Deep Venous Thrombosis (DVT) risk assessment on routine hemodialysis patient using Padua prediction score

Introduction: Hemodialysis requires invasive vascular access (VA) procedure which could emerge deep venous thrombosis (DVT) complication. Apart from VA, other risk factors, either modifiable or unmodifiable, could increase DVT risk. Those factors can be assessed by Padua Prediction Score (PPS). This study aims to assess which risk factors in PPS increase the risk of developing DVT in routine hemodialysis patients at BHCC main clinic. Methods: This research is a descriptive observational study with simple random sampling. The participants were 58 routine hemodialysis patients in BHCC. The inclusion criteria of this study were the ages above 17 years old, had history hemodialysis more than one, the patient willing to become of the sample subject. The patient that incompletely fulfills the questionnaire were already treated with anticoagulation were admitted for VTE, and had a history of discontinuing hemodialysis were excluded. The data were gathered using a questionnaire according to PPS. The data was analyzed by using SPP 25.0. The descriptive data was provided in a table and pie chart. Results: Based on the results of the PPS, 11 patients (18.96%) were among the high risk, and 47 patients (81.04%) were at low risk. The most potent risk factor in increasing the risk of DVT is reduced mobility with a risk priority number (RPN) of 30 (severity=3, occurrence=10). Recent (≤one month) trauma and surgery entail on second with an RPN of 24 (severity=2, occurrence=12). The third is occupied by heart and/or respiratory failure with a RPN of 14 (severity=1, occurrence=14). Previous VTE history with a RPN of 12 (severity=3, occurrence=4) placed fourth, followed by age≥ 70 (RPN=8, severity=1, occurrence=8) and obesity (BMI>= 30) with a RPN of 4 (severity=1, occurrence=4) at fifth and sixth respectively. Conclusion: "Reduced mobility" is the most prominent risk factor to increase DVT risk in routine hemodialysis patients, followed by other risk factors. Reduced mobility and obesity are modifiable risk factors that should be eliminated by educating routine hemodialysis patients.

Strategy of implementing aerobic exercise as a pleiotropic effect in cancer patients with a history of administration cardiotoxic agents: a systematic review

The development of health science, with the discovery of a type of treatment to reduce mortality due to cancer, namely using chemotherapy agents such as anthracycline and trastuzumab. From the number of studies that have been done, the types of drugs such as anthracycline and trastuzumab have a cardiotoxic effect which is often associated with decreased heart-lung function and the incidence of cardiomyopathy. Exercise is reported to have a pleiotropic effect. Therefore, this study aims to synthesize evidence from the application of pleiotropic exercise in cancer patients undergoing chemotherapy with cardiotoxic agents. The search was performed according to the recommended reporting items for systematic review and meta-analyses (PRISMA). Obtained an accumulation of 2397 articles from PubMed and Google Scholar (2016-2020), which were assisted by the PICO search engine. The article was reviewed by the author within sorting using inclusion and exclusion criteria and obtained 28 articles accordingly. Aerobic exercise has pleiotropic effects by stimulating antioxidants and reducing reactive oxygen species (ROS) levels, reducing pro-apoptosis molecular signaling, stimulating myofilament, facilitating concentric cardia hypertrophy remodeling, and changing cardiac metabolism via adenosine monophosphate (amp) with kinase-mediated. Pretreatment aerobic exercise with minimal supervised 30-min exercise sessions 3 times/week for ≥12 weeks effectively reduce the risk of chemotherapy-induced cardiomyopathy (CRC). Aerobic exercise has a significant pleiotropic effect in patients undergoing chemotherapy with cardiotoxic agents.

Anaesthesia management in Chronic Kidney Disease (CKD) patient undergo repair pseudoaneurysms surgery: a case report

Introduction: Chronic kidney disease (CKD) is marked by the presence of kidney damage (usually defined as estimated GFR < 60 mL/ min/1.73 m2) for 3 or more months, and it may be caused by a multitude of disease processes. Management of patients with CKD includes aggressive treatment of the underlying cause, pharmacologic therapy to delay disease progression and prevent complications, and preparation for hemodialysis as ESRD ensues. Case presentation: In this case report, a 48-year-old man with a pseudoaneurysms due to the insertion of a vascular access for hemodialysis, undergo repair pseudoaneurysms surgery under general anesthesia, at the Sanglah General Hospital, October 2020. The patient came with fully awareness, blood pressure 145/95 mmHg, heart rate 85 times per minute regular and oxygen saturation 97% with room air. Conclusion: General anesthesia in patients with CKD requires an understanding of the pathologic changes that accompany renal disease, co-existing medical conditions, and the impact of reduced renal function on drug pharmacokinetics.

