Vascular Access | ScienceGate

A pseudoaneurysm is defined as an aneurysmatic sac surrounded by fibrous tissue instead of other vascular layers such as the muscular one. It is a rare incident in infants especially in the brachial artery. Blunt trauma and vascular access attempts are the most common etiologic factors. We present two infants with brachial artery pseudoaneurysm in the antecubital region following accidental arterial puncture.

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Multidisciplinary management of vascular access for haemodialysis: from the preparation of the initial access to the treatment of stenosis and thrombosis

VASA ◽

10.1024/0301-1526/a000093 ◽

2011 ◽

Vol 40 (3) ◽

pp. 188-198 ◽

Cited By ~ 19

Author(s):

Reinhold ◽

Haage ◽

Hollenbeck ◽

Mickley ◽

Ranft

Keyword(s):

Vascular Access ◽

Central Venous ◽

Advantages And Disadvantages ◽

Multidisciplinary Study ◽

First Results ◽

Lower Complication ◽

Lower Complication Rate ◽

Access Problems ◽

Arteriovenous Grafts ◽

The Individual

In February 2008 a multidisciplinary study group was established in Germany to improve the treatment of patients with potential vascular access problems. As one of the first results of their work interdisciplinary recommendations for the management of vascular access were provided, from the creation of the initial access to the treatment of complications. As a rule the wrist arteriovenous fistula (AVF) is the access of choice due to its lower complication rate when compared to other types of access. The AVF should be created 3 months prior to the expected start of haemodialysis to allow for sufficient maturation. Second and third choice accesses are arteriovenous grafts (AVG) and central venous catheters (CVC). Ultrasound is a reliable tool for vessel selection before access creation, and also for the diagnosis of complications in AVF and grafts. Access stenosis and thrombosis can be treated surgically and interventionally. The comparison of both methods reveals advantages and disadvantages for each. The therapeutic decision should be based on the individual patients constitution, and also on the availability and experience of the involved specialists.

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Impact of an educative program on dialysis patients’ knowledge and mental health: controlled before and after program

Education thérapeutique du patient - Therapeutic patient education ◽

10.1051/tpe/2018015 ◽

2018 ◽

Vol 10 (2) ◽

pp. 20204

Author(s):

Laetitia Idier ◽

Aurélie Untas ◽

Nicole Rascle ◽

Michèle Koleck ◽

Maider Aguirrezabal ◽

...

Keyword(s):

Mental Health ◽

Depressive Symptoms ◽

Vascular Access ◽

Educational Program ◽

Psychological State ◽

Control Group ◽

Dialysis Patients ◽

Emotional Change ◽

The Impact ◽

Experimental Group

Introduction:Psychological impact of Therapeutic Patient Education (TPE) for dialysis patients is rarely evaluated since the focus of many studies is on medical variables (i.e., adherence).Objectives:The aims of this study were: 1) to estimate the impact of a TPE program on knowledge, depression and anxiety, 2) to examine change in knowledge as a mediator of the effects of a TPE program on mental health.Method:This study was conducted in three hemodialysis units and comprised two groups: an experimental group with education and a control group with routine care. The program was based of 5 educative sessions. Knowledge, depressive and anxious symptoms were assessed with self-reported outcomes measured before and 3 months after the program.Results:The sample comprised 125 patients. Knowledge about vascular access and nutrition (p < 0.01) and depressive symptoms increased in the experimental group (p < 0.01). Analysis of mediation showed that changes in knowledge about vascular access were a significant mediator of the effects of the program on depressive symptoms (F = 4.90;p = 0.01).Discussion:Knowledge acquired during an educational program could lead to an emotional change. Improving knowledge often leads to an awareness of the risks that can modify the psychological state of patients by reminding them of their vulnerability. This study shows that it is required to be attentive to the way of transmitting knowledge. It’s necessary adapting this transmission to the needs of patients and promoting the acquisition of psychosocial competence too.Conclusion:This study shows that knowledge acquired during an educational program can lead to an emotional change in the short term. A long-term follow-up of the population should be interesting to observe these emotional effects.

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Therapeutic Plasma Exchange Application in Children Requires Individual Decision

Journal of Pediatric Intensive Care ◽

10.1055/s-0040-1714098 ◽

2020 ◽

Author(s):

Gürkan Atay ◽

Demet Demirkol

Keyword(s):

Plasma Exchange ◽

Vascular Access ◽

Pediatric Patients ◽

Demyelinating Disease ◽

Pediatric Intensive Care ◽

Therapeutic Plasma Exchange ◽

Transplantation Rejection ◽

Access Problems ◽

Uremic Syndrome

AbstractTherapeutic plasma exchange (TPE) is a treatment administered with the aim of removing a pathogenic material or compound causing morbidity in a variety of neurologic, hematologic, renal, and autoimmune diseases. In this study, we aimed to assess the indications, efficacy, reliability, complications, and treatment response of pediatric patients for TPE. This retrospective study analyzed data from 39 patients aged from 0 to 18 years who underwent a total of 172 TPE sessions from January 2015 to April 2018 in a tertiary pediatric intensive care unit. Indications for TPE were, in order of frequency, macrophage activation syndrome (28.2%, n = 11), renal transplantation rejection (15.4%, n = 6), liver failure (15.4%, n = 6), Guillain–Barre's syndrome (15%, n = 6), hemolytic uremic syndrome (7.7%, n = 3), acute demyelinating disease (7.7%, n = 3), septic shock (5.1%, n = 2), and intoxication (5.1%, n = 2). No patient had any adverse event related to the TPE during the procedure. The TPE session was ended prematurely in one patient due to insufficient vascular access and lack of blood flow (2.6%). In the long term, thrombosis due to the indwelling central catheter occurred (5.1%, n = 2). TPE appears to be an effective first-stage or supplementary treatment in a variety of diseases, may be safely used in pediatric patients, and there are significant findings that its area of use will increase. In experienced hands and when assessed carefully, it appears that the rate of adverse reactions and vascular access problems may be low enough to be negligible.

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