Haemodialysis Patients with arteriovenous fistula: Knowledge, attitude, and practice in Patient Visiting Tertiary Centre of Nepal pre and post-operatively.
Authors: Dev Santosh , Sah Birendra , Yadav Bivek Kumar , Shrestha Uttam Krishna , Shrestha Kajan Raj 
Published: October 2023

Abstract
Introduction
Chronic kidney disease (CKD) affects over 800 million people globally, making it the leading cause of mortality in the 21st century. Hemodialysis, a procedure that filters water and waste from the blood, helps regulate vital blood minerals and blood pressure. Vascular access is crucial for hemodialysis, including arteriovenous fistulas (AVFs), arteriovenous grafts, and central venous catheters. The ideal venous access should provide enough blood for dialysis, be durable, and have a low rate of complications. AVF deficiency can lead to cardiovascular disorders, so it is important to ensure its patency and maintenance. Patient education and nurse care can help maintain AVF patency for a long time. This study aimed to examine AVF perceptions among hemodialysis patients in terms of knowledge and attitude.
Method
A descriptive cross-sectional study was conducted at the Maharagjung Medical Campus Haemodialysis Unit and Cardiovascular Surgery to assess knowledge, attitude, and practice toward arteriovenous fistula (AVF) care. The study included patients with CKD-V or ESRD, aged 18 years or <85 years, with radio-cephalic, brachiobasilic, or brachiocephalic fistulae created. The study was approved by the Tribhuvan University Institute of Medicine Institutional Review Board. Patients were interviewed before and after surgery using a structured questionnaire. The study used Naveed Rashid's knowledge score system, with 40% as poor knowledge, 40-70% as adequate knowledge, and over 70% as good knowledge out of a total score of 12. The data was processed using SPSS, and the chi-square test was applied to determine the relationship between knowledge, attitude, and practice of AVF care. A p-value of 0.05 was considered significant.
Result
A study of 173 patients with AVFs found that most had poor knowledge about AVF self-care, with 98.8% having poor knowledge preoperatively and 98.3% having good knowledge postoperatively. The study found a significant correlation between knowledge, sex, and socioeconomic status postoperatively, but not between knowledge and age group. Patients from upper and upper middle classes had better knowledge acquisition than those from lower middle classes. Attitude towards fistula care was high, with 99% of participants agreeing that it is beneficial preoperatively and postoperatively. However, 89.6% of participants were only satisfied with their decision to form a fistula over time. Initially, 97.1% of participants were motivated toward AVC care, but by the 6th week's follow-up, 78.0% were only motivated towards AVF care. Most patients practiced weight-bearing prevention, cleaning, and drying, but fewer practiced daily verification of fluid thrill, exercise with malleable balls, and avoiding blood pressure from the fistula hand.
Discussion
A study on hemodialysis via AVF access site found that most patients had poor knowledge of AVF care preoperatively and good knowledge postoperatively, indicating good delivery of information and knowledge at the hospital. The study also found that acquired knowledge correlated with socioeconomic status and sex postoperatively. Attitude towards fistula care was high, with 99% of participants agreeing that it is beneficial preoperatively and postoperatively. However, 89.6% of participants were only satisfied with their decision to form a fistula over time. Initially, 97.1% of participants were motivated toward AVC care, but by the 6th week's follow-up, 78.0% were only motivated towards AVF care. Despite poor knowledge before surgery, participants after counseling had good practice in all areas of AVF care. Avoidance behaviour was observed in exercising with malleable objects, daily thrill checks, and blood pressure from the fistula hand. The study suggests that practice can be improved by proper health professional-patient relationships and proper, adequate, and regular counselling.
Conclusion
The study reveals that patients' preoperative knowledge of AVF care can be improved through proper counselling, with forgetfulness and decreased self-motivation being key reasons for not following specific areas. Regular, timely counselling is recommended for practical aspects.