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Can the fistula arm be used to lift heavy items? Six-pound dumbbells versus handgrip exercise in a 6-month follow-up secondary analysis of a randomized controlled trial

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The Journal of Vascular Access
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Ya-wen Mo
Ya-wen Mo
Ya-wen Mo
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Li Song
Li Song
Li Song
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Jing-ya Huang
Jing-ya Huang
Jing-ya Huang
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Chun-yan Sun
Chun-yan Sun
Chun-yan Sun
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Introduction Patients with arteriovenous fistulas are advised to avoid carrying heavy objects draped over the fistula arm. Awareness gradually leads to overprotection and a reduction in the use of the fistula arm. However, restricting motion in the fistula arm leads to decreased quality of life and diminished muscle strength. The current safety recommendations regarding lifting heavy items with the fistula arm are primarily based on experience. Few studies have provided evidence clarifying the scope of safe activity and the influence of load bearing on the continued patency of arteriovenous fistulas. Methods This prospective observation was based on a long-term follow-up study in which 86 hemodialysis recipients with arteriovenous fistulas were randomized into either a dumbbell group or a handgrip group. The dumbbell group exercised with 6-lb dumbbells, while the handgrip group squeezed rubber balls. Postintervention primary patency and adverse events at the 6-month follow-up were analyzed. Results No significant difference in postintervention primary patency was observed between the dumbbell group and the handgrip group at 6 months (97.4% vs 95.0%). There were two participants with high-flow fistulas in the dumbbell group and three in the handgrip group, with no significant difference between the two groups (5.3% vs 7.5%). In both groups, there were no other adverse events reported regarding cardiac failure, aneurysm, puncture site hematoma, or hemorrhage. Conclusion Hemodialysis patients can safely use their fistula arm to lift objects weighing less than 6 lb, which encourages increased motion and helps preserve the functionality of the fistula arm.
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https://doi.org/10.1177/1129729819894090
The Journal of Vascular Access
2020, Vol. 21(5) 602 –608
© The Author(s) 2019
Article reuse guidelines:
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DOI: 10.1177/1129729819894090
journals.sagepub.com/home/jva
J VA e Journal of
Vascular Access
Can the fistula arm be used to lift heavy
items? Six-pound dumbbells versus
handgrip exercise in a 6-month follow-
up secondary analysis of a randomized
controlled trial
Ya-wen Mo1,2*, Li Song1*, Jing-ya Huang3, Chun-yan Sun1,2,
Li-fang Zhou1,2, Shu-qian Zheng2,4, Ting-ting Zhuang5,
Ying-gui Chen1,2, Yuan-han Chen1, Shuang-xin Liu1,
Xin-ling Liang1 and Xia Fu1,2
Abstract
Introduction: Patients with arteriovenous fistulas are advised to avoid carrying heavy objects draped over the fistula arm.
Awareness gradually leads to overprotection and a reduction in the use of the fistula arm. However, restricting motion
in the fistula arm leads to decreased quality of life and diminished muscle strength. The current safety recommendations
regarding lifting heavy items with the fistula arm are primarily based on experience. Few studies have provided evidence
clarifying the scope of safe activity and the influence of load bearing on the continued patency of arteriovenous fistulas.
Methods: This prospective observation was based on a long-term follow-up study in which 86 hemodialysis recipients
with arteriovenous fistulas were randomized into either a dumbbell group or a handgrip group. The dumbbell group
exercised with 6-lb dumbbells, while the handgrip group squeezed rubber balls. Postintervention primary patency and
adverse events at the 6-month follow-up were analyzed.
Results: No significant difference in postintervention primary patency was observed between the dumbbell group and
the handgrip group at 6 months (97.4% vs 95.0%). There were two participants with high-flow fistulas in the dumbbell
group and three in the handgrip group, with no significant difference between the two groups (5.3% vs 7.5%). In both
groups, there were no other adverse events reported regarding cardiac failure, aneurysm, puncture site hematoma, or
hemorrhage.
