Intra-access Pressure: Do We Really Need to Know? A Critical Review

2021 ◽  
Vol 4 (1) ◽  
pp. 189-192
Author(s):  
Abaid ur Rehman ◽  
Salman Imtiaz
Keyword(s):  
Early Detection ◽  
Diagnostic Accuracy ◽  
Vascular Access ◽  
Venous Catheter ◽  
Quick Method ◽  
Av Fistula ◽  
Simple Tool ◽  
Monitoring And Surveillance ◽  
Access Complications ◽  
Av Graft

  Arteriovenous (AV) fistula and AV graft are considered superior to venous catheter access, remarkable success has been achieved in increasing prevalence of AV fistula. However, vascular access complications are common and result in increased hospitalization, mortality and expense. Guidelines suggest various methods to maintain patency of vascular access. Amongst these various methods used for vascular access monitoring and surveillance, intra-access pressure (PIA) is a simple tool which can be helpful in early detection and management of stenosis in vascular access. Intra-access pressure, although a very simple and quick method of vascular access evaluation, has a low diagnostic accuracy in prediction of vascular access stenosis as compared to other methods of access surveillance. We discuss here the physiology, methodology and the utility of intra-access pressure.

scholarly journals Vascular Access, Complications and Survival in Incident Hemodialysis Patients

2021 ◽  
Vol 1 (2) ◽  
pp. 88-99
Author(s):  
Massimo Torreggiani ◽  
Lucia Bernasconi ◽  
Marco Colucci ◽  
Simone Accarino ◽  
Ettore Pasquinucci ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Central Venous Catheter ◽  
Vascular Access ◽  
Hospital Admissions ◽  
Patient Survival ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
Central Venous ◽  
Risk Of Death ◽  
Access Complications

The arteriovenous fistula (AVF) has long been considered the optimal vascular access. However, the evolving characteristics of the ageing dialysis population limit the creation of an AVF in all patients. Thus, more patients start hemodialysis (HD) with a central venous catheter (CVC) rather than an AVF, and the supremacy of the AVF has recently been questioned. The aim of this study was to analyze the incidence and rate of access complications in 100 patients between 2010 and 2015. A total of 63 patients started HD with an AVF, while 37 began HD with a CVC. We found no differences in patient survival according to the vascular access in use at the beginning of dialysis, but patients were more likely to die while undergoing dialysis by means of a CVC than an AVF. Patients started on dialysis with a CVC had more cardiovascular disease, while patients who began dialysis with an AVF presented more hypertension. Fistulas presented a longer survival time despite more hospital admissions, but CVCs bore a higher risk of infections. Our results suggest that starting dialysis with a CVC does not confer a greater risk of death.

Vascular Calcification Markers and Hemodialysis Vascular Access Complications

2018 ◽  
Vol 48 (5) ◽  
pp. 330-338 ◽  
Author(s):  
Beini Lyu ◽  
Tanushree Banerjee ◽  
Julia J. Scialla ◽  
Tariq Shafi ◽  
Alexander S. Yevzlin ◽  
...  
Keyword(s):  
Vascular Calcification ◽  
Vascular Access ◽  
Hemodialysis Patients ◽  
Fetuin A ◽  
Av Fistula ◽  
Morphogenetic Protein ◽  
Disease Study ◽  
Stage Renal Disease ◽  
End Stage ◽  
Access Complications

Background: Arteriovenous (AV) access dysfunction is a common complication in hemodialysis patients. Markers of vascular calcification are associated with cardiovascular outcomes and mortality in this population, but their association with vascular access outcomes is unknown. In this study, we aimed to evaluate the association between selected vascular calcification makers and vascular access complications in a cohort of hemodialysis patients. Method: Fetuin-A, osteopontin (OPN), osteoprotegerin (OPG), and bone morphogenetic protein-7 (BMP-7) were measured in blood samples from 219 dialysis patients in the Choice for Healthy Outcomes in Caring for end-stage renal disease study; these patients were using a permanent vascular access. Participants were followed for up to 1 year or until the occurrence of a vascular access intervention or replacement. Associations with AV fistula (AVF) and AV graft (AVG) intervention-free survival were assessed in models adjusted for demographic characteristics, comorbidities, and inflammation. Results: A total of 24 out 103 participants with an AVF and 43 out of 116 participants with an AVG had an intervention during follow-up. Lower fetuin-A, higher OPN, and higher BMP-7 were associated with a higher risk of AVF intervention (adjusted hazard ratios [aHR] for highest versus lowest tertile = 0.30 [95% CI 0.10–0.94]) for fetuin-A, 3.84 (95% CI 1.16–12.74) for OPN, and 3.49 (95% CI 1.16–10.52) for BMP-7. OPG was not significantly associated with the risk of AVF intervention. The associations of OPN and BMP-7 with AVF intervention appeared stronger among participants without diabetes (aHR 8.06; 95% CI 1.11–58.57 for OPN and aHR 2.55; 95% CI 1.08–6.08 for BMP-7, respectively) than among their counterparts with diabetes (p interaction = 0.06). None of the markers studied were significantly associated with AVG interventions. Conclusion: Lower fetuin-A and higher OPN and BMP-7 are associated with complications in AVF but not in AVG, suggesting a role for calcification in the pathogenesis AVF failure.

