Ultrasound of dialysis fistulae: Factors influencing Australian practice

Introduction: Due to the increasing prevalence of kidney failure in Australia, more sonographers are being expected to perform ultrasound examinations of arteriovenous fistulae (AVF), even when they may receive little support to do so. Methods: We surveyed respondents through the Australasian Sonographers Association (ASA), regarding their demographics, workplace, and experience in relation to AVF ultrasound examinations. Results: Fifty sonographers participated from metropolitan and regional areas. Sonographers in metropolitan areas had approximately three times more access to support compared to those in rural/remote areas, in performing AVF ultrasound examinations. Self-reported competency levels of AVF ultrasound examinations were novice/advanced beginner 28.6%, competent 30%, proficient/expert 40%. Less than a fifth of sonographers always performed a physical assessment, while almost half never physically assessed an AVF. Conclusion: Rural and remote sonographers have the least access to ongoing resources and support. The knowledge of the supporting role that non-ultrasound methods of AVF surveillance can play in improving the quality of ultrasound assessments, varied mainly by perception of competency. Sonographer competency, education, and support in AVF assessment is vital to avoid clinical uncertainty. Australian sonographers would benefit from further education and support to improve competency, confidence and patient outcomes.