Débranchement de fistule artérioveineuse : rationaliser la prise en charge du risque hémorragique

During the disconnection of the arteriovenous fistulas, the nursing staff manages a hemorrhagic risk function of various factors requiring the use of an adapted haemostatic treatment. In front of numerous available references, it seemed interesting to us to standardize the coverage of this risk within the service of hemodialysis. We realized an audit to analyze the practices of disconnections and estimate the context of use of the haemostatic agents. A review of the consumptions as well as a medical economic study were realized on the haemostatic agents used in dialysis. A revaluation of the practices after 6 months was programmed to validate the institution of the protocol. Fifty observed disconnections brought to light numerous critical points. A decision tree was established to direct the choice of the haemostatic method. The importance of the direct compression in first intention was reminded and data sheets were realized. Two absorbable bandages were deleted by the allocation and an alginate of class III was subjected to name specific prescription. The assessment in 6 months proves the support of the teams to this new protocol by the impact on the consumptions and the follow-up of the decision tree during the disconnections. This study allowed us to harmonize a common act and to put at the disposal of the nursing only bandage haemostatics indicated in the disconnection of the arteriovenous fistulas. The spread good use was a major axis of improvement of the practices as well as a help for the integration of the new procedure.