Introduction: Arteriovenous fistula (AVF) operation is recognized a gold standard of hemodialysis for end-stage renal disease. Because various complications may occur during perioperative period, medical care plays an important role in improving the possibility of AVF operation. The objective of the study was to explore the effect of the mode of multiple disciplinary team (MDT) medical care on the patients with end-stage renal disease treated by arteriovenous fistula (AVF) operation. Method: 98 patients with end-stage renal disease under the AVF operation were divided into observation group and control group. The control group was performed with regular medical care and for the observation group was treated under the mode of MDT medical care. Complications after operation, hospitalized time and medical satisfaction were comprehensively compared between the both groups. Results: The overall complications including swelling, bleeding, infection and thrombosis in observation group accounted for 5%, however, 19% of patients suffered different complications in the control group. The total complications significantly decreased in the observation group compared with control group (P < 0.001). The hospitalization time was shortened to 9.8 ± 5.6 days in the observation group, and the average hospitalization in control group was 17.8 ± 8.9 days. The medical satisfaction was increased by 20.83 percent in the observation group compared with the control group (P < 0.001). 75% patients in control group were satisfied with medical care, and 98.53% patients were satisfied for observation group. Conclusion: The mode of MDT medical care was beneficial for patients with end-stage renal disease after AVF operation, which could significantly reduce complications, hospitalized time and improve patients’ degree of satisfaction. Thus, it should be recommended in the clinical work.
Nowadays, hemodialysis is the main alternative treatment method for patients with end-stage renal disease [
Ninety-six patients (55 males and 41 females) aged between 18 years and 87 years (mean age, 61.2 years ± 13.7 years) with end-stage renal disease undergone AVF operation were included in the Department of Nephrology of the First Affiliated Hospital of Jinan University from January 2018 to July 2019 (
The members of MDT consist of nephrologists, specialized nurses, vascular
| Primary disease | No. Patients, n (%) |
|---|---|
| Hypertensive nephropathy | 49 (51.04) |
| Diabetic nephropathy | 29 (30.20) |
| Chronic glomerulonephritis | 5 (5.20) |
| Obstructive kidney disease | 8 (8.33) |
| Renal cysts | 2 (2.08) |
| Nephrotic syndrome | 2 (2.08) |
| IGA nephropathy | 1 (1.04) |
surgeons, ultrasound doctors and interventional radiologists. Preoperative examination was completed after the patient’s admission. Meanwhile, the transplant surgeon of vascular access group checked the distribution of the patient’s arm blood vessels with ultrasound doctors and interventional radiologists preoperatively. Medical care plans were discussed and specified according to the condition of patient under MDT mode. In addition, the MDT members explained the surgical procedures and precautions to patients in detail. Finally, the vascular surgeon made an optimal surgical plan for the patient. The MDT medical care mode for the patients during the perioperative period in detail was as following:
1) Preoperative notification and psychological intervention
A specialized nursing staff pre-educated the patient about the basic knowledge about AVF, the treatment methods, and the risks of common complications after AVF operation so as to make the patient psychologically cooperate with surgical treatment, eliminate tension and fear, which could make the whole treatment progress more smoothly.
2) Preoperative preparation
The patient was instructed to wash the surgical area with soap 3 times, and bathe the day before operation, moreover, the patient’s vital signs and blood glucose changes were recorded and reported to the vascular surgeon if there is any abnormality.
3) Post-operative medical care
On the first day after AVF operation, the specialized nursing staff recorded the patient’s vital signs, inquired the patient about the symptoms of discomfort, and taught the patient to raise the arm appropriately to promote blood return and reduce swelling and bleeding of the limb on the side of operation. Within three days after the operation, the patient was instructed not to flex excessively in case of thrombosis and hematoma occurrence in the operation area. Meanwhile, it was forbidden for medical staff to measure blood pressure, draw blood, intravenous injection, and blood transfusion on the side limbs of the internal fistula. Moreover, the patient was told to wear loose cuffs as much as possible and monitor the internal fistula noise at least 3 times a day.
4) Daily internal fistula care
The patient performed AVF operation should keep the skin clean, trim the nails regularly in case of accidental injuries of internal fistula limbs of fistula after discharge. If the wound is free of bleeding, infection, the internal fistula limb could be used daily. In addition, the patient should measure blood pressure in time, and soak the limbs of the internal fistula with warm water appropriately on a certain time. Follow-up was necessary to prevent blockage of AVF. Finally, it was forbidden for patients to lift weights over 5 kg and prevented compression of AVF.
On the contrary, the patients in control group were administered with routine medical care in our nephrology department. A nurse in charge was responsible for the patients’ admission education, physical examination, postoperative care, functional exercise, and discharge education for patients. Then, the vascular surgeon performed AVF operation after assessing the patients’ examination results from ultrasound and imaging departments. A follow-up inquiry was made for each patient after discharge on a certain time by telephone.
1) Postoperative complications Postoperative complications include swelling, bleeding, infection, and thrombosis was precisely recorded for each patient.
2) Length of hospitalization The average hospitalized time of the patients in two groups was compared.
