EFFECTIVENESS OF THE ENHANCE-AC TRAINING PROGRAM ON VASCULAR ACCESS CANNULATION OUTCOMES IN HAEMODIALYSIS: A PRE-POST STUDY

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Abstract Title *

EFFECTIVENESS OF THE ENHANCE-AC TRAINING PROGRAM ON VASCULAR ACCESS CANNULATION OUTCOMES IN HAEMODIALYSIS: A PRE-POST STUDY

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Co-author 1

Soo Ying Yew syyew@ummc.edu.my University Malaya Medical Centre Department of Medicine Kuala Lumpur Malaysia *

Co-author 2

Muhammad Hafiz Azizie Mustapha azizie@ummc.edu.my University Malaya Medical Centre Nursing Department Kuala Lumpur Malaysia -

Co-author 3

Wan Ahmad Hafiz Wan Md Adnan ahmad.hafiz@ummc.edu.my University Malaya Department of Medicine Kuala Lumpur Malaysia -

Co-author 4

Soo Kun Lim limsk@ummc.edu.my Faculty of Medicine Department of Medicine Kuala Lumpur Malaysia -

Co-author 5

Chye Chung Gan ccgan@ummc.edu.my Faculty of Medicine Department of Medicine Kuala Lumpur Malaysia -

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Introduction

Arteriovenous fistulas (AVFs) and grafts (AVGs) serve as the lifeline for patients on hemodialysis. Successful cannulation of AVFs and AVGs is critical for optimal hemodialysis delivery.

The ENHANCE- AC program in a one-day hands-on workshop, focused on ultrasound-guided vascular access assessment and cannulation, aiming to improve the cannulation success and reduce reliance on haemodialysis catheters (HDC).

The study aims to evaluate the effectiveness of ENHANCE- AC programme in improving cannulation outcome among renal nurses.

Methods

A retrospective analysis was conducted on two patient cohorts undergoing AVF or AVG cannulation before and after the implementation of the ENHANCE-AC program.Data collected included fistula type, cannulation attempts (with/without USG), vascular access referrals, complications, and outcomes such as need for HDC insertion and AVF/AVG usability in subsequent dialysis sessions.

Results

A total of 35 patients were recruited, comprising pre ENHANCE-AC( n=17) and post ENHANCE-AC (n=18). The cohort had a median age of 56 years ( IQR 11) and predominantly male(62.9%).

Following the ENHANCE-AC program, there was a significant reduction in referrals to vascular access services (VAS) (41.2% vs.5.6%, p=0.012) and in HDC insertions (17.6%vs.5.6%, p=0.007). The proportion of AVFs/AVGs successful usable for the next dialysis session improved significantly from 41.2% pre ENHANCE-AC to 94.4% post ENHANCE-AC (p=0.012). ENHANCE-AC improved the confidence and skill of renal nurses with successful cannulation even without a significant difference in USG usage (23.5%vs.27.8%, p=0.774).

Both groups showed similar patterns in the number of cannulation attempts, with a slight trend toward fewer attempts required post ENHANCE-AC. Complication rates were comparable between groups (p=0.116).

Conclusion

The ENHANCE-AC program significantly improved vascular access usability and reduced the need for temporary HDC insertion and VAS referrals. These findings support the effectiveness of structured cannulation training in optimizing AV access outcomes in haemodialysis patients. The ENHANCE-AC initiative demonstrates the potential for sustainable improvement in cannulation practices and sets the foundation for broader adoption across dialysis units to enhance patient care.

This abstract is submitted at the Malaysian Society of Nephrology (MSN) Annual Congress 2025.

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