Conclusion: Hemodialysis patients can safely use their fistula arm to lift objects weighing less than 6 lb, which encourages
increased motion and helps preserve the functionality of the fistula arm.
Keywords
Arteriovenous fistula, vascular access, hemodialysis, arm exercise, isometric exercise, upper extremity, patient safety
Date received: 22 July 2019; accepted: 18 November 2019
1 Division of Nephrology, Guangdong Provincial People’s Hospital,
Guangdong Academy of Medical Sciences, Guangzhou, China
2School of Nursing, Southern Medical University, Guangzhou, China
3
Division of Nephrology, Shenzhen Traditional Chinese Medicine
Hospital, Shenzhen, China
4
Division of Nephrology, Guangzhou Nansha Central Hospital,
Guangzhou, China
5
Department of Rehabilitation Medicine, Guangdong Second Traditional
Chinese Medicine Hospital, Guangzhou, China
*Ya-wen Mo and Li Song have contributed equally to the paper.
Corresponding authors:
Xin-ling Liang, Division of Nephrology, Guangdong Provincial People’s
Hospital, Guangdong Academy of Medical Sciences, Guangzhou
510080, China.
Email: xinlingliang_ggh@163.com
Xia Fu, Division of Nephrology, Guangdong Provincial People’s
Hospital, Guangdong Academy of Medical Sciences, Guangzhou
510080, China.
Email: fx-rena@163.com
894090JVA0010.1177/1129729819894090The Journal of Vascular AccessMo et al.
research-article2019
Original research article
... Arteriovenous fistula (AVF) is the safest and most preferable vascular access for maintenance hemodialysis (HD) in chronic kidney disease patients, and its health needs attention [1]. Stenosis and thrombosis are the major cardiovascular complications that compromise AVF health and cause its loss. ...
... When these complications occur, a new invasive intervention must be performed to regain the AVF patency, such as percutaneous transluminal angioplasty, surgery, and endovascular interventions [1]. Therefore, the prevention of these complications needs to be better investigated. ...
... Some studies show that the upper limb muscle training with recent AVF increases its vessel diameter and vasodilatation, besides, contributing to adequate AVF maturation [7]. Also, Mo et al. [1] investigated the upper limb muscle training of the AVF in patients undergoing maintenance HD and showed an improvement in the AVF draining vein diameter and its blood flow after a 3-month exercise period using a dumbbell. Both authors reinforce exercise's importance also in AVF maintenance [1,7]. ...
Aerobic Exercise Increases Vascular Diameter of Arteriovenous Fistula in Hemodialysis Patients
Article
  • Nov 2021
Introduction: A healthy arteriovenous fistula (AVF) depends on adequate vessel diameter which can be maintained through aerobic exercises. A randomized crossover study was conducted to evaluate the acute effects of aerobic exercise on a cycle ergometer on AVF vascular diameter, through ultrasound, and on blood pressure (BP). Methods: Eight hemodialysis (HD) patients completed 2 different occasions in random order with a 7-day washout: (a) exercising moment, in which 30-min aerobic exercise was performed on a cycle ergometer; and (b) resting moment, which was performed 30-min with the patient sitting in a chair. Both occasions were evaluated 1-h before the second weekly HD day. Results: A significant increase in AVF vascular diameter induced by 30-min aerobic exercise was found (1.15 ± 0.56 to 1.47 ± 0.66 cm; p = 0.042), whereas systolic (p = 0.105) and diastolic BP (p = 0.366) did not change. Conclusions: We can conclude that acute aerobic exercise was shown to be effective in improving the AVF vascular diameter in HD patients. The aerobic exercise benefits in endothelium-dependent vasodilation which may be an effective, practical, and economic strategy to maintain AVF patency.
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... However, they found no difference in outcome when they followed up with their patients over 6 months in a subsequent study. 29 On the other hand, a well-designed specific arm exercise may still provide new insights and infer the possibility of prescribing an efficient exercise program. 25,26,28 Recently, Nantakool et al. 24 found that a specific degree of the isometric exercise program was advantageous over isotonic exercise to enhance AVF maturation. ...
