Living with an arterio -venous fistula for hemodialysis

Cleo J Richard, The University of Texas School of Nursing at Houston


Background. End stage renal disease (ESRD) is a chronic, noncurable condition that requires dialysis and/or a kidney transplant to sustain life. A vascular access is required for hemodialysis and a fistula is the medically preferred access. Although clients must continually monitor and protect their fistulas, these activities have not been well studied from the clients' perspective. The purpose of this study was to examine the experience of clients with ESRD on hemodialysis negotiating living with a fistula. Methods. This qualitative, ethnographic study examined the shared cultural experience of living with a vascular access for hemodialysis. Data were collected from semi-structured interviews, field notes, and artifacts. Data analysis was an iterative process that involved data collection, reduction, display, and interpretation. A codebook was developed and applied to the data set. Strategies of data validation, reflexivity, and debriefing sessions were used to assure trustworthiness. Findings. Fourteen informants were interviewed, 12 at home and two in a private office. Informants were eager to talk and interviews lasted 1.5-4 hours. The overarching theme was vulnerability and an underlying theme was body awareness. Vulnerability was based on having ESRD, requiring dialysis, and being dependent on the health care system and a vascular access for survival. The response to vulnerability was to be continually vigilant and assertive to protect oneself. This dependency created a situation that often led to mistrust of the health care system, in both hemodialysis and in maintenance of the access. The mistrust was focused on the technology as well as providers (e.g., nurses, technicians, and physicians). Informants identified strategies to maintain their access. Additionally they iterated many concerns about pain with cannulation and the appearance of the access and internal and external stigma of the access. Conclusions. This study revealed new insights into clients' perspectives and experiences of the vascular access in the context of hemodialysis. From the informants' perspectives, caring for and maintaining an access and negotiating care during hemodialysis are complex processes. Stigma of the access was an important issue for informants and evoked the greatest emotional responses.

Subject Area

Cultural anthropology|Behavioral psychology|Nursing

Recommended Citation

Richard, Cleo J, "Living with an arterio -venous fistula for hemodialysis" (2008). Texas Medical Center Dissertations (via ProQuest). AAI3332191.