sample -test was employed for the comparison of variance between groups, and the test was employed for counting data. Logistic multivariate regression was employed to analyze the risk factors of late loss of power in autologous arteriovenous fistula (AVF). Results:(1) Late failure of arteriovenous fistula in hemodialysis patients: the results of HE staining showed the following: (1) histological changes of venous intima: 100% of the patients had varying degrees of intimal hyperplasia, mainly eccentric hyperplasia, resulting in luminal stenosis, and annular uniform intimal hyperplasia in some patients, and (2) histological changes of venous media: 81.6% of the patients had venous media lesions, which were mainly in two cases; one was media smooth muscle hyperplasia with fibrous tissue hyperplasia, and the other was smooth muscle compression when intimal hyperplasia was serious, resulting in smooth muscle fiber rupture, disarrangement, focal necrosis, atrophy, and thinning, and some smooth muscle stroma showed vitreous degeneration and myxoid degeneration. A few cases showed multifocal neutrophil, lymphocyte, and plasma cell infiltration. (2) First of all, we surveyed the general data, and there were significant differences in age, history of diabetes, history of hypertension, and uric acid nephropathy ( < 0.05). There was no significant difference in sex, body mass index, smoking history, polycystic kidney disease, chronic glomerulonephritis, and obstructive nephropathy between the two groups ( > 0.05). Secondly, we compared the levels of hemoglobin, eosinophils, platelet count, and hematocrit. The levels of hemoglobin, eosinophils, and hematocrit in the failure group were higher, and the platelet count was lower compared to that of the unobstructed group ( < 0.05). Furthermore, the calcium and phosphorus product and the level of C-reactive protein (CRP) in the failure group were higher, while the levels of fibrinogen and INR in the unobstructed group were lower. The levels of plasma protein, alkaline phosphatase, and cholesterol were higher in the failure group, while the level of triglyceride was lower in the failure group ( < 0.05). Finally, logistic regression analysis showed that age, hemoglobin, hematocrit, and calcium-phosphorus product were the risk factors for late failure of arteriovenous fistula in hemodialysis patients ( < 0.05). There exhibited no significant correlation between diabetes, hypertension, uric acid nephropathy, eosinophil, CRP, fibrinogen, INR, plasma protein, alkaline phosphatase, cholesterol, triglyceride, and late failure of arteriovenous fistula in hemodialysis patients. Conclusion:Age, hemoglobin, hematocrit, and calcium-phosphorus product are independent risk factors for late failure of arteriovenous fistula in hemodialysis patients. The hemoglobin, eosinophil, platelet count, and hematocele in hemodialysis patients with late failure of arteriovenous fistula were higher. The indexes related to biochemistry, blood coagulation, and nutrition were significantly different from those without late failure of arteriovenous fistula. Thus, the risk of late failure of arteriovenous fistula can be predicted.

Intimal hyperplasia and stenosis are often cited as causes of arteriovenous fistula maturation failure, but definitive evidence is lacking. We examined the associations among preexisting venous intimal hyperplasia, fistula venous stenosis after creation, and clinical maturation failure. The Hemodialysis Fistula Maturation Study prospectively observed 602 men and women through arteriovenous fistula creation surgery and their postoperative course. A segment of the vein used to create the fistula was collected intraoperatively for histomorphometric examination. On ultrasounds performed 1 day and 2 and 6 weeks after fistula creation, we assessed fistula venous stenosis using pre-specified criteria on the basis of ratios of luminal diameters and peak blood flow velocities at certain locations along the vessel. We determined fistula clinical maturation using criteria for usability during dialysis. Preexisting venous intimal hyperplasia, expressed per 10% increase in a hyperplasia index (range of 0%-100%), modestly associated with lower fistula blood flow rate (relative change, -2.5%; 95% confidence interval [95% CI], -4.6% to -0.4%; =0.02) at 6 weeks but did not significantly associate with stenosis (odds ratio [OR], 1.07; 95% CI, 1.00 to 1.16; =0.07) at 6 weeks or failure to mature clinically without procedural assistance (OR, 1.07; 95% CI, 0.99 to 1.15; =0.07). Fistula venous stenosis at 6 weeks associated with maturation failure (OR, 1.98; 95% CI, 1.25 to 3.12; =0.004) after controlling for case mix factors, dialysis status, and fistula location. These findings suggest that postoperative fistula venous stenosis associates with fistula maturation failure. Preoperative venous hyperplasia may associate with maturation failure but if so, only modestly.