... A patient's misconception of AVF arm restriction may also gradually lead to overprotection and a reduction in muscle strength. 29 ...
A Randomized Trial of Postoperative Handgrip Exercises for Fistula Maturation in Patients With Newly Created Wrist Radiocephalic Arteriovenous Fistulas
Article
Full-text available
  • Dec 2022
Introduction We aimed to substantiate the benefit of postoperative handgrip exercises in enhancing the maturation of an arteriovenous wrist fistula. Methods We randomly assigned 119 patients aged 20–80 years who had wrist arteriovenous fistulas to undergo either a basic handgrip exercise program (group A), an advanced program (group B), or an advanced-plus upper arm banding program (group C). Outcomes were assessed by ultrasonographic evaluation of the diameter and flow at each follow-up. The attending nephrologist decided the clinical use of the fistula. Results We identified no significant differences among the handgrip exercise groups in the mean diameter and blood flow 14, 30, 60, and 90 days after the creation of the wrist arteriovenous fistula (p = 0.55, 0.88, 0.21, and 0.19 for the diameter; 0.94, 0.81, 0.49, and 0.56 for the flow, respectively). The intent-to-treat analysis also found no difference in the clinical use of fistulas for hemodialysis (p = 0.997). Conclusion In patients with a newly created wrist arteriovenous fistula, advancing frequency, with or without adding intensity using an upper arm tourniquet, of postoperative handgrip exercises did not enhance the growth of the fistula or increase the rate of clinical use over three months. (ClinicalTrials.gov ID: NCT03077815).
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... Increased awareness of patients gradually leads to overprotection and reduction of the fistula arm usage. So, HD patients can safely use their vascular access arm to lift objects weighing less than 6 lb, which encourages HD patients to increase motion and help them to preserve their fistula arm's functionality (Mo et al., 2019). In relation to hardworking as an occupation that considered one factor of vascular access failure, nearly two thirds of the studied patients were uncertain about perceived Novelty Journals hardworking can be one cause of vascular access failure, in contrast to the studied nurse's perception, nearly three quarters of the studied nurses were agreed that hardworking can be one cause of vascular access failure. ...
Factors Associated with Hemodialysis Patients' Vascular Accesses Failure as Perceived by Nurses and Patients: a retrospective study
Article
Full-text available
  • Dec 2023
Vascular access failure among hemodialysis patients is common and associated with excess mortality, morbidity, and hospital costs. Management of vascular access properly improves the quality of life for hemodialysis (HD) patients and allows for lifesaving hemodialysis treatment. This study aimed to assess factors associated with hemodialysis patients' vascular access failure as perceived by nurses and patients. A descriptive research design (Retrospective study) was utilized for this study. This study was conducted at the hemodialysis unit of Al-Mowasa University Hospital which is affiliated with Alexandria University. Subjects of this study comprised all nurses (25) working at the Hemodialysis Unit of Al-Mowasa University Hospital who were available at the time of data collection, and (95) HD patients, all of them were be included in this study. The results revealed that, there was a statistically significant in relation to patient, vascular access, surgery and nurses' practices factors. This study concluded that the most common factors of vascular access failure by the majority of the studied patients and nurses were; insufficient income, followed by prolonged duration of hemodialysis, advanced age, being a male, chronic diseases, anemia, intradialytic complications, smoking, hardworking, using metal needles, lack of vascular access arm exercise, insertion of dialysis needles several times during cannulation, inappropriate practices related to vascular access maintenance, lack of periodical follow up, surgical wound complications, lack of vascular access assessment, unfollowing aseptic technique practices before, during and after cannulation and decannulation, lack of instructions given to the patients for vascular access maintenance, lack of proper management of vascular access complications, were the most common identified factors.
