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. At present, a few studies believe that many risk factors are associated with venous needle dislodgment and bleeding, including difficult needle fixation, restlessness, unconsciousness, or abnormal movement. However, only a few studies are focusing on patient disease, medication, and other risk assessments. Therefore, this study aims to explore the risk factors of patients with venous needle dislodgment and bleeding and hope to establish the risk classification.
Method
This study was a prospective study conducted in the hemodialysis room of Tainan Regional Hospital. Before starting to collect the venous needle dislodgment and bleeding data, we performed a training program for medical and nursing staff, including venous puncture, fixation, puncture site assessment, and management. During the three months from July 2019 to 2019/9, we collected clinical data were collected, including patient sex, gender, diseases, records of dialysis access blockage, anticoagulant dose, and a high-risk assessment record (eight risk factors). Finally, we analyzed the data and compared the data between the two groups of patients who experienced needle dislodgement and bleeding. We applied statistical software STATA, chi_square, z-test. P<0.05 was defined as significant.
Results
Seventy patients were included in this study, with an average age of 63.23 (± 1.2 years) and 45 males (64.28%). In 2019 / 7-9, there were a total of 32 patients with 72 venous needle dislodgment and bleeding. The patients with the condition as below were considered high-risk patients. In terms of gender, whether it is a high risk, diabetes, high blood pressure, whether to use sleeping pills, diabetic hypotension, whether to use warfarin or to use anticoagulant doses are all not statistically significant. The proportion of patients with vascular-access and undergoing percutaneous transluminal angioplasty was 35.2% (11) in high-risk patients and 10.3% (4) in low-risk patients, p <0.01.
Conclusion
Before data collection in this study, a standardized training program was performed for medical care and vascular access monitoring. However, there were no new risk factors were found. This research model can provide a new direction for further research.
Serum levels of proANP and albumin are independent predictors of mortality in the high-risk patients (elderly and diabetics) treated by haemodialysis (HD) and continuous peritoneal dialysis in 4-year prospective observation
