Barriers and facilitators to vascular access point‐of‐care ultrasound in haemodialysis: An international survey of haemodialysis clinicians

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Abstract
Background: Utilising point‐of‐care ultrasound for assessment and cannulation of vascular access in people receiving haemodialysis has shown positive clinical results. Nonetheless, there is variation in how renal health care professionals worldwide embrace this method, and there's a lack of research on the factors that promote or hinder its adoption.Objectives: To explore regional differences, and barriers and facilitators, to the use of point‐of‐care ultrasound for assessment and cannulation of vascular access in haemodialysis.Design: Exploratory descriptive cross‐sectional web‐based survey.Participants: Healthcare clinicians working in haemodialysis responsible for cannulation of arteriovenous fistula or grafts.Results: The survey was completed by 645 health care clinicians from 38 countries. 75% to 93% of respondents from Australia/New Zealand, Canada, Europe and United Kingdom/Ireland reported access to ultrasound, compared to 26% (n = 43/167) from the United States. United States respondent's reported lower levels of ultrasound training than other regions. Facilitators for using ultrasound were: the availability of ultrasound training (87%, n = 558), to reduce miscannulations (76%, n = 255/336) and to improve patient outcomes (73%, n = 246/336). Point‐of‐care ultrasound barriers were lack of access to ultrasound education (82%, n = 196/239), lack of ultrasound machines (33%, n = 212/645) or believing that ultrasound was someone else's role (38%, n = 29/86).Conclusions: This study revealed national and regional differences related to haemodialysis point‐of‐care ultrasound. Understanding the regions requiring more education and implementation of ultrasound and what motivates staff, or deters from using ultrasound, is crucial for effectiveness of future implementation and workplace change initiatives.

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