Abstract:

Objective To formulate an expert consensus on the puncture of difficult arteriovenous fistula under real-time guidance of ultrasound（hereinafter referred to as the consensus）. To standardize the clinical practice of ultrasound-guided puncture of difficult autologous arteriovenous fistula. Methods We conducted a comprehensive literature review of domestic and international publications，integrated clinical nursing experts’ practical experience，and followed evidence-based nursing principles to identify the best available evidence. Through expert panel discussions and 3 rounds of Delphi expert consultation，we systematically revised，refined and improved the initial draft of the consensus，ultimately developing the finalized version. Results The response rates of the 3 rounds of Delphi expert correspondence inquiries were all 100%；the authority coefficient of expert correspondence inquiries was 0.97；the mean importance assignment of the 3 rounds of correspondence inquiries was more than 3.50. The Kendall coordination coefficients of the 3 rounds of expert consultation were 0.127，0.120，and 0.201，respectively （P<0.05），and the degree of coordination of expert opinions was good and the expert opinions were consistent. The consensus summarized 5 aspects，including relevant terms and definitions，indications for real-time ultrasound-guided arteriovenous fistula puncture，personnel qualifications and training，difficult arteriovenous fistula puncture procedures under real-time ultrasound-guided，and nursing quality control. Conclusion The consensus is scientific，which can provide a basis for hemodialysis practitioners to practice the puncture of difficult arteriovenous fistula under real-time guidance of ultrasound.

Key words: Point-of-Care Ultrasound, Difficult Cannulation of Arteriovenous Fistula, Hemodialysis, Expert Consensus

摘要：

目的 制订超声实时引导下疑难动静脉内瘘穿刺专家共识（以下简称“共识”），规范超声引导下疑难自体动静脉内瘘穿刺临床实践。 方法 检索国内外相关文献，结合临床护理专家工作经验及循证，通过3轮德尔菲专家函询及专家论证，对“共识”初稿进行修改和完善，形成“共识”终稿。 结果 3轮德尔菲专家函询应答率均为100%，专家函询的权威系数为0.97，3轮函询重要性赋值均数均>3.50分。3轮函询的肯德尔和谐系数分别为0.127、0.120、0.201（P<0.05），专家意见协调程度较好，专家意见较为一致。“共识”总结了5个方面的内容，包括相关术语及定义、超声实时引导下动静脉内瘘穿刺适应证、人员资质与培训、超声实时引导下穿刺程序和护理质量控制。 结论 “共识”具有一定的科学性，可为血液透析从业人员行超声实时引导下疑难动静脉内瘘穿刺实践提供参考。

关键词: 超声实时引导, 疑难动静脉内瘘, 血液透析, 专家共识