Flow volume measured by duplex ultrasound in native arteriovenous fistula for hemodialysis: a case report

Background : Native arteriovenous fistula (AVF) is the vascular access of choice for hemodialysis patients. AVF lasts longer than artificial grafts or central venous catheters. In addition, AVF has fewer complications than other vascular accesses. The use of Doppler ultrasound is used to facilitate fistula construction (vascular mapping) including AVF maturation to see if AVF can be used. Doppler ultrasound monitoring for maturation of AV fistulas should be monitored sonographically until the fistula is ready for use, especially when maturation is slow and in patients whose veins cannot easily be assessed by physical examination alone (eg because of obesity). The AVF DUS flow volume measurement may be the only imaging tool that can be used to monitor a fistula even during its maturation. Even so, DUS should always be done before AVF is used for the first time. This examination provides baseline data on vascular access, which can be useful in subsequent tests performed to evaluate functional problems. Case report : A man, 52 years old who has done AV Fitula two weeks ago. Currently patients are using a double lumen catheter (CDL) for routine hemodialysis. One day the patient had his CDL removed. Even though the patient feels thrill in the AV fistula, the nephrorologist still doubts whether the AV fistula is ripe and can be used. For this reason, a Duplex Ultrasound is performed to assess the diameter, velocity flow, PSV and TAMV .By positioning the sample volume in the presumed stenosis site, the Doppler velocity test detects a systolic peak velocity. Conclusion: Color flow Doppler imaging should be used as a tool to screen for areas of high velocity and to aid in the optimal placement of the pulsed Doppler sample volume. The pulsed Doppler sample volume should be set at the smallest size possible to detect discrete changes in blood flow meanwhile doppler ultrasound should be use in monitoring for maturation of AV fistulas

A three years’ experience of Arteriovenous Fistula (AVF) cases in a tertiary care hospital of East Java, Indonesia: a descriptive observational study

Introduction: The incidence of end-stage renal disease (ESRD) globally is 700 million people approximately. Patients with ESRD need vascular access for hemodialysis as renal replacement therapy (RRT). Among hemodialysis access, arteriovenous fistula is considered as the most preferred form of vascular access due to its characteristics. This study aimed to to present a descriptive characteristic of arteriovenous fistula creation cases in a tertiary care hospital with a specific view of demographic parameters, fistulas' sites, type of fistulas. Methods: We conducted a descriptive study of single-center in the Department of Thoracic, Cardiac and Vascular Surgery of Dr. Soetomo Academic General Hospital Surabaya, collected data from January 1st, 2017 to December 31st, 2020. All patients who undergo arteriovenous fistula creation considered as a subject in this study. We retrieved the characteristics of the patients, the type of fistula, the site, surgical technique, and underlying disease from patients’ electronic medical data records. Results: A total of 167 patients requiring long-term hemodialysis in our center. Females were dominantly in our study with 56.9% (95). Most of AVFs were created on the left arm. Radiocephalic type of AVF was the most common arteriovenous fistula type found in 111 subjects (66.5%). The highest postoperative successful rate was found in brachiocephalic type in 78.8%, followed by radiocephalic AVF type with 66.7%. The wrist region was favorable in subjects (43.1%). Conclusions: Arteriovenous fistulas for hemodialysis are needed and in our center. Radiocephalic AVFs are the most common type. Further study to learn the different aspects of arteriovenous fistula cases is needed to fulfill queries in the local population.

Percutaneous transluminal angioplasty procedure for central venous stenosis inpatient undergoing hemodialysis in Pelni Hospital: case series

Introduction: Many causes leads to kidney impairment. This does not rule out the increasing number of patients undergoing hemodialysis. The common vascular access used during hemodialysis is an arteriovenous fistula (AVF). The arteriovenous fistula was preferred because it lasts longer and has a lower risk of infection for vascular access, meanwhile central venous stenosis or occlusion in the vein that carries the blood from the extremities to the heart often occur. If vascular access is still used during hemodialysis in which central venous stenosis is formed, it needs to make a new vascular access option. Percutaneous transluminal angiography (PTA) main objectives are to dilate the venous lesion that has occlusion more than 50% and extending the lifespan of arteriovenous fistula. In this case, we report six patients hemodialysis with central venous stenosis treated with percutaneous transluminal angiography. This procedure has benefits that are arteriovenous fistula can be used again to reach hemodialysis adequacy optimally and reduce pain and swelling in the arms. Case description: There six cases who were 45,48,57.58,63 and 66 years old who underwent percutaneous transluminal angioplasty procedures for central venous stenosis. Several past illnesses of the patients underlying the kidney impairment such chronic hypertension, chronic coronary heart complications, and/or diabetes. Several patients felt AVF swollen and/or painful. Minimal residual stenosis after balloon angioplasty was performed. Conclusion: According to our cases, patients that underwent the hemodialysis felt swollen or/and pain due to stenosis ballooning angioplasty help minimize the residual stenosis.

