Measuring Cannulation Skills for Hemodialysis: Objective Versus Subjective Assessment.

Lack of cannulation skill during hemodialysis treatments results in poor clinical outcomes due to infiltration and other cannulation-related trauma. Unfortunately, training of patient care technicians and nurses, specifically on the "technical" aspects of cannulation, has traditionally not received much attention. Simulators have been successfully deployed in many medical specialties for assessment and training of clinical skills. However, simulators have not been as widely used in nursing, especially in the context of training clinical personnel in the dialysis unit. We designed a state-of-the-art simulator for quantifying skill for hemodialysis cannulation. In this study, 52 nurses and patient care technicians with varying levels of clinical experience performed 16 cannulations on the simulator with different fistula properties. We formulated a composite metric for objectively measuring overall success of cannulation and compared this metric with subjective assessment by experts. In addition, we examined if years of clinical experience correlated with objective and subjective scores for cannulation skill. Results indicated that, while subjective and objective metrics generally correlated with each other, the objective metric was more precise and better suited for quantifying cannulation skill. Further, the simulator-based objective metric provides several advantages over subjective ratings, including providing fine-grained assessment of skill, consistency in measurement unaffected by subjective biases, and basing assessment on a more complete evaluation of performance. Years of clinical experience, however, demonstrated little correlation with either method of skill assessment. The methods presented for cannulation skill assessment in this study, if widely applied, could result in improved cannulation skill among our PCTs and nurses, which could positively impact patient outcomes in a tangible way.

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Copyright © 2021 Liu, Bible, Petersen, Roy-Chaudhury, Geissler, Brouwer-Maier and Singapogu.

Déclaration de conflit d'intérêts

RS reports grant from NIH/NIDDK, during the conduct of the study. He is also Founder of Radiant Ventures, LLC. PR-C is the consultant/Advisory Board member for WL Gore, BD-Bard, Medtronic, Cormedix, Humacyte, Akebia, Bayer, Vifor Pharma and Reata; Founder and CSO of Inovasc LLC. DB-M is an employee of Transonic Systems Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.