Analysis of the 2024 practical examination for the Hemodialysis Vascular Access Intervention Technique Specialized Training Program_West China Medical Journal

Authors：

XU Yuankai ¹ ,  ZHANG Lihong ² , SHI Yaxue ³ , CUI Tianlei ⁴ , FU Qining ⁵ , WANG Pei ⁶ , YE Hong ⁷ , JIANG Xinxin ¹ , JIANG Hua ⁸ , LI Hua ⁹ , FU Ping ⁴ , WANG Yuzhu ¹⁰ , JIN Qizhuang ¹¹ , ZUO Li ¹²

1. Department of Nephrology, Zhejiang Hospital, Hangzhou, Zhejiang 310013, P. R. China;
2. Second Department of Nephrology, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050023, P. R. China;
3. Department of Vascular Surgery, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200030, P. R. China;
4. Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
5. Department of Vascular Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P. R. China;
6. Department of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 451191, P. R. China;
7. Department of Nephrology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210011, P. R. China;
8. Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, P. R. China;
9. Department of Nephrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 311500, P. R. China;
10. Department of Nephrology,Beijing Haidian Hospital, Beijing 100080, P. R. China;
11. Department of Nephrology, Peking University First Hospital, Beijing 100034, P. R. China;
12. Department of Nephrology, Peking University People’s Hospital, Beijing 100044, P. R. China;

Corresponding?author：

ZHANG Lihong, Email: xgtl2011@163.com

Keywords：

hemodialysis; vascular access; arteriovenous fistula; training; examination

DOI：

10.7507/1002-0179.202605084

Video：

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Objective To analyze the results of the 2024 annual competency assessment of the Hemodialysis Vascular Access Intervention Technique Specialized Training Program, evaluate trainees’ current operational competence, identify weaknesses in the training system, and provide evidence for optimizing the training curriculum. Methods From August to September 2024, trainees underwent offline practical ultrasound examinations at two sites: Chongqing (southern region) and Shijiazhuang (northern region). The examination assessed functional evaluation of arteriovenous fistulas in real maintenance hemodialysis patients, including physical examination and ultrasound evaluation. domestic mainstream ultrasound systems were used, and faculty members conducted one-on-one proctoring. Anonymous questionnaires were administered to examiners and trainees after the examination. Common problems and learning needs were ranked and scored according to severity. Results A total of 223 trainees actually participated in the offline examination, with 17 faculty members supervising the test. Among the 223 trainees, 209 passed the examination, with a pass rate of 93.7%. Examiner survey results indicated that the most prominent common problem was poor ultrasound image quality (score ratio 80.15%), followed by failure to detect clinically significant stenosis during physical examination (69.12%) and unfamiliarity with ultrasound probe manipulation (64.71%). Enhanced practical ultrasound training was identified as the most urgent learning need. Trainee survey results revealed that the most difficult examination item was visualization and diameter measurement of the anastomosis (score ratio 67.94%), while the most significant adverse factor was unfamiliarity with the ultrasound machine brand and operating interface (91.03%). A total of 76.47% of examiners and 80.92% of trainees agreed that standardized operating procedures for arteriovenous fistula physical examination and ultrasound assessment should be established as soon as possible. Conclusions Notable deficiencies were observed in ultrasound image acquisition, accuracy of physical examination, and proficiency in equipment operation. It is recommended to establish standardized operating procedures promptly, strengthen practical ultrasound training and physical examination education, refine scoring criteria, and unify training materials to improve training quality and assessment uniformity.

Citation： XU Yuankai, ZHANG Lihong, SHI Yaxue, CUI Tianlei, FU Qining, WANG Pei, YE Hong, JIANG Xinxin, JIANG Hua, LI Hua, FU Ping, WANG Yuzhu, JIN Qizhuang, ZUO Li. Analysis of the 2024 practical examination for the Hemodialysis Vascular Access Intervention Technique Specialized Training Program. West China Medical Journal, 2026, 41(7): 1150-1155. doi: 10.7507/1002-0179.202605084 Copy

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1. 中國醫院協會血液凈化中心分會血管通路專業組, 王玉柱, 劉宗旸, 等. 動靜脈內瘺超聲引導經皮腔內血管成形術規范化操作流程專家共識(第 1 版)[J]. 中國血液凈化, 2024, 23(12): 881-890.
2. 陳香美. 血液凈化標準操作規程(2020 版)[M]. 北京: 人民軍醫出版社, 2020: 95-102.
3. Lee T, Roy-Chaudhury P. Advances and new frontiers in the pathophysiology of venous neointimal hyperplasia and dialysis access stenosis[J]. Adv Chronic Kidney Dis, 2009, 16(5):329-338.
4. Munguía MM, Vásquez P, Mattsson E, et al. Acoustical detection of venous stenosis in hemodialysis patients using principal component analysis[C]//2010 Annual International Conference of the IEEE Engineering in Medicine and Biology. Buenos Aires, Argentina, 2010: 3654-3657.
5. 徐元愷, 趙藝欣, 張文云, 等. 自體動靜脈內瘺觸診與血流量的對應關系分析[J]. 中國血液凈化, 2016, 15 (11) : 624-627.
6. 徐元愷, 張文云, 段青青, 等. 吻合口動脈端狹窄致自體動靜脈內瘺早期失功的初步研究[J]. 中國血液凈化, 2016, 15 (9): 494-497.
7. Lok CE, Huber TS, Lee T, et al. KDOQI clinical practice guideline for vascular access: 2019 update[J]. Am J Kidney Dis, 2020, 75 (4 supple 2): S1-S164.
8. 徐元愷, 張麗紅. 自體動靜脈內瘺并發癥的物理檢查應用[J]. 中國血管外科雜志(電子版), 2016, 8(4): 259-261, 266.
9. Schmidli J, Widmer MK, Basile C, et al. Editor's choice-vascular access: 2018 clinical practice guidelines of the European society for vascular surgery (ESVS)[J]. Eur J Vasc Endovasc Surg, 2018, 55(6): 757-818.
10. 金其莊, 王玉柱, 葉朝陽, 等. 中國血液透析用血管通路專家共識(第 2 版)[J]. 中國血液凈化, 2019, 18(6): 365-381.
11. Saran R, Robinson B, Abbott KC, et al. US Renal Data System 2019 Annual Data Report: Epidemiology of Kidney Disease in the United States[J]. Am J Kidney Dis, 2020, 75(1 Suppl 1): A6-A7.
12. 國家腎臟病醫療質量控制中心, 中國腎臟病數據登記系統. 2024 年中國血液透析數據報告[R]. 北京: 國家腎臟病醫療質量控制中心, 2025.
13. Lazcano-Etchebarne C, Aboian E, Strosberg D, et al. Recent innovations and advances in arteriovenous fistula creation: a narrative review[J]. Vasc Investig Ther, 2025, 8(1): 7-17.
14. 梁耀先, 趙新菊, 韋洮. 中國血液透析行業發展調研報告[J]. 中國血液凈化, 2024, 23(5): 321-329.
15. 楊婷, 辛惠君, 劉偉, 等. 非公立血液透析中心醫保支付及成本利潤分析[J]. 中國衛生經濟, 2025, 44(12): 72-77.

West China Medical Journal

Analysis of the 2024 practical examination for the Hemodialysis Vascular Access Intervention Technique Specialized Training Program

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