OBJECTIVES:To investigate the effects of prophylactic flow restriction for brachiocephalic arteriovenous fistula on postoperative high-flow-related complications and patency rate in patients undergoing hemodialysis. METHODS:Clinical data of patients with end-stage renal disease who underwent brachiocephalic arteriovenous fistula surgery for hemodialysis from February 2017 to May 2022 in Department of Nephrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were retrospectively analyzed. During surgery, a 4-5 mm vascular suture loop was placed around the vein near the anastomosis as a flow restriction device in 43 patients (flow restriction group), while 42 patients did not receive the prophylactic flow restriction ring (control group). All patients were followed up for 1 to 5 years. The incidence rates of complications related to the hemodialysis access pathway, including distal ischemia syndrome, the formation of arteriovenous fistula aneurysms, thrombus, high-flow congestive heart failure, anastomosis of the vein within 1 cm of the anastomosis and cephalic arch stenosis, were compared between the two groups. The natural blood flow rate of the arteriovenous fistula, anastomosis size, the internal diameter of the vein near the anastomosis, primary patency rate, assisted primary patency rate, and secondary patency rate of the arteriovenous fistula, were also evaluated and compared between the two groups. Logistic regression analysis was used to investigate the factors affecting arteriovenous fistula patency rates, as well as the impact of the flow-restricting ring on postoperative factors. RESULTS:Ultrasound measurements showed that the internal diameter of the vein at the site of the flow restriction ring in the flow restriction group was (3.7±0.6) mm at three months postoperatively, which was significantly smaller than the internal diameter of the narrowest part of the vein near the anastomosis in the control group [(4.1±1.0) mm, =－2.416, <0.01]. The postoperative anastomotic diameter and natural blood flow rate of the arteriovenous fistula in the flow restriction group were both significantly lower than those in the control group (both <0.05). Furthermore, the incidence rates of various complications in the flow restriction group were significantly lower than those in the control group (all <0.05). At 6, 12, and 24 months postoperatively, the primary patency rate and assisted primary patency rate in the flow restriction group were significantly higher than those in the control group (both <0.05), while there was no significant difference in secondary patency rates between the two groups (>0.05). Binary logistic regression analysis indicated that age, diabetes, and natural blood flow rate of the arteriovenous fistula at 3 months postoperatively were independent risk factors for primary patency rate, while the flow restriction for brachiocephalic arteriovenous fistula was an independent protective factor for primary patency rate (<0.01 or <0.05). The application of flow restriction was negatively correlated with anastomotic diameter at 6 and 12 months, natural arteriovenous fistula blood flow, and the incidence rates of cephalic arch stenosis and aneurysm formation (all <0.05). CONCLUSIONS:The prophylactic constriction during brachiocephalic arteriovenous fistula surgery in patients undergoing hemodialysis can limit the size of the anastomosis and postoperative arteriovenous fistula blood flow, reducing complications such as cephalic arch stenosis and high-flow heart failure, and increasing primary patency rates of arteriovenous fistula and delay the reintervention of the fistula.

Improving the level of arteriovenous fistula (AVF) self-care behavior by people receiving hemodialysis is an effective way to reduce the occurrence of complications and mortality. The aim of this study was to assess the self-care behavior of Chinese patients undergoing hemodialysis with arteriovenous fistula. The assessment of self-care behaviors with arteriovenous fistula in hemodialysis (ASBHD-AVF, Portuguese version) was translated into Chinese using Brislin's translation model. The content validity was evaluated by six experts. Then we involved 301 hemodialysis patients with AVF to explore the construct validity of the Chinese version of ASBHD-AVF. Ultimately 216 patients from eight dialysis centers of general hospitals in China were recruited to evaluate the patients' self-care behavior about AVF. Measures included demographic questionnaire, and the Chinese ASBHD-AVF. The Chinese ASBHD-AVF that included 12 items has a good internal consistency (α = 0.865) and content validity (CVI = 0.979). Principal component analysis generated two factors which explained 53.525% of the total variance. About 69.9% of hemodialysis patients' AVF self-care behavior were at a low or moderate level. The level of self-care behavior and knowledge need to be improved. Nurses should give specific guidance according to the patients' own characteristics and different influence factors, in order to improve the recipients' self-care behavior.

BACKGROUND:Vascular access is required for hemodialysis and arterio-venous fistula is the preferred access. Various guidelines have recommended monitoring and surveillance of arterio-venous fistula as the standard of care. This study looked into usefulness of clinical examination to detect complications of arterio-venous fistula. METHODS:The study was conducted in the from February 2022 till September 2022 under Nephrology unit, Departement of Internal Medicine at Universal College of Medical Sciences. Ethical clearance was taken. Patients undergoing hemodialysis were enrolled in the study. After informed and written consent, clinical examination of arterio-venous fistula was done by look, listen and feel method. Data was collected as per the approved performa. Statistical analysis was done using Statistical Package for the Social Sciences software version 17. RESULTS:Total enrolled study population was 73. Mean age of the study population was 47.45 years ± 14.60 years with a Male: Female ratio of 1.3:1. Complications were seen in a total of 33 patients with an overall rate of 45.2%. The mean duration of AVF creation was 32.68 ± 24.56 months. Most common complication of arterio-venous fistula was overall stenosis 18 (24.7%). CONCLUSIONS:There is a higher rate of complications of arterio-venous fistula. Monitoring and surveillance of arterio-venous fistula should be performed as a standard of care in every hemodialysis centre.

