Protocolo de cuidados com fístula e enxerto arteriovenosos para pacientes em hemodiálise

Abstract

The durability of vascular access for hemodialysis depends on multiple factors, ranging from its creation to cannulation techniques and access maintenance. The adoption of preventive and corrective measures that promote vascular access patency is directly associated with reduced morbidity and mortality in hemodialysis patients. Objective: To develop a care protocol for patients undergoing hemodialysis focused on arteriovenous fistulas and grafts. Methodology: This is a methodological study conducted in three phases: (1) assessment of existing clinical guidelines for vascular access in hemodialysis; (2) a scoping review on care practices for arteriovenous fistulas and grafts; and (3) development of a specific care protocol. Results: Seven clinical guidelines published between 2014 and 2024 on hemodialysis vascular access were identified and analyzed. Most scored above 50% across all domains of the AGREE II (Appraisal of Guidelines for Research & Evaluation) tool. The scoping review included 104 publications, categorized into the following themes: preoperative vascular mapping, pharmacological interventions for access maturation, clinical monitoring, physical examination, exercise regimens, cannulation techniques (including ultrasound-guided methods), and self-care practices. The protocol was constructed using six of the evaluated guidelines and the evidence synthesized from the scoping review. Its structure followed the standard model established by HUCAM (Cassiano Antônio Moraes University Hospital), in accordance with the norms of the Unit for Quality and Patient Safety Management (UGQSP). Conclusion: This study resulted in a care protocol for arteriovenous fistulas and grafts tailored to hemodialysis patients. Additionally, a scoping review was conducted, identifying key practices and technologies essential for optimizing vascular access management.