scholarly journals Assessment of the invisible blood contamination on nurses’ gloved hands during vascular access procedures in a hemodialysis unit

2021 ◽  
Author(s):  
Li Li ◽  
Kaiwen Ni ◽  
Xuewei Du ◽  
Suzhen Wu ◽  
Jianping Zhang ◽  
...  
Keyword(s):  
Vascular Access ◽  
Blood Contamination ◽  
Hemodialysis Unit ◽  
The Invisible

scholarly journals Vascular Access Blood Flow Estimation Based On Standardized Extracorporeal Blood Flow in Hemodialysis Patients

2021 ◽  
Author(s):  
Franklin Geovany Mora-Bravo ◽  
Sonia Catalina Rivera González ◽  
Pamela Tatiana Morales Torres ◽  
Marco Rivera Ullauri
Keyword(s):  
Blood Flow ◽  
Observational Study ◽  
Upper Limb ◽  
Vascular Access ◽  
Hemodialysis Patients ◽  
Arterial Line ◽  
Flow Estimation ◽  
Extracorporeal Blood ◽  
Hemodialysis Unit ◽  
The Right

Abstract Background: Measurement of vascular access flow (Qa) is a recommendation in the care of hemodialysis patients. We developed an observational study to answer the following question: Can access blood flow be estimated?Methods: This observational study was carried out in the hemodialysis unit of the José Carrasco Arteaga Hospital in Cuenca-Ecuador. The sample calculation was 41 cases. Patients older than 17 years with stage 5d chronic renal failure and vascular access with arteriovenous fistula were included. The variables were descriptive of the population: Qa and extracorporeal blood flow (Qb). Qa measurement was performed with the Transonic ® monitor. Qb was measured at dynamic arterial line pressures (DALPs) of -60 mmHg, -100 mmHg, -160 mmHg, and -200 mmHg. The correlation coefficient "r" was obtained between Qa and Qb. SPSS 22.0 was used to analyze the information and perform a linear regression equation to estimate access blood flow (eQa).Results: Fifty-seven patients aged 62.9 ± 12.7 years with 29.4 ± 33 months on hemodialysis were included; 23 women (40.3%) and 45.6% had diabetic nephropathy. Fistulas were seen in 40 cases in the left upper limb (70.2%) and 17 (29.8%) in the right upper limb. The prevalence of aneurysms was 10.5%. The 50th percentile of Qb was 415 mL/min with a DALP of -200 mmHg. The mean access flow was 1516 ± 878 ml/min. The correlation between Qb and Qa was statistically more significant between Qb and DALP of -200 mmHg. The association had a coefficient Rs = 0.643 (IC 0.453 to 0.771) P <0.0001. The estimated access flow eQa = (Qb at DALP of -200 mmHg (mL/min) * 16.63) - 5449.71.Conclusions: It was possible to estimate access blood flow with parameters for easy intradialysis measurements. The equation obtained, if applied to the same patient with the same DALP, could become a useful parameter for monitoring vascular access.Trial registration: ClinicalTrials.gov Identifier: NCT00522704. Registered 14 March 2008, https://clinicaltrials.gov/ct2/show/NCT00522704

Surveillance System of Hemodialysis-Associated Infections in a Pediatric Unit

2012 ◽  
Vol 33 (5) ◽  
pp. 521-523 ◽  
Author(s):  
Carolina Sucupira ◽  
Marcelo Luiz Abramczyk ◽  
João Tomas de Abreu Carvalhaes ◽  
Maria Isabel de Moraes-Pinto
Keyword(s):  
Staphylococcus Aureus ◽  
Disease Control ◽  
Adult Patient ◽  
Vascular Access ◽  
Surveillance System ◽  
Patient Surveys ◽  
Infection Surveillance ◽  
Hemodialysis Unit ◽  
Pediatric Hemodialysis ◽  
Control And Prevention

The bloodstream infection surveillance system proposed by the Centers for Disease Control and Prevention (CDC) was prospectively conducted in a pediatric hemodialysis unit. Thirty patients were included; 73% had a catheter for vascular access at enrollment. Vascular access infection rate was 21.1 per 100 patient-months, well above those observed in adult patient surveys.Staphylococcus aureuswas most frequently isolated (23%).