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... In this study of 86 dialysis patients, patients were randomized to exercising with 6-lb dumbbells (dumbbell group) or squeezable rubber balls (handgrip group). They found no differences between the two groups regarding AVF patency and complications including aneurysm, puncture site hematoma, hemorrhage, or cardiac failure, suggesting safety of moderate weight exercise in this population [36]. Dialysis access can fail, and patients may require additional surgeries for creation of new dialysis access propagating the cycle of not exercising or lifting with the arm with dialysis access. ...
Prevalence and feasibility of assessing the frailty phenotype among hemodialysis patients in a dialysis unit
Article
Full-text available
  • Dec 2023
  • BMC Nephrol
Background Frailty increases risk of morbidity and mortality in hemodialysis patients. Frailty assessments could trigger risk reduction interventions if broadly adopted in clinical practice. We aimed to assess the clinical feasibility of frailty assessment among Veteran hemodialysis patients. Methods Hemodialysis patients’ ≥50 years were recruited from a single dialysis unit between 9/1/2021 and 3/31/2022.Patients who consented underwent a frailty phenotype assessment by clinical staff. Five criteria were assessed: unintentional weight loss, low grip strength, self-reported exhaustion, slow gait speed, and low physical activity. Participants were classified as frail (3–5 points), pre-frail (1–2 points) or non-frail (0 points). Feasibility was determined by the number of eligible participants completing the assessment. Results Among 82 unique dialysis patients, 45 (52%) completed the assessment, 13 (16%) refused, 18 (23%) were not offered the assessment due to death, transfers, or switch to transplant or peritoneal dialysis, and 6 patients were excluded because they did not meet mobility criteria. Among assessed patients, 40(88%) patients were identified as pre-frail (46.6%) or frail (42.2%). Low grip strength was most common (90%). Those who refused were more likely to have peripheral vascular disease (p = 0.001), low albumin (p = 0.0187), low sodium (p = 0.0422), and ineligible for kidney transplant (p = 0.005). Conclusions Just over half of eligible hemodialysis patients completed the frailty assessment suggesting difficulty with broad clinical adoption expectations. Among those assessed, frailty and pre-frailty prevalence was high. Given patients who were not tested were clinically high risk, our reported prevalence likely underestimates true frailty prevalence. Providing frailty reduction interventions to all hemodialysis patients could have high impact for this group.
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... 4,10 Previous studies have used dumbbells and elastic bands, progressive manual gripping, structured isometric, and blood flow restriction exercises. 6,[11][12][13] These studies investigated whether exercises would improve AVF maturation and despite it seems they do, which was confirmed by previous systematic reviews, the evidence is not well-established yet. 5,14 Based on the available evidence, we have chosen some exercises that may potentially help AVF maturation and maintenance. ...
Exercise guide to help on arteriovenous fistula maturation and maintenance
Article
Full-text available
Background The arteriovenous fistula is the main vascular access in hemodialysis. Arteriovenous fistula access is generally evaluated by a vascular surgeon after 2 weeks of its surgery, however, exercise programs may begin earlier for improving outcomes. Therefore, we propose this guide with simple, but potentially effective exercises, using low-cost materials that can be safely performed by the patients at home or in the dialysis center. It also provides to the dialysis staff team a starting point for implementing an upper-limb exercise program that may facilitate arteriovenous fistula maturation and maintenance. Methods This exercise routine for arteriovenous fistula maturation can be performed three to four times a day, every day, from 2 to 4 weeks. After its maturation, it can be performed on every non-dialysis day for conventional treatment and every other day, before dialysis, for short daily treatment. Conclusions Based on the available evidence, we have gathered some exercises, in a very easy and understandable language, that may potentially help arteriovenous fistula maturation and maintenance for hemodialysis patients.
