AUSTIN, Texas — An educational program designed for inpatient nursing staff about best practices for venipuncture in patients with decreased glomerular filtration rates can help preserve veins for the future construction of arteriovenous fistulas, according to a data presented in the poster session at the National Kidney Foundation Spring Clinical Meetings.
“We, as nurses, tend to put in an IV and draw blood where we see the best vein, which is usually veins that can be determinant to the formulation of [arteriovenous] AV fistulas,” Kelly S. Shakoor MS, RN, DNPc, of Wayne State College of Nursing, told Healio Nephrology. “When patients have a [glomerular filtration rate] GFR less than 60 [mg/dL], it is important that we start using, as much as we can, the lower veins – hand veins and wrist veins – to try to save those upper veins for future fistula formation.”
Shakoor said the researchers developed this quality improvement project to increase inpatient nursing staff awareness of vein preservation efforts with their venipuncture practices. Prior to the intervention, inpatient nursing staff took a survey to assess baseline knowledge and beliefs on chronic kidney disease (CKD), GFR and venipuncture. This was followed by an online educational program on the best practices for venipuncture for patients with decreased GFR. Inpatient nursing staff also identified patients who had GFRs less than 60 mg/dL during this 30-day pilot program. Participants were assessed after the intervention to find changes in knowledge and beliefs.
Researchers found a 61% increase in awareness among the inpatient nursing staff that patients with a GFR level less than 60 mg/dL should undergo a vein assessment prior to venipuncture. Additionally, there was a 9% increase in awareness among inpatient nursing staff that the dorsum of the hand is the preferred site. All participants responded that the visual reminder of the patient’s GFR status in the form of an above-the-bed sign was an effective way to promote use of the dorsum of the hands for venipuncture.
“It is important nurses understand that they look up these lab levels when you are doing venipunctural procedures,” Shakoor said. – by Kristine Houck, MA, ELS
Shakoor KS, et al. Poster 192. Presented at: National Kidney Foundation Spring Clinical Meetings; April 10-14, 2018; Austin, Texas.
Shakoor reports no relevant financial disclosures.