scholarly journals P1538AN EXPERIENCE OF FORCED SHUTDOWN OF HEMODIALYSIS UNIT IN SOUTHERN INDIA DUE TO FLOODS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Mohammed Shoeb Ahmed Khan ◽  
Ummer Saidali ◽  
Bipi Prasannan ◽  
Vinod Kumar K ◽  
Vishnu Urs ◽  
...  
Keyword(s):  
Vascular Access ◽  
Blood Stream Infection ◽  
Healthcare Services ◽  
Maintenance Hemodialysis ◽  
Indian Government ◽  
Sequence Of Events ◽  
Hemodialysis Unit ◽  
Dialysis Vintage ◽  
Clinical Consequences ◽  
Dialysis Nurses

Abstract Background and Aims The southern state of India, Kerala was hit by the worst flood in the last century on 16.08.18, due to unprecedented monsoon rains. The Indian government had declared it a Level 3 Calamity. According to the Kerala government, over 483 people died, about a million people were evacuated. This paper describes the experience of the Hemodialysis (HD) unit at Aster Medcity, which was forcibly closed due to floods. The Nephrology department does over 1100 dialysis treatments per month and about 60 kidney transplants per year. Aim To study unexpected shutdown of hemodialysis unit and its effect on maintenance hemodialysis patients. Method This is a descriptive study of forced closure of HD unit due to floods. The sequence of events till shut down after the decision of closure has been retrospectively studied by reviewing the minutes of meetings with chief of medical services and memory recall of the Nephrology team involved in the process. Role of HD nurses during the period of flood was also studied. HD patients were interviewed and impact of floods on them was recorded, including, ability to find an alternate HD unit, any missed HD sessions, access to medicines and admissions in hospital. The characteristics of HD patients was recorded. After reopening of our HD unit, 30days assessment was done for clinical consequences including, hospitalization, infections, vascular access problems and seroconversion. Results The services of HD unit were suspended from midnight 17.08.18 to 27.08.18. The HD unit is at the ground floor of the hospital. The HD unit has 13 HD machines, which were used for 77 maintenance HD patients (Males: 55; Females: 22). The mean age was 61 ±14 years and the median dialysis vintage was 2 years. Vascular access was a catheter (tunnelled and non-tunnelled) in 19 patients, arterio-venous fistula in 57 patients and arterio-venous graft in 1 patient. Patients known to have Diabetes were 77.7%, Hypertension 91%, Coronary artery disease were 26 in number and chronic liver disease were 5. Hospital authorities decided to evacuate the hospital 24 hours before the floods hit the hospital premises. The Nephrology team comprised of 4 consultants, 6 residents, 33 dialysis nurses and technicians and a social worker. The HD unit was closed after draining the reverse osmosis (RO) plant at 10pm on 16.08.18. The lead consultant contacted potentially safe HD units in other parts of the state; willingness for accepting HD patients and the surge capacity of each HD unit was recorded. The HD patients were informed over telephone the centers they can approach and HD summary (includes diagnosis and HD details) was sent to them via e-mail. All HD patients were reminded to comply with diet restrictions and inform the shelter camp regarding the same. Accordingly, 77 HD patients were accommodated in 25 HD units. 12 dialysis nurses provided their services voluntarily at other HD units unaffected by floods. 15 HD patients were displaced from their homes due to floods. 19 HD patients missed one HD session; 5 HD patients missed two HD sessions; 1 patient missed three HD sessions. Our HD unit reopened on 27.08.18 after complete disinfection of the RO plant and servicing of HD machines by the manufacturer. All patients returned to our HD unit. In the first 30 days after floods, 3 patients were admitted to intensive care unit with fluid overload, 3 patients were admitted with respiratory tract infection, 2 patients had an AV fistula dysfunction, 3 patients developed catheter related blood stream infection. There was no seroconversion. There was no mortality in HD patients during and one month after flood. Conclusion The timely decision to suspend dialysis services played a crucial role in preparing for HD unit closure, arranging alternate HD places for patients and providing treatment summaries. However, the increase in adverse clinical consequences heralds the drop in the quality of healthcare services during natural disasters.