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... Increased awareness of patients gradually leads to overprotection and reduction of the fistula arm usage. So, HD patients can safely use their vascular access arm to lift objects weighing less than 6 lb, which encourages HD patients to increase motion and help them to preserve their fistula arm's functionality (Mo et al., 2019). In relation to hardworking as an occupation that considered one factor of vascular access failure, nearly two thirds of the studied patients were uncertain about perceived Novelty Journals hardworking can be one cause of vascular access failure, in contrast to the studied nurse's perception, nearly three quarters of the studied nurses were agreed that hardworking can be one cause of vascular access failure. ...
View
... Increased awareness of patients gradually leads to overprotection and reduction of the fistula arm usage. So, HD patients can safely use their vascular access arm to lift objects weighing less than 6 lb, which encourages HD patients to increase motion and help them to preserve their fistula arm's functionality (Mo et al., 2019). In relation to hardworking as an occupation that considered one factor of vascular access failure, nearly two thirds of the studied patients were uncertain about perceived Novelty Journals hardworking can be one cause of vascular access failure, in contrast to the studied nurse's perception, nearly three quarters of the studied nurses were agreed that hardworking can be one cause of vascular access failure. ...
View
Impact of load and movement on arteriovenous fistula flow
Article
Introduction Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis. Whether acute arm movement impacts arteriovenous fistula (AVF) blood flow is unknown. Methods In this cross-sectional analysis, we evaluated AVF blood flow using an ultrasound device at resting and after three muscle movements for proximal (elbow flexion, shoulder adduction and abduction) or distal AVF (fist extension and flexion, fingers squeeze), without and with a 2 kg load. Results We included 23 patients (14 men), 53 ± 13 years, 26.1% with diabetes, on dialysis for a median time of 5.2 months. At rest, blood flow in proximal and distal AVF were 4355 (2470, 7233) mL/min and 2286 (2063, 2442) mL/min, respectively. There was no significant difference between blood flow at resting and any movement before and after load in either proximal or distal AVF ( p > 0.05 for all comparisons). Conclusion Acute arm movement with or without load does not significantly alter the blood flow of mature AVF. These results demystify the general belief that patients should avoid AVF arm movement.
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Upper limb exercise for arteriovenous fistula maturation in people requiring permanent haemodialysis access
Article
Full-text available
  • Oct 2022
  • COCHRANE DB SYST REV
Background: The failure of arteriovenous fistulas (AVF) to mature is a major problem in patients with kidney failure who require haemodialysis (HD). Preoperative planning is an important factor in increasing functional AVF. Upper limb exercise has been recommended to gain AVF maturation. Studies of pre- and post-operative upper limb exercises in patients with kidney failure patients have been reported; however, the optimal program for this population is unknown due to inconsistent results among these programs. Objectives: We aimed to determine if upper limb exercise would be beneficial for AVF maturation (prior to and post AVF creation) in patients with kidney failure and to improve AVF outcomes. This review also aimed to identify adverse events related to upper limb exercise. Search methods: We searched the Cochrane Kidney and Transplant Register of Studies up to 15 March 2022 through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov, and other resources (e.g. reference list, contacting relevant individuals, and grey literature). Selection criteria: We included randomised controlled trials (RCTs) and quasi-RCTs, comparing upper limb exercise training programs with no intervention or other control programs before or after AVF creation in patients with kidney failure. Outcome measures included time to mature, ultrasound and clinical maturation, venous diameter, blood flow in the inflow artery, dialysis efficacy indicator, vascular access function (functional AVF), vascular access complications, and adverse events. Data collection and analysis: Study selection and data extraction were taken by four independent authors. Bias assessment and quality assessment were undertaken independently by two authors. The effect estimate was analysed using risk ratio (RR) with 95% confidence intervals (CI) for dichotomous data, or mean difference (MD) or standardised mean difference (SMD) for continuous data. