A system for preventing internal fistula needle dislodgement: Delphi study and pilot evaluation.

Area of Science:

• Nephrology
• Nursing
• Medical Device Safety

Background:

• Internal fistula needle dislodgement (IND) is a complication in hemodialysis (HD).
• Effective risk assessment tools are needed to prevent IND in HD patients.
• Current methods for predicting IND risk lack comprehensive validation.

Purpose of the Study:

• To develop and validate a scoring system for risk assessment (SSRA) to predict internal fistula needle dislodgement (IND) in hemodialysis (HD) patients.
• To evaluate the effectiveness of SSRA-guided nursing interventions in reducing IND incidence.
• To establish a reliable tool for proactive IND prevention in HD settings.

Main Methods:

• The SSRA was developed using literature review, expert consultation, a Delphi study, and the analytic hierarchy process.
• A pilot study randomized 218 HD patients into control (routine care) and experimental (SSRA-guided interventions) groups.
• The incidence of IND was compared between groups over a one-year period.

Main Results:

• The SSRA was finalized with three first-level, 11 second-level, and 26 third-level indices.
• The experimental group, utilizing SSRA-based nursing measures, demonstrated a significantly lower IND rate compared to the control group (p < .01).
• The study included 16 dialysis nursing experts and 218 hemodialysis patients.

Conclusions:

• A scientific, reliable, and feasible SSRA was established for identifying HD patients at high risk of IND.
• The SSRA facilitates timely intervention and the implementation of targeted nursing procedures to prevent IND.
• This scoring system enhances patient safety and care quality in hemodialysis.