Negotiating living with an arteriovenous fistula for hemodialysis

Nephrol Nurs J. Jul-Aug 2010;37(4):363-74; quiz 375.


The purpose of this study was to examine how clients with end stage renal disease on hemodialysis negotiate living with an arteriovenous fistula. A fistula is the preferred access for hemodialysis, and clients must continually monitor and protect their fistula. In this qualitative, ethnographic study, data were collected during fieldwork and semistructured interviews. Constructivism and a cultural negotiation model provided frameworks for the study. Fourteen clients were interviewed; interviews lasted 1.5 to 4 hours. Results revealed new insights into informants'perspectives and experiences with a vascular access. The overarching theme was vulnerability, and underlying themes were body awareness, dependency, mistrust, and stigma. The response to vulnerability was to be continually vigilant and assertive to protect the holistic self Stigma of the vascular access was an important issue for informants and evoked the greatest emotional responses.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Activities of Daily Living / psychology
  • Adaptation, Psychological*
  • Adult
  • Aged
  • Aged, 80 and over
  • Anthropology, Cultural
  • Arteriovenous Shunt, Surgical / psychology*
  • Attitude to Health*
  • Body Image
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Kidney Failure, Chronic / psychology*
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Models, Psychological
  • Negotiating / psychology*
  • Nursing Methodology Research
  • Qualitative Research
  • Renal Dialysis* / instrumentation
  • Renal Dialysis* / psychology
  • Self Care / psychology
  • Stereotyping
  • Trust
  • Vulnerable Populations / psychology