Date of Graduation

Fall 12-13-2019

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions


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First Advisor

Robin Jackson, MSN, RN, CNL



Aneurysm, which is the dilatation of the arteriovenous fistula (AVF), and pseudo-aneurysm, which is caused by leaking of blood outside the arteriovenous graft (AVG), pose a threat to the vascular access (VA) and the patient (Mudoni et al., 2015). Uneven vein penetration by dialysis needles and subsequent skin scarring lead to the development of inflammatory changes in the VA area. Scab formation masks the signs of ongoing inflammation. Damage to and tearing of the scab can then lead to lethal exsanguination from the VA (Handlos, Marecová, Smatanová, Dvořáček, & Dobiáš, 2018). Dialysis staff members are trained to use the entire length of the VA for cannulation; this rope-ladder cannulation method relies on changing the puncture sites for each dialysis treatment (Twardowski, 2015). However, in daily clinical practice, often the same area of the fistula or graft is cannulated for reasons of comfort and ease (Verhallen, Kooistra, & Jaarsveld, 2007). An engaged outpatient in-center hemodialysis (HD) team adopts the use of a disposable measuring tool of their choice to create a VA-specific cannulation plan to achieve the aim of reducing aneurysm or pseudoaneurysm formation in new VA by 50% within one year. Weekly audits of Chairside VA assessment monitor adherence to cannulation plan. The monthly quality score VA-in-use percentage reflects VA longevity. Continuous assessment of patients’ care experience and the team’s adherence to the cannulation plan will identify opportunities for improvement, and determine the successful adoption of evidence-based practice (EBP).

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