Impact of a trained vascular access coordinator on a vascular access program in India

2021 ◽  
pp. 112972982110016
Author(s):  
Ekta Pundir ◽  
Ashish Sharma ◽  
Sarbpreet Singh ◽  
Shivakumar Patil ◽  
Gaurav Shankar Pandey ◽  
...  
Keyword(s):  
Early Detection ◽  
Vascular Access ◽  
Steady Increase ◽  
Secondary Patency ◽  
Operation Theatre ◽  
Av Fistula ◽  
Av Fistulas ◽  
The Impact ◽  
Access Program

Background: Native AV fistulas are the ideal access for hemodialysis but require monitoring and multiple interventions in some patients to keep them functioning. The aim of the study was to assess the impact of the appointment of a trained vascular access coordinator (VAC) for fistula monitoring, on the evolution of the vascular access program at our institute. Method: Data was retrieved from the departmental database for the baseline year 2014 and compared with the data from 2018. Initial review showed that appointment of the VAC in 2015 resulted in a steady increase in the number of AV fistula interventions over 2 years to a plateau in 2018 which was chosen as the comparison year. The number of AVF’s created, number of salvage procedures performed, and follow-up data were compared. Other parameters like number of operation theatre hours, surgeons, and nursing staff remained constant during this period. Result: Total numbers of AVFs increased from 511 to 713 (39.3%). The number of follow-up visits to surgeons reduced from an average of 4–0.25 visits per patient during this period. Follow up Doppler examinations increased from 761 to 1296 (70%) indicating improved follow up. The salvage procedures increased from 44 to 161 (272%) with early detection of fistula dysfunction. Primary and secondary patency rates of 86% and 92% at 3 months could be achieved whereas limited follow-up data was available for 2014. Conclusion: Appointment of trained VAC increased the number of vascular access procedures, improved follow-up care, and led to early detection and intervention for access dysfunction while reducing the workload of surgeons.

scholarly journals Vascular Access Profile of End Stage Renal Disease Patients on Maintenance Hemodialysis: Experience from a Tertiary Care Center of Bangladesh

2019 ◽  
Vol 7 (1) ◽  
pp. 26-28
Author(s):  
Md Mostarshid Billah ◽  
Md Anisur Rahman ◽  
Muhammad Abdur Rahim ◽  
Tufayel Ahmed Chowdhury ◽  
Md Abdul Latif ◽  
...  
Keyword(s):  
Vascular Access ◽  
Care Center ◽  
Tertiary Care ◽  
Study Participant ◽  
Venous Catheter ◽  
Maintenance Hemodialysis ◽  
Care Hospital ◽  
Cross Sectional ◽  
Femoral Catheter ◽  
Av Fistula

Background: A well-functioning vascular access (VA) is essential to provide efficient hemodialysis (HD) therapy. There are 3 main types of access: arterio-venous fistula (AVF), arterio-venous graft (AVG) and central venous catheter (temporary or permanent). The aim of our study was to find vascular access profile of ESRD patients on maintenance hemodialysis in a tertiary care hospital. Methods: This cross-sectional study was carried out in the Department of Nephrology and Dialysis of BIRDEM General Hospital, Dhaka, Bangladesh from November to December, 2015. After taking informed consent from the patients, data were collected from face to face interview and record books of the patients. Results: Total patients were 107, male were 78 (72.9 %) and female were 29 (27.1%). The mean age was 57.3 ± 11.4 (range 32-80) years. Mean duration of CKD was found 5.7 ± 4.2 (range 1-20) years. Maximum dialysis duration was 6.5 years with mean of 1.7 ± 1.3 years. Near two-thirds (68.2%) of the patients were on thrice-weekly dialysis and one-third (31.8%) were on twice-weekly dialysis. The vascular access at initiation of dialysis was temporary catheter in majority (91.6%) of study participant and AV fistula in 8.4% cases. Of temporary catheter one-third (33.7%) were temporary jugular catheter and two-third (66.3%) were temporary femoral catheter. Among jugular catheter 9.1% were left sided catheter and rest (90.9%) were right sided catheter. Among the femoral catheter 70.8% and 29.2% were right and left side respectively. The current vascular access was AV fistula in 90.7%, temporary catheters 4.7%, permanent catheter 3.7% and AVG 0.9% in study patients. Of AVF near one third (29.9%) were radio-cephalic and 70.1% were brachial (62.6% brachio-cephalic, 7.5% brachio-basilic) fistulas. About seventeen percent (16.8%) patients had AVF failure. Conclusion: Temporary dialysis catheters were the most common initial vascular access. Less than one-tenth patients started dialysis with AV fistula. More than two-thirds patients were on thrice weekly dialysis. AV fistula was the most common current vascular access with very small number of permanent catheter and AV graft. Bangladesh Crit Care J March 2019; 7(1): 26-28

