Abstract
For maintaining favorable vascular access, it is important to improve the puncture technique and puncture without error. In our clinic, we have made an effort to reduce vascular access mispuncture from three years ago. This time, we examined the frequency, cause and situation regarding the mispuncture of arteriovenous shunts over a 1-year period. All punctures for arteriovenous shunts in chronic hemodialysis patients were studied from January to December 2010. The miss notebook in which mispunctures had been recorded was utilized for an investigation of mispuncture. It was judged to be a mispuncture when one of the arterial or venous side veins failed in the first puncture. The mispuncture was classified by time of occurrence into the following three groups : (1)consecutive miss, (2)miss within one week, (3)sporadic miss. The total number of dialysis procedures employing arteriovenous shunts was 15,101 and the number of dialysis procedures involving a mispuncture was 215 (1.4%). This low rate is regarded as the effect of the previous effort to avoid mispuncture. Based on the classification, consecutive misses numbered 15(7%), misses within one week numbered 19(9%), and sporadic misses, the majority, numbered 181(84%). There were few consecutive misses and misses within one week. This may be due to the effect of reporting the contents of the miss notebook to the medical staff in the morning conference on the next dialysis day. In addition, sporadic misses, comprising the majority of mispunctures, were related to the poor concentration of medical staff. We think that it is possible to reduce sporadic misses by maintaining concentration during puncture.
