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.

scholarly journals Preservation of vascular access.

1993 ◽  
Vol 4 (4) ◽  
pp. 997-1003
Author(s):  
J L Porile ◽  
M Richter
Keyword(s):  
Vascular Access ◽  
Venous Pressure ◽  
Graft Loss ◽  
Laboratory Evaluation ◽  
Dialysis Access ◽  
New Techniques ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Access Problems

Preservation of vascular access is critical in the long-term successful management of hemodialysis patients. Dialysis access abnormalities are the most common cause of hospitalization in this patient group, and access problems can increase the morbidity and cost involved in the care of these patients. Native fistulas are preferable to synthetic grafts because of longer survival and a lower complication rate. Venous outflow stenosis is the most common site of obstruction in a failing graft. The pathophysiology of access failure is poorly understood, but it seems to be related to intimal hyperplasia in the native vessel downstream from the anastomosis. The stimulation of local growth factors by needle puncture may also play a role. An assessment of access adequacy includes careful physical examination, laboratory evaluation, and ultimately, angiography. Measurements of recirculation and venous pressure are commonly used to screen for access dysfunction, and their appropriate use will lower the incidence of graft loss in dialysis units. Treatment is usually either angioplasty or surgery, with some centers having success with thrombolytic therapy. New techniques such as atherectomy and stent placement may prove to be beneficial, but this requires further study.

KHA-CARI Guideline: Vascular access - central venous catheters, arteriovenous fistulae and arteriovenous grafts

Nephrology ◽  
2013 ◽  
Vol 18 (11) ◽  
pp. 701-705 ◽  
Author(s):  
Kevan R Polkinghorne ◽  
George K Chin ◽  
Rob J MacGinley ◽  
Andrew R Owen ◽  
Christine Russell ◽  
...  
Keyword(s):  
Vascular Access ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Arteriovenous Fistulae ◽  
Arteriovenous Grafts

Retrospective Analysis of Catheter-Related Infections in a Hemodialysis Unit

2006 ◽  
Vol 27 (9) ◽  
pp. 969-973 ◽  
Author(s):  
Linda A. Colville ◽  
Andy H. Lee
Keyword(s):  
Retrospective Analysis ◽  
Infection Rate ◽  
Vascular Access ◽  
Bloodstream Infections ◽  
Incidence Rates ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Arteriovenous Fistulae ◽  
Access Methods ◽  
Arteriovenous Grafts

Objective.To compare the incidence rates of catheter-related bloodstream infection associated with different vascular access methods in patients receiving hemodialysis.Setting.Tertiary care public hospital in Western Australia.Design.Retrospective analysis of surveillance data collected by the hospital's infection control department.Methods.The number of confirmed bloodstream infections for each type of vascular access was identified for the period from July 2002 through June 2003. The corresponding number of patient-days was determined to calculate the infection incidence rates. The serially correlated data were then analyzed using Poisson generalized estimating equations.Results.A total of 32 confirmed bloodstream infections were identified. Infection rates, in number of infections per 1,000 patient-days, were as follows: 0.4 for native arteriovenous fistulae; 2.86 for synthetic arteriovenous grafts; 4.02 for permanent, tunneled, cuffed central venous catheters; and 20.2 for temporary, nontunneled, noncuffed central venous catheters. Compared with permanent catheters, the monthly infection rate associated with the temporary catheters was significantly higher (incident rate ratio [IRR], 5.025 [95% confidence interval {CI}, 1.532-16.484]; P = .008) and that of arteriovenous fistulae was significantly lower (IRR, 0.099 [95% CI, 0.030-0.324]; P = .001). The monthly infection rate for arteriovenous grafts was not significantly different from that for permanent central venous catheters (IRR, 0.702 [95% CI, 0.246-2.008]; P = .510).Conclusions.A hierarchy of infection risk associated with vascular access type is evident. Native arteriovenous fistulae should be recommended for all patients receiving chronic hemodialysis, to minimize infection.

Brachio-azygos transthoracic arteriovenous grafts for hemodialysis patients with bilateral central venous obstruction: A small case series

2021 ◽  
pp. 112972982110585
Author(s):  
Dan Song ◽  
Young Woo Park
Keyword(s):  
Lower Extremity ◽  
Vascular Access ◽  
Median Sternotomy ◽  
Case Series ◽  
Hemodialysis Patients ◽  
Arteriovenous Graft ◽  
Venous Obstruction ◽  
Central Venous ◽  
Arteriovenous Grafts ◽  
Central Venous Obstruction

Background: It is difficult to find a reliable outflow vein for vascular access in hemodialysis patients with bilateral central venous obstruction. The lower extremity veins are currently used as the most common alternative veins to make a new vascular access. However, in patients not amenable to make lower extremity access, intrathoracic vein should be considered as an outflow vein, but there are limitations in its use due to postoperative complications. Methods: We introduce a series of cases that underwent arteriovenous graft operation using an intrathoracic vein, the azygos arch, as an outflow vein. Brachio-azygos transthoracic arteriovenous graft is a surgical procedure that anastomoses the azygos arch and the brachial artery with 7 mm ringed polytetrafluoroethylene graft via lateral thoracotomy without median sternotomy. Results: The chest tubes of the patients were removed on the third postoperative day and they discharged within a week. About 1 month later, hemodialysis was initiated through the BATAVG, and it has been used without access dysfunction. Conclusion: Brachio-azygos transthoracic arteriovenous grafts were performed using the azygos arches without major complications. The azygos arch can be a good alternative outflow vein to make a new vascular access for hemodialysis patients with bilateral central venous obstruction.

Therapeutic Plasma Exchange Application in Children Requires Individual Decision

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.

ADMINISTRATION MODELS IN THE SYSTEM OF FORENSIC EXAMINATION INSTITUTIONS FROM THE POSITION OF SCIENTIFIC MANAGEMENT

2016 ◽  
Vol 16 ◽  
pp. 179-184
Author(s):  
S. V. Kudryashova
Keyword(s):  
Scientific Management ◽  
Competing Values ◽  
State Institutions ◽  
Advantages And Disadvantages ◽  
Forensic Examination ◽  
Forensic Institutions ◽  
The Individual

The individual forensic activity in comparison with the activity of forensic experts of specialized state institutions is considered, the main advantages and disadvantages are determined. The directions of development of specialized state and non-state forensic institutions are presented in accordance with R. Quinn's competing values model.

Wykorzystanie mediów społecznościowych w komunikacji z klientem na przykładzie firm sektora piwowarskiego

2015 ◽  
pp. 161-176 ◽  
Author(s):  
Piotr Szamrowski ◽  
Adam Pawlewicz
Keyword(s):  
Social Media ◽  
Public Relations ◽  
Small Enterprises ◽  
Brewing Industry ◽  
Video Sharing ◽  
Advantages And Disadvantages ◽  
Media Platform ◽  
The Individual ◽  
Media Channels ◽  
Regional Character

The main objective of this paper is to identify the platforms and social media tools utilized by the brewing industry in communication with the stakeholders, mainly with potential clients. In addition, the study sought to determine the nature of the published content, identify those responsible for their management, and present the advantages and disadvantages of their conduct in communication and creating the image of the company. The results indicate that only 25% of the surveyed companies do not use social media in PR. This applies only to small enterprises, with regional character. All the major brewing companies in their public relations activities use at least one type of social media, focusing in most cases on social networking (Facebook) and Video Sharing (YouTube). In addition, some of the largest brands included in the individual equity groups have their own social media channels used to communicate with the stakeholders. General promotion of company products and, what is very important, creating a dialogue with social media platform community, were seen as the most important benefits of using social media.

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