Arteriovenous shunt as the best hemodialysis access in Chronic Kidney Disease (CKD) patients: a literature review

Arteriovenous Shunt (AV Shunt) is a minor surgical operation that connects (creating anastomoses) the arteries and veins in the arm or other body part for the purpose of making connection access for hemodialysis. AV shunt is the primary choice in establishing vascular access for hemodialysis in patients with Chronic Kidney Disease (CKD). Therefore, this study aims to review the arteriovenous shunt as a hemodialysis access option in CKD patients. The literature study was conducted by searching various written sources, whether in the form of books, archives, articles and journals, or documents relevant to the problem being studied. The mortality rate after AV shunt is 0%, even though it still has postoperative complications. Based on the location of the operation, making the AV shunt is prioritized on the distal part that is not dominant to minimize the damage to the AV shunt. The location of the wrist, namely the brachiocephalic, is a top priority in making an AV shunt because it has many advantages. AV shunt is the primary choice of vascular access for hemodialysis in patients with chronic kidney disease. It is hoped that through the AV shunt, the life expectancy of patients with CKD can be increased, and patients with CKD must receive support from other disciplines such as interns, psychologists, and the patient's family.

Central venous catheters retention in a patient with mitral valve replacement: a case report

Background: Retention of central venous catheters (CVC) is one complication that may occur when open-heart surgery is performed (such as mitral valve replacement). In this case report, we describe case retention of CVC in a patient with Mitral Valve Replacement (MVR) related to sutured of Superior Vena Cava (SVC) wall on cannulation site. Case Presentation: A 15-year-old boy was admitted to Sanglah Hospital with a history of Heart failure with severe regurgitation of the mitral valve, severe tricuspid regurgitation, and left ventricular dysfunction due to rheumatic heart disease. Mitral valve replacement, tricuspid valve repair and left atrial reduction was performed. After five days of postoperative observation, the CVC could be removed. However, there is resistance when removing the catheter. After diagnostic examination, it was found that the CVC was sutured to the superior vena cava wall. The patient was then scheduled for a redo sternotomy to evacuate the CVC. The patient was discharged seven days after redo sternotomy was performed without any further postoperative complications. Conclusions: Retention of CVC during open-heart surgery is one complication that increases the risk for morbidity or mortality to the patient after heart surgery.

Comparison of ethanol lock and heparin lock solution as prevention of catheter-related bloodstream infection in hemodialysis patients: systematic review and meta-analysis of randomized controlled trials

Introduction: Catheter-related bloodstream infection (CRBSI) is a common complication of catheter use for vascular access in hemodialysis patients and a major cause of morbidity and mortality. Preventive measures, including antibiotic lock, are inadequate due to the risk of resistance and insufficient effect against bacterial biofilm. Ethanol, an antimicrobial substance, is a potential prophylactic lock-in preventing CRBSI. This study aims to assess ethanol lock's effectiveness in preventing CRBSI in hemodialysis patients with a catheter as vascular access and its impact on catheter dysfunction. Methods: Researchers systematically searched online databases including Pubmed, Cochrane Library, and Science Direct for relevant randomized controlled trials (RCTs) published within 2011 until 2020. Relevant data were pooled in PICOs (Population, Intervention, Control, Outcomes) format and analyzed with Review Manager (version 5.3.5, Cochrane Collaboration, Denmark). Results: Seven RCTs involving 453 patients were assessed. The primary outcome indicates that prophylactic ethanol lock significantly reduces the incidence of CRBSI compared to that of heparin lock (RR=0.32, 95% CI 0.12-0.83, p=0.02, heterogeneity I2=68%). The secondary outcome suggests no significant difference in the incidence of catheter dysfunction in ethanol lock and heparin lock (RR=0.75, 95% CI 0.23-2.40, p=0.63, heterogeneity I2=68%). Conclusion: Ethanol is a potential prophylactic lock agent in preventing CRBSI in hemodialysis patients with catheter access. Further research is needed to synchronize the procedural use of ethanol lock and evaluate its long-term effect.

Primary patency of native arteriovenous fistula in elderly at Abdul Wahab Sjahranie Hospital, Samarinda, Indonesia

Introduction. Arteriovenous fistula (AVF) is preferred to be selected by the patient and clinician due to long term survival and fewer complications than other vascular access. Radiocephalic (RC) fistula is the first choice for dialysis access and should be performed in elderly renal failure patients. Several authors have advocated that the brachiocephalic (BC) fistula should be considered the surgeons' first option. We aim to analyze the primary patency of RC and BC AVF in the elderly. Method. This prospective cohort study was conducted from June 2018 to March 2020, which included 58 elderly patients who underwent surgery to create AVF. Demographic data were collected from medical records. Meanwhile, information about patient’s primary patency of RC and BC AVF were followed up to first access dysfunction or any intervention by phone. The survival data were analyzed using the Kaplan-Meier method Result. There were 58 elderly patients divided into 51 (87.9 %) patients with RC, 4 (6.9%) patients with BC, and 3 (5.2%) patients with Basilic Vein Transposition (BVT). The survival rate of RC was 70.5 % after six months and 29.4 % after 12 months. Meanwhile, 50% of BC patients survived in the first six months, and 25% survive for a year. On the other hand, 1 of 3 patients died in the BVT group in the first month after access placement due to hemodialysis complication, and the remaining two BVT patients survived in three months. Conclusion. RC has a patency rate of 70.5% in six months and 29.4% in a year. Choosing the right type and site of the anastomosis is essential as life expectancy increases in the elderly to preserve the veins for future access site.