OBJECTIVE:the objective of this study is to explore the effect of a self-management mode on hemodialysis in autogenous arteriovenous fistula patients, and assess the improvement in their self-care, as well as the management and protection abilities of patients through the self-management mode, so as to improve the quality of dialysis. METHOD:A total of 100 patients undergoing maintenance hemodialysis, who have autogenous fistula and were cared for in the First Affiliated Hospital of Wenzhou Medical University from August 2019 to February 2020 were selected. All patients were divided into either an experimental group (group A, 50 people) or a control group (group B, 50 people), at random. Patients in group A were given self-management education and self-protection behavior education of internal fistulas based on routine nursing, while patients in group B were only given routine nursing. Initially, the general clinical data between the two groups was compared. Then, the patient self-management scale and internal fistula quality assessment were used to evaluate the patients' self-management ability and internal fistula quality. A Philips ClearVue 850 color Doppler ultrasound diagnostic instrument was used to monitor thrombus in patients. RESULTS:we found no significant difference in gender, dialysis frequency (3 times a week), dialysis time and blood biochemical indexes between the two groups (P > 0.05). There were statistically significant differences in the self-management ability, internal fistula quality, time effect, grouping effect and interaction effect between the two groups before and after the experiment (P < 0.001). The result of the ultrasound examination show that 75 patients with arteriovenous fistula results were normal, while 25 patients had complications, including 11 patients with steal phenomenon, 8 patients with stenosis, and 6 patients had thrombosis. CONCLUSION:self-management intervention and ultrasonic thrombus monitoring for hemodialysis patients can improve the quality of autogenous arteriovenous fistulas, and help doctors treat patients according to their individual complications and improve the cure rate of the disease.

ObjectivesThis study aimed to collect evidence to improve the arteriovenous fistula practice by investigating vascular access routes and by identifying the factors influencing the preferred types of vascular access routes for the first-time hemodialysis in our center.MethodsWe performed an epidemiological, prospective, cohort study. The study included 308 patients, who underwent hemodialysis for the first time between March 2023 and August 2023 in our hemodialysis center. We evaluated biochemical parameters, preferred vascular access routes for the first-time hemodialysis, planned/emergency hemodialysis status, the qualifications of the healthcare provider, who inserted the central venous catheter, if applicable, the presence of hypervolemia, anticoagulant use, nephrology follow-up findings, and in-hospital mortality in all patients and in those, who continued with chronic hemodialysis.ResultsThe number of patients, who continued with chronic hemodialysis, was 167 (54.2%) and a temporary internal jugular central venous catheter was the most commonly preferred vascular access route for the first-time hemodialysis (47.3%). A central venous catheter was most commonly inserted by a nephrologist (53.7%) in chronic hemodialysis patients. Of the patients continuing with chronic hemodialysis, 45.5% were followed up in the nephrology outpatient clinic, 9.6% initiated hemodialysis on a planned basis, and 8.4% initiated hemodialysis with an arteriovenous fistula. A temporary internal jugular central venous catheter was commonly preferred when patients were followed up in the nephrology clinic and when the insertion was performed by a nephrologist; a transient femoral central venous catheter was commonly preferred in case of hypervolemia ( < .001, < .001, and = .028, respectively). Age, gender, etiology, anticoagulant use, or biochemical test results did not act on the selection of the access site for the insertion of central venous catheter at the time of the first hemodialysis treatment. The access site for central venous catheter was not associated with in-hospital mortality ( = .644). In the overall patient group, the in-hospital mortality was significantly low in patients followed up in the nephrology clinic ( = .014).ConclusionThe use of pre-emptive arteriovenous fistula for the first hemodialysis treatment occurs much less commonly than expected. Hemodialysis initiation rates with pre-emptive arteriovenous fistula lag behind nephrology outpatient follow-up rates.