QUALITY OF LIFE OF PATIENTS ON HEMODIALYSIS (RESULTS OF OWN RESEARCH AND FOREIGN EXPERIENCE)

2021 ◽  
pp. 47-55
Author(s):  
LIDIYA N. SHTYPINA ◽  
MARINA A. SHAPOVALOVA ◽  
SERGEY N. SIMONOV ◽  
ALEXANDER V. BARANOV
Keyword(s):  
Quality Of Life ◽  
Vascular Access ◽  
Short Form ◽  
Economic Status ◽  
Venous Catheter ◽  
Life Assessment ◽  
Main Diagnosis ◽  
Av Fistula ◽  
Socio Economic Status

The purpose of this research was to study the quality of life of patients on hemodialysis. At the same time, both own data and data from literary sources and electronic resources were used. Quality of life assessment is an important element of health assessment and helps to suggest appropriate measures that need to be taken to improve the quality of life of patients with end-stage renal failure. Own data were collected in one of the hemodialysis centers of Tambov in 2020. To assess the quality of life, we have adapted the assessment questionnaire WHOQOL-BREF (short form WHO-100), which is used worldwide. It included information on socio-demographic characteristics, the main diagnosis, concomitant diseases, the type of vascular access, the duration of hemodialysis, and the serological status of hepatitis. Patients ( n = 138) were divided into 3 subgroups according to the duration of dialysis: 1 year, 2 years, and 3 years. The socio-economic status of the participating patients was divided into categories of upper, middle, and low socio-economic status, depending on income, level of education, and type of employment. The results of this research indicate that the quality of life of patients on hemodialysis is significantly reduced. Such determinants as age, longer duration of dialysis, diabetes, and hypertension, central venous catheter as vascular access for dialysis, lower socio-economic status and a positive result of a serological study of hepatitis are all statistically significant factors that negatively affect the quality of life. Some of these factors can be controlled, leveled, or compensated for. Therefore, in order to improve the quality of life of hemodialysis patients, it is necessary to strive for better control of diabetes and hypertension, encourage the use of an AV fistula rather than a central catheter, and improve infection control for hepatitis viruses.

AV Fistula Rates: Changing the Culture of Vascular Access

2005 ◽  
Vol 6 (1) ◽  
pp. 13-17 ◽  
Author(s):  
R.L. Mcgill ◽  
R.J. Marcus ◽  
D.A. Healy ◽  
D.J. Brouwer ◽  
B.C. Smith ◽  
...  
Keyword(s):  
Vascular Access ◽  
Av Fistula

scholarly journals Emergency Department Visits During Outpatient Parenteral Antimicrobial Therapy: A Cohort Study

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S333-S334
Author(s):  
So Lim Kim ◽  
Angela Everett ◽  
Susan J Rehm ◽  
Steven Gordon ◽  
Nabin Shrestha
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Hospital Admission ◽  
Vascular Access ◽  
Antimicrobial Therapy ◽  
Cleveland Clinic ◽  
Emergency Department Visits ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Ed Visits ◽  
Access Complications