3) Medical satisfaction survey The medical satisfaction survey was conducted by telephone questionnaire as a part of follow-up. Satisfaction degree was classified according to the feedback of the patients as following: very satisfied: 80 to 100 scores; satisfaction: 60 to 79 scores; dissatisfaction: ≤59 scores.
Medical satisfaction survey of patient in the nephrology department of Jinan University
The Clinical quality survey data were statistically analyzed by SPSS_21.0 software. The two-independent-samples tests or χ2 test was used for analysis between the two groups. P < 0.05 was considered statistically significant.
Out of 96 patients with end-stage renal disease, 49 had Hypertensive nephropathy as to say a prevalence of 51.04%. Twenty-nine patients had diabetic nephropathy and 5 had chronic glomerulonephritis. Eight patients had past medical history of Obstructive kidney disease, 2 patients had renal cysts and 2 patients suffered from nephrotic syndrome. Only 1 patient was diagnosed as IGA nephropathy.
The two-independent-samples tests showed that the complications in the observation group were significantly lower than those in the control group, and the difference was statistically significant (P < 0.001). In our study, swelling was found in 6 patients (12.5%) in the control group and only 2 patients had swelling in the observation group (4.2%). Bleeding was noted in 8 patients and 3 patients in the control group (16.7%) and observation group (6.3%) respectively. There were 2 patients (4.2%) and 3 patients (6.3%) underwent infection and thrombosis respectively in the control group. On the contrary, infection and thrombosis were not found in the observation group (
The length of hospitalization in the two groups was recorded and analyzed using t-test. It showed that the length of stay in the observation group was significantly shorter than that in the control group (P < 0.001). The hospitalization time was shortened to 9.8 ± 5.6 days in the observation group, and the average hospitalization in control group was 17.8 ± 8.9 days (
75% patients in control group were satisfied with medical care, and 98.53% patients were satisfied for observation group. The satisfaction degree of patients in
| Complications | Control group | Observation group |
|---|---|---|
| swelling | 6 (12.5) | 2 (4.2) |
| bleeding | 8 (16.7) | 3 (6.3) |
| infection | 2 (4.2) | 0 (0) |
| thrombosis | 3 (6.3) | 0 (0) |
| total | 19 (38) | 5 (12) |
| Mann-Whitney U | 816 | P < 0.001 |
| group | Average stay (day) |
|---|---|
| Control group | 17.8 ± 8.9 |
| Observation group | 9.8 ± 5.6 |
| t | 5.453 |
| P | <0.001 |
the observation group was significantly higher than that in the control group (P < 0.001) (
AVF is considered the gold standard modality of vascular access for maintaining hemodialysis because of its superior patency, provision of high quality of life, and low risk of patient mortality [
Compared with the conventional medical care, the application of MDT mode could significantly reduce the complications postoperatively. The Duplex ultrasound identifies suitable arteries and veins for successful AVF creation [
In the control group, most patients complained lack of systemic instruct about how to restore the function of AVF. However, there were only several patients complained the complicated clinical examination. Most patients under MDT
| group | very satisfied | satisfied | less satisfied | overall satisfaction (%) |
|---|---|---|---|---|
| Control group 12 | 26 | 1036 (75) | ||
| Observation group | 43 | 3 | 2 | 46 (95.83) |
| χ2 43.464 | ||||
| P < 0.001 | ||||
medical care were greatly satisfied with the good service and quick feedback from doctors and nurses. Under the novel MDT medical care mode, patient satisfaction degree has improved significantly, which greatly reduced the occurrence of doctor-patient contradictions, and made medical care work more smoothly. Consequently, the whole medical work entered a virtuous circulation mode and realized seamless connection between different departments. To be noted, the decreases of patients’ complications significantly shortened the length of patient hospitalization and reduced medical costs. Therefore, the MDT mode of medical care can better provide patients with high-quality services, thereby achieve good effects on treatment and medical care.
MDT mode of medical care is a new trial in clinical work, which needs more team-spirit and cooperation. This may be an obstacle to the application of MDT mode. Second, the MDT mode of medical care should be optimized to reduce medical costs.
The MDT medical care mode focuses on the specialties of nephrologists, vascular access group doctors, ultrasound doctors, and interventional surgeons, and provides a simple and easy-to-use medical system based on disciplines such as laboratory medicine and imaging. Optimizing the allocation of resources greatly shortens the average hospital stay of patients, reduces the medical expenses and financial burden on patients, and improves high medical satisfaction. Therefore, the multi-disciplinary medical nursing mode is scientific and effective in current nursing work, and it is worthy of popularization and application in clinical work.
We thank all the staff of the Department of Nephrology of the First Affiliated Hospital of Jinan University. This research was supported by grant 2013B090400004 from Guangzhou Academic foundation of the Industry-Academy-Cooperation, China.
All authors have no conflicts of interest to declare.
Yang, H., Deng, Z.H., Zhong, Y.X., Yin, L.H., Liu, F.N. and Chen, Y. (2020) The Medical Care of Multiple Disciplinary Team Reduces the Risks of Complications in Patients after Arteriovenous Fistula Operation. Open Journal of Nephrology, 10, 117-124. https://doi.org/10.4236/ojneph.2020.102012