The number of patients with chronic kidney disease re-quiring renal replacement therapy has increased world-wide. The most common replacement therapy is hemo-dialysis （HD）. Vascular access （VA） has a key role for ...The number of patients with chronic kidney disease re-quiring renal replacement therapy has increased world-wide. The most common replacement therapy is hemo-dialysis （HD）. Vascular access （VA） has a key role for successful treatment. Despite the advances that have taken place in the feld of the HD procedure, few things have changed with regards to VA in recent years. Ar-teriovenous fstula （AVF）, polytetrafuoroethylene graft and the cuffed double lumen silicone catheter are the most common used for VA. In the long term, a number of complications may present and more than one VA is needed during the HD life. The most common com-plications for all of VA types are thrombosis, bleeding and infection, the most common cause of morbidity in these patients. It has been estimated that VA dysfunc-tion is responsible for 20% of all hospitalizations. The annual cost of placing and looking after dialysis VA in the United States exceeds 1 billion dollars per year. A good functional access is also vital in order to deliver adequate HD therapy. It seems that the native AVF that Brescia and Cimino described in 1966 still remains the frst choice for VA. The native forearm AVFs have the longest survival and require the fewest interventions. For this reason, the forearm AVF is the frst choice, fol-lowed by the upper-arm AVF, the arteriovenous graft and the cuffed central venous catheter is the final choice. In conclusion, VA remains the most importantissue for patients on HD and despite the technical im-provements, a number of problems and complications have to be resolved.展开更多
Background: Chemotherapy in colorectal cancer is usually administered as continuous infusion of 5-fluorouracil, often in combination with oxaliplatin or irinotecan. Targeted drugs are most efficient and tolerable in c...Background: Chemotherapy in colorectal cancer is usually administered as continuous infusion of 5-fluorouracil, often in combination with oxaliplatin or irinotecan. Targeted drugs are most efficient and tolerable in conjunction with continuous infusion dosing. Implanted venous access devices (VAD) are the prerequisite for continuous infusion administration. The reported catheter migration frequency with VAD is 0% - 3.5%. The purpose of this case-control study was to evaluate the predisposing factors of catheter migration. Methods: We inserted VADs in 88 radically operated colorectal cancer patients randomized to adjuvant 48-hour-infusion chemotherapy repeated every 14 days, altogether 12 times over 24 weeks. Three out of 88 patients (3.4%) had a symptomatic catheter migration from the superior caval vein into the internal jugular vein. The fourth case had chemotherapy for osteosarcoma. These 4 cases were compared with 12 controls from the same 88 patient study population, matched for age, sex, body mass index (BMI), physical activity level and right subclavian insertion site. Tip position, port model, complications, catheter length and material was studied. The post insertion catheter tip position in the chest X-ray was numbered from 1 (in subclavia) to 8 (in atrium). Results: The four cases, all male, had a median position of 3 (range 3 - 4) and controls 6 (range 4 - 8), P = 0.004, median difference 3 (CI95% 1 - 5). At notification of migration the patients had experienced discomfort in the neck region starting 5 to15 days before at strenuous upper extremities activity with Valsalva maneuvers. Conclusion: Optimal catheter tip position when sitting is in the right atrium or low in the superior vena cava to avoid migration. Patients with VADs should avoid strenuous activity with Valsalva maneuvers.展开更多
Objective:This paper mainly analyzes the effect of infrared radiation combined with external application nursing on maintenance of vascular access in hemodialysis patients.Methods:A total of 150 hemodialysis patients ...Objective:This paper mainly analyzes the effect of infrared radiation combined with external application nursing on maintenance of vascular access in hemodialysis patients.Methods:A total of 150 hemodialysis patients in our hospital from December 2019 to September 2020 were divided into the conventional group and the study group,75 cases in each group.The conventional group was given external application nursing alone,and the study group was given infrared radiation combined with external application nursing,and the effect on the maintenance of vascular access was counted.Results:After the intervention,the indexes of URR,kt/V and human albumin in the study group were higher than those in the routine group,and the indexes of β2-mg and MIS in the study group were lower than those in the routine group,P<0.05;The improvement of vascular elasticity and quality of life in the study group was higher than that in the conventional group,and the incidence of complications was lower than that in the conventional group,P<0.05.Conclusion:Infrared radiation combined with external application of nursing care in hemodialysis patients with vascular access maintenance effect is significant,can effectively improve vascular elasticity.展开更多
