How Can Clinicians Help Patients With Heart Catheters Convert to AVF Placement?

Emergency dialysis treatment usually starts in the hospital with a hemodialysis heart catheter. Often, patients do not have the option to get an arteriovenous fistula (AVF) due to the immediate necessity of dialysis. Sometimes, patients become comfortable with having a heart catheter and do not want an AVF because they do not wish to undergo surgery or experience the trauma of starting a new process or getting stuck by a needle.

As health care providers, we need to teach patients that a heart catheter is in fact temporary, and the long-term goal is to have an AVF. We must put processes in place to walk patients through their fears, which may act as barriers to better health.

Any clinician can play a role, including dietitians like me. We are trained not only in food and nutrition, but in health and wellness. I have successfully used a heart model to teach my patients about the importance of getting an AVF, and I believe it can be an effective tool for others.

Designing, Using a Visual Aid

Visual aids help many people learn and can be used to empower patients. Clinicians can modify a heart model to include a catheter, which can help patients visualize the damage and impact this device may have on their own hearts.

QWORK human heart models are available from Amazon. Once you have one, it will need a hole drilled for catheter placement. A biomedical technician can help drill holes through the #15 superior vena cava, which will allow the catheter to pass through. A clinic manager may be able to help locate expired catheters to use for this purpose. Expired catheters also may be purchased for approximately $20 to $30 through supply companies such as Merit Medical.

Once you have a complete model with the catheter in place, you will need a plan for sharing it with patients. Physicians, clinic managers, or social workers should play a role in developing the plan. The social worker may be able to assist with any psychosocial concerns related to removing the catheter. Working as a team allows you to bring more expertise to patients and helps build more credibility and trust. However, clinicians, including dietitians, can take the lead in educating patients and then refer those who are ready to proceed with getting an AVF to the clinic manager. Once patients are identified, the necessary appointments can be made.

Talking Points to Discuss With Patients

It can be helpful to have a list of talking points to discuss with patients during the demonstration of the heart model. The talking points should be patient-specific. Also, keep in mind the tone of the conversation. It is not about showing patients how much we know; it is about showing them how much we care.

Some general talking points may include:

• Risks of keeping a heart catheter
  • Causes constant tapping on the heart, resulting in scarring and callusing of the soft tissue; this effect can be demonstrated by physically tapping a pen lightly and consistently on the patient’s hand while talking to them
  • Incurs greater risk of permanent damage to the heart the longer it is in use
• Benefits of switching to an AVF
  • Lowers risk of infections/sepsis and prevents hospitalizations
  • Helps improve outcomes, such as clearance, phosphorus, albumin, and blood pressure (BP)
  • Makes the dialysis experience more comfortable
  • Lowers BP rates versus a heart catheter, resulting in lower risk of strokes and a stronger heart
  • Helps increase lifespan
  • Improves quality of life, such as enabling a patient to take showers and swim
• Ways to improve the experience of changing from a heart catheter to an AVF
  • A buttonhole or tiny scab or flap may be created where the needle is inserted for patients who have a fear of needles
  • Numbing creams and sprays can reduce the sensation of needle insertion

It is especially important to teach patients who already have some form of heart disease that having a catheter adds more stress to their heart.

Improving Outcomes

Patients who received this education enjoyed seeing the heart model, and they had a much better understanding of the heart catheter, its placement, and the importance of removal.

As clinicians, we should be doing all we can to empower our patients and help them live longer, healthier lives. Visual aids such as a customized heart model are powerful tools to aid us in educating patients to make the best decisions for their health.