BACKGROUND:Central venous catheterization is increasingly performed as a temporary vascular access for hemodialysis therapy in developing countries and it can be associated with serious complications. Iatrogenic common carotid artery-jugular vein arteriovenous fistula is a rare but serious complication of internal jugular vein catheterization for hemodialysis access. Few cases of such complication of uremic patients on hemodialysis have been reported in the literature. AIM:To report a case of iatrogenic common carotid artery-jugular vein arteriovenous fistula caused by internal jugular vein catheterization of a hemodialysis patient and its surgical repair. RESULT:The iatrogenic arteriovenous fistula was repaired. CONCLUSION:Acquaintance of anatomical landmarks, careful preparation, experience of the physician and the ultrasound guidance are important factors to reduce the risk of complications during internal jugular vein catheterization. Surgical repair should be performed earlier in order to avoid the development of other serious complications.

BACKGROUND:We aimed to analyze the effect of nursing strategies on patients with chronic renal failure (CRF) undergoing maintenance hemodialysis (MHD) treatment by puncturing on arteriovenous fistula (AVF). METHODS:Ninety-two patients with chronic renal failure undergoing maintenance hemodialysis (MHD) between Jan 2014 and Jan 2015 were included in the study (all undergoing AVF, dialysis for 2-3 sessions per week, 4-5 h per session) and randomly divided into control group and observation group. Patients in control group were given standard nursing care and patients in observation group were given professional nursing of internal fistula. The complication rate and dysfunction rate during internal fistula perioperative period, fistula usage time and effect on life quality of patients of these two groups were compared (during 18-month follow-up). RESULTS:The complication rate and dysfunction rate during internal fistula perioperative period of the observation group were significantly lower than that of the control group, and the difference was statistically significant (<0.05). The median time of internal fistula usage was significantly prolonged, and the health index, emotion index and psychology index quality-of-life in the observation group were significantly higher than that of the control group (<0.05). CONCLUSION:Professional nursing strategies of internal fistula can prolong service time, decrease complications and improve life quality for patients undergoing maintenance hemodialysis treatment via arteriovenous fistula.

As survival among patients with renal failure improves, vascular access becomes more difficult, and preservation of functioning access increases in importance. Subclavian vein thrombosis associated with a distal arteriovenous fistula can result in massive and debilitating swelling of the affected extremity. We describe a novel crossover bypass grafting procedure to the contralateral internal jugular vein in a patient with a thrombosed internal jugular and subclavian vein. This procedure resulted in preservation of the functioning arteriovenous fistula and resolution of the symptoms. Unlike previously described crossover procedures to the contralateral basilic or axillary veins, this bypass graft has the added benefit of not obviating future fistula creation in that extremity.

OBJECTIVE:To investigate the effect of puncture-related pain on the quality of life in patients undergoing maintenance hemodialysis through internal arteriovenous fi stula. METHODS:A total of 180 hemodialysis patients with the arteriovenous fistula were surveyed by the kidney disease quality of life short form(KDQOL-SF1.3), demographic data questionnaire, visual analogue scale and pain self-efficacy questionnaire. RESULTS:The median score of puncture-related pain was 5 and the score of pain self-efficacy was (31.42±14.59). The quality of life in the patients undergoing maintenance hemodialysis is poor. KDQOL-SF1.3 was (69.45±24.19), SF-36 was (49.82±19.17) and ESRD-targeted was (55.46±18.37). Multivariate analysis demonstrated that the quality of life was positively correlated with the patient gender (β=0.152, P< 0.05, OR=1.638, 95% CI 1.241-1.954), working position (β=0.307, P< 0.05, OR=2.069, 95% CI 1.206--3.148), using time of arteriovenous fistula (β=-0.815, P< 0.05, OR=0.223, 95% CI 0.095-0.741), the score of pain (β=-0.017, P< 0.05, OR=1.004, 95% CI 0.886-1.431) and pain self-efficacy (β=-0.409, P< 0.05, OR=0.803, 95% CI 0.710-0.984). There existed negative correlation between the quality of life score and the puncture-related pain score in these patients (r=-0.472, -0.465, -0.381, P< 0.01), positive correlation between the quality of life score and the score of pain self-efficacy (r=0.647, 0.203, 0.518, P< 0.05), and negative correlation between the puncture-related pain score and the score of pain self-efficacy(r=-0.745, P< 0.01). CONCLUSION:Puncture-related pain is a crucial influential factor on the quality of life in the patients undergoing maintenance hemodialysis through internal arteriovenous fistula.

Vascular access for dialysis in patients with terminal renal failure has assumed increasing importance on surgical services as more and more facilities are developing to support such patients for longer period. Longevity of such vascular access is aimed for, meticulous care is needed in its creation. Direct arterio-venous fistula is best method available, but in case of its failure, fistula formation using graft is useful alternative. Complications associated with vascular access still represent one of the most frequent and significant problems encountered in a hemodialysis center. Measures to overcome such problems are discussed. Historical background and literature are reviewed. Seven patients treated with maintenance hemodialysis are presented. One of them had severe haemorrhage from the fistula, an unusual complication of internal arterio-venous fistula.