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Main results: Nine studies (579 participants) were included, and seven studies (519 participants) conducting post-operative exercise training could be meta-analysed. Three comparisons were undertaken: (i) isotonic exercise training versus no intervention; (ii) isometric versus isotonic exercise training; and (iii) isotonic (high volume) versus isotonic exercise training (low volume). Due to insufficient data, we could not analyse pre-operative exercise training. Overall, the risk of bias was low for selection and reporting bias, high for performance and attrition bias, and unclear for detection bias. Compared to no intervention, isotonic exercise training may make little or no difference to ultrasound maturation (2 studies, 263 participants: RR 1.09, 95% CI 0.94 to 1.25; I² = 0%; low certainty evidence), but may improve clinical maturation (2 studies, 263 participants: RR 1.14, 95% CI 1.02 to 1.27; I² = 0%; low certainty evidence). Compared to isotonic exercise training, isometric exercise training may improve both ultrasound maturation (3 studies, 160 participants: RR 1.56, 95% CI 1.21 to 2.00; I² = 22%; low certainty evidence) and clinical maturation (3 studies, 160 participants: RR 1.80, 95% CI 1.18 to 2.76; I² = 53%; low certainty evidence). Venous diameter (3 studies, 160 participants: MD 0.84 mm, 95% CI 0.45 to 1.23; I² = 0%; low certainty evidence) and blood flow in the inflow artery (3 studies, 160 participants: MD 140.62 mL/min, 95% CI 38.72 to 242.52; I² = 0%; low certainty evidence) may be greater with isometric exercise training. It is uncertain whether isometric exercise training reduces vascular access complications (2 studies, 110 participants: RR 2.54, 95% CI 0.38 to 17.08; I² = 47%; very low certainty evidence). It is uncertain whether high volume isotonic exercise training improves venous diameter (2 studies, 93 participants: MD 0.19 mm, 95% CI -0.75 to 1.13; I² = 34%; very low certainty evidence) or blood flow in the inflow artery (1 study, 15 participants: MD -287.70 mL/min, 95% CI -625.99 to 60.59; very low certainty evidence) compared to low volume isotonic exercise training. None of the included studies reported time to mature, dialysis efficacy indicator, vascular access function, or adverse events. Authors' conclusions: Our findings suggest that the current research evidence examining upper limb exercise programs is of low quality, attributable to variability in the type of interventions used and the overall low number of studies and participants.
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Self-Care Behavior of Hemodialysis Patients With Arteriovenous Fistula in China: A Multicenter, Cross-Sectional Study
Article
Full-text available
  • Oct 2018
  • THER APHER DIAL
Introduction Improving the level of AVF self‐care behavior by people receiving hemodialysis is an effective way to reduce the occurrence of complications and mortality. The aim of this study was to assess the self‐care behavior of Chinese patients undergoing hemodialysis with arteriovenous fistula. Methods The ASBHD‐AVF (Portuguese version) was translated into Chinese using Brislin's translation model. The content validity was evaluated by 6 experts. Then we involved 301 hemodialysis patients with AVF to explore the construct validity of the Chinese version of ASBHD‐AVF. Ultimately 216 patients from 8 dialysis centers of general hospital in China were recruited to evaluate the patients’ self‐care behavior about AVF. Measures included demographic questionnaire, and the Chinese ASBHD‐AVF. Results The Chinese ASBHD‐AVF that included 12 items has a good internal consistency (α=0.865) and content validity(CVI=0.979). Principal component analysis generated 2 factors which explained 53.525% of the total variance. 69.9% of hemodialysis patients' AVF self‐care behavior were at a low or moderate level. Discussion The level of self‐care behavior and knowledge need to be improved. Nurses should give specific guidance according to the patients' own characteristics and different influence factors, in order to improve the recipients' self‐care behavior.