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) carries risk of vascular access complications, antimicrobial adverse effects, and worsening of infection. Both OPAT-related and unrelated events may lead to emergency department (ED) visits. The purpose of this study was to describe adverse events that result in ED visits and risk factors associated with ED visits during OPAT. Methods OPAT courses between January 1, 2013 and December 31, 2016 at Cleveland Clinic were identified from the institution’s OPAT registry. ED visits within 30 days of OPAT initiation were reviewed. Reasons and potential risk factors for ED visits were sought in the medical record. Results Among 11,440 OPAT courses during the study period, 603 (5%) were associated with 1 or more ED visits within 30 days of OPAT initiation. Mean patient age was 58 years and 57% were males. 379 ED visits (49%) were OPAT-related; the most common visit reason was vascular access complication, which occurred in 211 (56%) of OPAT-related ED visits. The most common vascular access complications were occlusion and dislodgement, which occurred in 99 and 34 patients (47% and 16% of vascular access complications, respectively). In a multivariable logistic regression model, at least one prior ED visit in the preceding year (prior ED visit) was most strongly associated with one or more ED visits during an OPAT course (OR 2.96, 95% CI 2.38 – 3.71, p-value < 0.001). Other significant factors were younger age (p 0.01), female sex (p 0.01), home county residence (P < 0.001), and having a PICC (p 0.05). 549 ED visits (71%) resulted in discharge from the ED within 24 hours, 18 (2%) left against medical advice, 46 (6%) were observed up to 24 hours, and 150 ED visits (20%) led to hospital admission. Prior ED visit was not associated with hospital admission among patients who visited the ED during OPAT. Conclusion OPAT-related ED visits are most often due to vascular access complications, especially line occlusions. Patients with a prior ED visit in the preceding year have a 3-fold higher odds of at least one ED visit during OPAT compared with patients without a prior ED visit. A strategy of managing occlusions at home and a focus on patients with prior ED visits could potentially prevent a substantial proportion of OPAT-related ED visits. Disclosures All authors: No reported disclosures.

scholarly journals Independent Validation of Sepsis Index for Sepsis Screening in the Emergency Department

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1292
Author(s):  
Luisa Agnello ◽  
Alessandro Iacona ◽  
Salvatore Maestri ◽  
Bruna Lo Sasso ◽  
Rosaria Vincenza Giglio ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Early Detection ◽  
Diagnostic Accuracy ◽  
Positive Likelihood Ratio ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Distribution Width ◽  
Independent Validation ◽  
Sepsis Screening

(1) Background: The early detection of sepsis is still challenging, and there is an urgent need for biomarkers that could identify patients at a high risk of developing it. We recently developed an index, namely the Sepsis Index (SI), based on the combination of two CBC parameters: monocyte distribution width (MDW) and mean monocyte volume (MMV). In this study, we sought to independently validate the performance of SI as a tool for the early detection of patients at a high risk of sepsis in the Emergency Department (ED). (2) Methods: We enrolled all consecutive patients attending the ED with a request of the CBC. MDW and MMV were measured on samples collected in K3-EDTA tubes on the UniCel DxH 900 haematology analyser. SI was calculated based on the MDW and MMV. (3) Results: We enrolled a total of 703 patients stratified into four subgroups according to the Sepsis-2 criteria: control (498), infection (105), SIRS (52) and sepsis (48). The sepsis subgroup displayed the highest MDW (median 27.5, IQR 24.6–32.9) and SI (median 1.15, IQR 1.05–1.29) values. The ROC curve analysis for the prediction of sepsis showed a good and comparable diagnostic accuracy of the MDW and SI. However, the SI displayed an increased specificity, positive predictive value and positive likelihood ratio in comparison to MDW alone. (4) Conclusions: SI improves the diagnostic accuracy of MDW for sepsis screening.

scholarly journals Ultrasound evaluation of access complications: Thrombosis, aneurysms, pseudoaneurysms and infections

2021 ◽  
pp. 112972982110180
Author(s):  
Mario Meola ◽  
Antonio Marciello ◽  
Gianfranco Di Salle ◽  
Ilaria Petrucci
Keyword(s):  
Vascular Access ◽  
Pulse Wave ◽  
De Novo ◽  
Late Complications ◽  
Prosthesis Infection ◽  
Ultrasound Evaluation ◽  
Access Complications ◽  
Vein Stenosis ◽  
Post Implantation

Arteriovenous fistula (AVF) complications are classified based on fistula outcomes. This review aims to update colour Doppler (CD) and pulse wave Doppler (PWD) roles in managing early and late complications of the native and prosthetic AVF. Vascular access (VA) failure occurs because inflow or outflow stenosis activates Wirchow’s triad inducing thrombosis. Therefore, the diagnosis of the tributary artery and outgoing vein stenosis will be the first topic considered. Post-implantation complications occur from the inability to achieve AVF maturation and dialysis suitability due to inflow/outflow stenosis. Late stenosis is usually a sequence of early defects repaired to maintain patency. Less frequently, in the mature AVF or graft, complications are acquired ‘de novo’. They derive either from incorrect management of vascular access (haematoma, pseudoaneurysm, prosthesis infection) or wall pathologies (aneurysm, myxoid valve degeneration, kinking, coiling, abnormal dilation from defects of elastic structures). High-resolution transducers (10–20 MHz) allow the characterization of the wall damage, haemodynamic dysfunctions, early and late complications even if phlebography remains the gold standard for the diagnosis for its sensitivity and specificity.

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