Ultrasound-Based Assessment of Arteriovenous Fistula Maturation: A Reproducible Protocol for Nursing Practice

This article presents a standardized, evidence-informed nursing protocol for point-of-care ultrasound-guided assessment of arteriovenous fistula (AVF) maturation in adult patients undergoing hemodialysis. The protocol translates current best evidence into a reproducible, step-by-step method to support safe, accurate, and consistent bedside surveillance by trained nurses. It is structured using an operational adaptation of the Indication-Acquisition-Interpretation-Nursing Decision-Making framework to guide clinical reasoning and ultrasound-based evaluation. The protocol details patient positioning, infection prevention measures, systematic clinical examination of the AVF, ultrasound system preparation, and standardized ultrasound assessment of venous anatomy and hemodynamics, including vein diameter, depth, access flow, and resistance index. Key technical elements, such as transducer selection, image optimization, avoidance of vessel compression, and identification of stenosis or flow abnormalities, are explicitly described. Nursing decision-making related to fistula maturation status, suitability for cannulation, referral for further vascular evaluation, and documentation is also incorporated. The protocol assumes prior structured training and competency assessment in vascular point-of-care ultrasound for nurses performing the examination. By integrating point-of-care ultrasound as an extension of routine vascular access surveillance, this protocol aims to support early identification of non-maturing fistulas, guide timely clinical decision-making, and support the assessment of functional AVF use in clinical practice. This standardized approach is intended to promote consistency in maturation assessment and support the implementation of ultrasound-guided AVF surveillance as an advanced, evidence-informed nursing practice across diverse clinical settings.