Assessment of Physical and Psychological Effect of Constant Site and Different Sites of Puncture on Haemodialysis Patients

Abstract

ABSTRACT End stage renal disease should have replacement therapy for lifelong either hemodialysis or peritoneal dialysis and transplantation .Patient who will be managed by hemodialysis is as a lifelong treatment need vascular access (arterio venous access). Arterio venous access should be punctured every session either in constant or different sites and the both technique will affect the quality of dialysis session and purification of the blood. The aim of this study is to assess the physical and psychological effect of constant site and different sites of punctures of hemodialysis patients. Design: descriptive comparative design was used. Setting: this study was conducted in hemodialysis unit at El Demerdash hospital, Ain shams university subjects: composed of 100 hemodialysis patients,50 were receiving constant site puncture and another 50 receiving different sites punctures Tools: two tools were used for data collection 1- An interview questionnaire: it’s composed of six parts demographic data, medical and surgical history, patient knowledge regarding (arterio venous fistula), Assessing pain level, anxiety level and depression level 2-Physical assessment sheet for assessing the local complications of arterio venous fistula as infections ,open sores at the site of puncture, itching, warmth, aneurysm, stenosis, edema, and change the skin shape. The Observation also include the survival of the fistula. Results: the study showed statistically difference in preferred type of insertion, Number of survival fistula, and Total number of arterio venous fistula complications in the both groups either in constant site or different sites during puncture. The result showed also Positive correlation and significant between total satisfactory knowledge with pain, anxiety and depression in constant site puncture group. Conclusion Changing the site of puncture resulted in: A shorten fistula survival, feeling of anxiety and depression for the patients and also felling of pain during insertion, while using constant site puncture leading to more local complications at the site of insertion. Recommendations: psychological support for the haemodialysis patient during puncture if it was from constant site or different sites is needed, follow up continuously.