الفهرس 
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Abstract
End stage renal disease (ESRD) is the complete failure of the kidneys to function. The kidneys can no longer able to perform its functions such as removing wastes, concentrate urine and regulate electrolytes.
Patients with end stage renal disease (ESRD) undergoes complex treatment regimen. Including a wide range of dietary restrictions, medications and renal replacement therapy (RRT) i.e. hemodialysis (HD), peritoneal dialysis (PD) and kidney transplantation which is an effective life saving and life sustaining treatment. Hemodialysis is the preferred modality in most countries. The corner stone of hemodialysis is asset of operation known as dialysis access surgery including hemodialysis catheter procedure, arteriovenous bridge graft and arteriovenous fistula which is commonly used.
Arteriovenous fistulae are usually subjected to many complications such as thrombosis, stenosis, and infection. Arteriovenous fistula requires specialized nursing care, the focus of which should include assessing the access for patency, pain, signs of infection, tissue trauma or edema and bleeding. The nurse will also work with the patient to ensure that he can monitor the vascular access thoroughly and independently.
This study was carried out to evaluate the effect of implementing a protocol of postoperative arteriovenous fistula care on the clinical outcomes of patients with end stage renal disease
Material and method:-
The present study was conducted in hemodialysis unit and in surgical departments of Gamal Abdel Naser Health Insurance Hospital in Alexandria, Egypt. The sample comprised sixty adult patients with end stage renal diseases who were free from comorbid conditions and had arteriovenous fistula for the first time. Two tools were used for data collection, Tool one: Arteriovenous fistula assessment sheet which comprised four parts (1) Sociodemographic data (2) Assessment of the arteriovenous fistula (3) Assessment of range of motion in elbow joint (4) Color doppler examination of the arteriovenous fistula. Tool II comprised two parts (1) Arteriovenous fistula clinical outcomes check list (2) Arteriovenous fistula photographic pictures
Assessment of the arteriovenous fistula was done for both groups on the 1st postoperative day, and then on 3rd postoperative day, and then on 7th postoperative day, and then after complete maturation of the fistula approximately one month using the arteriovenous fistula assessment sheet. On the 3rd postoperative day the protocol of care of the arteriovenous fistula was started, and applied for the study group (group I) only (including fistula arm active exercises 15 min 3 times /day after suture removal (after ten days) and before the dialysis session till complete fistula maturation and teaching on how to maintain AVF and avoid its complications). Evaluation of the arteriovenous fistula was done for the two groups using the arteriovenous fistula clinical outcomes check list (tool II).