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Influence of arteriovenous fistula on daily living behaviors involving the upper limbs in hemodialysis patients: a cross-sectional questionnaire study
Article
Full-text available
  • Oct 2018
  • BMC Nephrol
Background Arteriovenous fistulae can restrict daily living behaviors involving the upper limbs in hemodialysis patients, but no studies have investigated the detailed effects of an arteriovenous fistula on routine life activities. Accordingly, many medical caregivers are unable to explain the effects of an arteriovenous fistula on daily life, particularly during non-dialysis periods, because they cannot observe them directly. Methods Thirty outpatients undergoing hemodialysis at 2 facilities scored the difficulty due to an arteriovenous fistula in performing 48 living behaviors during non-dialysis and 10 behaviors during dialysis into 5 grades in a comprehensive questionnaire survey. These behaviors were selected based on an open-answer pre-questionnaire administered to the 30 patients beforehand. The scores were also compared between dominant arm and non-dominant arm arteriovenous fistula groups. Results During non-dialysis, the difficulty scores of behaviors restricted out of concern for arteriovenous fistula obstruction (wear a wristwatch, hang a bag on the arm, carry a baby or a dog in the arms, wear a short-sleeved shirt, etc.) increased. The difficulties of “wear a wristwatch” and “hang a bag on the arm” were significantly higher in the non-dominant arm arteriovenous fistula group (both P < 0.05). In contrast, scores related to motor function (write, eat or drink, scratch an itch, etc.) increased remarkably during dialysis because of connection of the arteriovenous fistula to the dialysis machine. The difficulties of “write” and “eat or drink” were significantly higher in the dominant arm arteriovenous fistula group (both P < 0.05). Conclusions Several key daily living behaviors restricted by an arteriovenous fistula were identified in this questionnaire survey. These results will be useful for pre-operative explanation of arteriovenous fistula surgery and arm selection in end-stage renal disease patients.
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The Spectrum of Hand Dysfunction After Hemodialysis Fistula Placement
Article
Full-text available
  • Nov 2016
Introduction: Contemporary dogma has classically attributed hand dysfunction following hemodialysis arteriovenous fistula (AVF) placement to regional ischemia. We hypothesize that hemodynamic perturbations alone do not entirely explain the postoperative changes in hand function and, furthermore, that various elements of hand function are differentially affected following surgery. Methods: Bilateral wrist and digital pressures and upper extremity nerve conduction tests were recorded preoperatively and at 6 weeks and 6 months following upper extremity AVF construction in 46 patients. Concurrently, biomechanical tests were administered to evaluate multiple limb functional domains including grip strength, dexterity, sensation and perception of hand function. Results: Mean age was 59±14 years (75% male) and 48% were on hemodialysis at the time of access placement. 69% had a brachial-based AVF, and the remainder had radial-based accesses. Six weeks following AVF placement, a significant decrease in access side digital pressures was observed, with only partial recovery at 6 months (P<0.0001). Grip strength was significantly worse in the access side limb (P=0.0003), and Disability of Arm, Shoulder and Hand Questionnaire (DASH) score substantially worsened postoperatively (P=0.06). Digital sensation and limb dexterity did not differ between limb sides (P>0.1) or change significantly over time (P>0.1). Principal component analyses demonstrated that nerve conduction parameters tended to track the biomechanical parameters, yet both were relatively independent of the hemodynamic parameters. Conclusion: Our findings suggest that ischemia alone does not completely explain access-related hand dysfunction and that future study is needed to elucidate alternative mechanisms.
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Arteriovenous Access Failure, Stenosis, and Thrombosis
Article
Full-text available
  • Sep 2016
Vascular access-related complications can lead to patient morbidity and reduced patient quality of life. Some of the common arteriovenous access complications include failure to mature, stenosis formation, and thrombosis. Abrégé Les complications liées à la création d'un accès vasculaire peuvent s'avérer une cause de morbidité et entraîner une réduction de la qualité de vie du patient. Les complications artérioveineuses les plus répandues incluent un défaut de maturation et le développement d'une sténose ou d'une thrombose.
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Arteriovenous Access
Article
Full-text available
  • Sep 2016
Complications of vascular access lead to morbidity and may reduce quality of life. In this module, we review both infectious and noninfectious arteriovenous access complications including neuropathy, aneurysm, and high-output access. For the challenging patients who have developed many complications and are now nearing their last vascular access, we highlight some potentially novel approaches.