scholarly journals P1562IMPLEMENTATION FOR INTEGRATED PROGRAM OF HEMODIALYSIS VASCULAR ACCESS PUNCTURE TRAINING AND AN ALARM SYSTEM MAY REDUCE THE INCIDENT OF VENOUS NEEDLE DISLODGMENT AND BLEEDING

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Chi-Yang Hsin ◽  
HsuanMing Lin ◽  
KuanYu Chen ◽  
YuChih Lin ◽  
HsiangWei Hu
Keyword(s):  
Incidence Rate ◽  
Vascular Access ◽  
Large Scale ◽  
Control Period ◽  
Care Program ◽  
Alarm System ◽  
Home Dialysis ◽  
Control Phase ◽  
Hemodialysis Unit ◽  
Integrated Program

Abstract Background and Aims A puncture of vascular access is commonly used in clinical treatment, such as hemodialysis or central venous catheters. At this time, leakage or infection associated with Venous needle dislodgement(VND) is a high risk of fatality, especially for patients with restlessness, impaired cognition, isolation, or home dialysis. In general dialysis procedures, medical personnel relies on patient reports and caregivers to manually inspect the site of dialysis puncture and detect the occurrence of needle removal and blood transfusion. There are some devices for detecting the presence of needle dislodgement in the market. Still, there are no large-scale reports for the integrated program for nursing training and device implantation. This study aims to conduct a program for an integrated training course and the VND device and hopes to reduce the incidence of needle removal and blood leakage. Method This study was divided into two phases, the control phase, and the study period. In the first phase, the abnormal events of ou venous needle dislodgement and blood leakage was recorded in the hemodialysis unit room during the first three months. Before the study period, we introduced an integrated program, including the standard process of fistula puncture, care during hemodialysis, an inspection of the venous puncture site, and an alarm system. In the study period, we also conducted the standard program and collected the data of the events of venous dislodgement or bleeding. Results The control phase was conducted during the three months from July 2019 to September 2019, and the study period was performed in November 2019. A total of 62 patients completed the study. During the control period, there were a total of 2087 dialysis treatments, of which 30 patients had venous needle dislodgement or bleeding. There were a total of 70 events of venous needle dislodgement or bleeding occurred, and the incidence rate was 3.3 events per 100 sessions. After the conduction of the integrated program and implantation of the alarm system in November 2019, there were a total of 682 dialysis sessions, and 15 events of venous needle dislodgement or bleeding occurred. The incidence rate was 2.2 events per 100 courses. Conclusion This study introduced venous needle dislodgement or bleeding alarm system in the hemodialysis unit. Compared with the traditional method, after the integrated care program, including fistula puncture, care, inspection, introduction, and use of the alarm system, venous needle dislodgement or bleeding dropped from 3.3 to 2.2 per 100 sessions. Therefore, through standardized training and program, it may be related to the decrease in the incidence of venous needle dislodgement or bleeding. This training mode can be worth promoting to more dialysis units to improve the quality of patient care. More follow-up studies are needed to provide multiple evidence.

The Invisible Exit Sign

2006 ◽  
Vol 37 (2) ◽  
pp. 14
Author(s):  
ALAN ROCKOFF
Keyword(s):  
The Invisible

Pseudoaneurysm of the brachial artey in two infants following accidental artertial puncture

VASA ◽  
2005 ◽  
Vol 34 (3) ◽  
pp. 198-200 ◽  
Author(s):  
Yilmaz ◽  
Dogan ◽  
Tok ◽  
Hazirolan ◽  
Guvener ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Vascular Access ◽  
Brachial Artery ◽  
Fibrous Tissue ◽  
Arterial Puncture ◽  
Artery Pseudoaneurysm

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.

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

VASA ◽  
2011 ◽  
Vol 40 (3) ◽  
pp. 188-198 ◽  
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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