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The Vascular Access Questionnaire: assessing patient-reported views of vascular access
R R Quinn1, D L Lamping, C E Lok
1Department of Medicine, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. robert.quinn@sunnybrook.ca
Insights
Patient satisfaction with hemodialysis (HD) vascular access is key. While symptom scores were similar between catheters and arteriovenous fistulas (AVF), fistulas caused more concern regarding appearance and bleeding.
Area of Science:
- Nephrology
- Vascular Surgery
- Patient-Reported Outcomes
Background:
- Central venous catheters (CVCs) for hemodialysis (HD) increase complication risks versus arteriovenous fistulas (AVFs).
- High CVC utilization persists, potentially driven by patient satisfaction.
- Understanding patient perspectives is crucial for optimizing vascular access choices.
Purpose of the Study:
- To develop and validate the Vascular Access Questionnaire (VAQ) for assessing patient-reported views on vascular access.
- To compare patient-reported symptom scores between HD patients using CVCs and AVFs.
Main Methods:
- The Vascular Access Questionnaire (VAQ) was developed to measure patient-reported issues.
- Chronic HD patients (N=222) at two centers rated 17 access-related problems.
- VAQ symptom scores were compared between catheter and fistula users.
Main Results:
- No significant difference in overall symptom scores between catheter and fistula users (p=0.36).
- Fistula users reported greater bother from pain, bleeding, bruising, swelling, and appearance.
- Elderly patients reported lower symptom scores with catheters compared to fistulas.
Conclusions:
- Patient concerns focus on access appearance and cannulation complications, especially in the elderly.
- Improved education on catheter risks and reduced cannulation complications may increase AVF rates.
- Enhancing patient satisfaction requires addressing specific concerns related to vascular access methods.
Background:
The use of central venous catheters for vascular access in hemodialysis (HD) patients is associated with an increased risk of complications compared to arteriovenous fistulas (AVF). Despite this, catheter use remains high and patient satisfaction may be an important driver of catheter use.
Methods:
We developed the Vascular Access Questionnaire (VAQ) to measure patient-reported views of their vascular access. Chronic HD patients at two centers were asked to rate how bothered they were by 17 access-related problems. VAQ symptom scores were compared between patients using catheters and those using fistulas for vascular access.
Results:
Two hundred and twenty-two patients were eligible for the study. Symptom score was not different between patients using catheters and those using fistulas (p=0.36). However, patients using fistulas were more likely to be at least moderately bothered by pain, bleeding, bruising, swelling, and the appearance of their access than patients using catheters. Elderly patients reported lower symptom scores with catheters than fistulas.
Conclusions:
Patients appear to be primarily concerned with the appearance of their access and cannulation-related complications, particularly the elderly. Better education about the risk of adverse events with catheters and the implementation of measures aimed at reducing cannulation-related complications may help to increase fistula rates and improve patient satisfaction with their vascular access.
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