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Effect of Dumbbell Exercise on Arteriovenous Fistula in Patients Undergoing Maintenance Haemodialysis: A Prospective Randomized Controlled Trial
Article
  • Sep 2019
Background: Arteriovenous fistulas (AVF) have been the main vascular accesses for haemodialysis patients, but the maintenance after maturation poses serious challenges. Arm exercises promote the maturation of AVFs. However, few studies have evaluated the effect of arm exercise on matured AVF and addressed the intervention for late fistula failure. Objectives: The study was conducted to explore the effect of dumbbell exercise on mature AVF. Methods: 86 participants undergoing haemodialysis with AVFs were randomized into the control group and experimental group. The experimental group held 6-pound dumbbells on non-dialysis days for 3 months, while the control group squeezed rubber balls. Results: For blood flow of draining vein (DV; primary outcome), the between-group effects, interaction effect and time effect showed significant differences. A significant increase in blood flow of DV was observed in the dumbbell group at the 3rd month (mean difference, 359.50 [111.90-829.05] mL/min; p = 0.001). The difference in blood flow of AVF proximal artery, blood flow of brachial artery, the diameter of DV and the incidence of adverse events at 3 months (secondary outcomes) between the 2 groups was insignificant. Conclusion: Prolonged training with arm exercises is essential for patients with AVFs though the fistula has matured. The designed dumbbell exercise is an economical, effective intervention to maintain the function of AVF, especially for patients with potential reduction of access blood flow and no percutaneous transluminal angioplasty indication.
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Using Interdisciplinary Cooperation to Improve the Rate of Proper Performance of a Hand Exercise Among Hemodialysis Patients With Arteriovenous Fistula Construction
Article
  • Jun 2017
Background & problems: Patients who undergo new arteriovenous fistula (AVF) construction as part of their hemodialysis treatment program are required to perform hand exercises properly in order to maintain AVF function. However, poor performance of these hand exercises currently results in the failure of many patients to preserve AVF function. Purpose: To increase the rate of performing this hand exercise properly from 55% to 80%. Resolution: A comprehensive investigation identified the following five main problems: (a) Insufficient muscular endurance; (b) Resistance was not labeled on the ball; (c) Difficulties with maintaining a grip on the ball during the exercise; (d) Lack of standardized education procedures; and (e) Nurses lack latest knowledge on the hand exercise. The strategies used to improve the situation included: (a) Interdisciplinary team cooperation with physiotherapists to design individualized resistance training regimens; (b) Exercise tool improvement; (c) Standardized AVF care; (d) Continuous education for nursing staffs; and (e) Seed teacher program for hand exercise. Results: The rate of proper hand exercise performance increased from 55% to 93%. Conclusions: This nursing project involved an interdisciplinary team that included physiotherapists in order to successfully improve the rate at which the hand exercise was performed properly. This positive experience may be applied to other hemodialysis departments in the treatment of patients with AVF.
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Vascular Access Effects on Motor Performance and Anthropometric Indices of Upper Extremities: Fistula and Arm Motor Abilities
Article
  • Jun 2016
  • Ther Apher
A decrement of upper extremity motor performance is a concern with vascular access creation. We analyzed differences in handgrip strength, tapping test and anthropometric indices of arms with and without vascular access (N = 87) and compared them to bilateral differences in control subjects (N = 140). Fistula harboring arms had weaker grip strength than contralateral arms of 2.7 kg and this difference was statistically marginally larger than the difference between non-dominant and dominant arms in controls of 1.6 kg (mean difference 1.1 kg, P = 0.06). No difference in the magnitude of inferiority of fistula arms compared to control non-dominant arms was present in the tapping test. Absolute results of both motor tests on any side were significantly worse in dialysis patients. Although weaker and slower, fistula arms showed larger mean upper-arm and forearm circumferences of 0.4–0.6 cm. Our results show no significant negative effect of arteriovenous access on motor performance of upper extremities.
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