To investigate the safety and efficacy of chitosan ( Anscare,Daxon) in reducing vascular ac cess complications compared to a kind of radial compression device( TR-BAND,Terumo) . Method: We studied 128 patients who had...To investigate the safety and efficacy of chitosan ( Anscare,Daxon) in reducing vascular ac cess complications compared to a kind of radial compression device( TR-BAND,Terumo) . Method: We studied 128 patients who had undergone transradial angiography in our center from December 2009 to April 2010. Among them,64 patients were randomly treated with radial compression device ( TR-BAND,Terumo) when the procedure was over ( CD group) . The other 64 patients were dealt with chitosan ( CS group) . The compression time,the major and minor access site bleeding complications and the errhysis were observed. Results: There were no statistical differences in the baseline clinical characteristics of the patients between two groups. The compression time in CS group was significantly shorter than that of CD group ( P < 0. 001) . There were 12 patients suffering from minor access site bleeding while only 3 patients experienced these minor complications in CS group( 19% vs 4% ,P < 0. 05) . At the same time 20 patients had er- rhysis in CD group and 4 patients in CS group ( 31% vs 6% ,P < 0. 001) . Conclusion: Chitosan,compared to radial compression device ( TR-BAND,Terumo) ,can not only shorten the compression time,but also significantly reduce the rate of minor access site bleeding and puncture-site errhyis.展开更多
Transcatheter aortic valve implantation(TAVI) using stent-based bioprostheses has recently emerged as a promising alternative to surgical valve replacement in selected patients. The main route for TAVI is retrograde a...Transcatheter aortic valve implantation(TAVI) using stent-based bioprostheses has recently emerged as a promising alternative to surgical valve replacement in selected patients. The main route for TAVI is retrograde access from the femoral artery using large sheaths(16-24 F). Vascular access complications are a clinically relevant issue in TAVI procedures since they are reported to occur in up to one fourth of patients and are strongly associated with adverse outcomes. In the present paper, we review the different types of vascular access site complications associated with transfemoral TAVI. Moreover, we discuss the possible optimal management strategies with particular attention to the relevance of early diagnosis and prompt treatment using endovascular techniques.展开更多
BACKGROUND Although the number of patients who need central venous ports for permanent vascular access is increasing,there is still no“gold standard”for the implantation technique.AIM To identify the implantation te...BACKGROUND Although the number of patients who need central venous ports for permanent vascular access is increasing,there is still no“gold standard”for the implantation technique.AIM To identify the implantation technique that should be favored.METHODS Two hundred central venous port-implanted patients in a tertiary hospital were retrospectively evaluated.Patients were assigned into two groups according to the access method.The first group comprised patients whose jugular veins were used,and the second group comprised patients whose subclavian veins were used.Groups were evaluated regarding age,sex,application side,primary diagnosis,active follow-up period in the hospital,chemotherapy agents administered,number of complications,and the Clavien-Dindo severity score.The distribution of the variables was tested with the Kolmogorov-Smirnov test and the Mann-Whitney U test.Theχ^(2) test was used to analyze the variables.RESULTS There was no statistically significant difference between the groups regarding age,sex,side,number of chemotherapy drugs,and duration of port usage(P>0.05).Only 2 patients in group 1 had complications,whereas in group 2 we observed 19 patients with complications(P<0.05).No port occlusion was found in group 1,but the catheters of 4 patients were occluded in group 2.One port was infected in group 1 compared to three infected ports in group 2.Two port ruptures,two pneumothorax,one revision due to a mechanical problem,one tachyarrhythmia during implantation,and four suture line problems were also recorded in group 2 patients.We also showed that it would be sufficient to evaluate and wash ports once every 2 mo.CONCLUSION Our results robustly confirm that the jugular vein route is safer than the subclavian vein approach for central venous port implantation.展开更多
目的探讨Donabedian质量理论干预模式对行血管通路术的血液透析患者血管通路并发症发生率的影响。方法选取福建医科大学附属第二医院2021年12月—2022年12月收治的160例血液透析患者作为研究对象,按照随机数字表法分为对照组(n=80,予以...目的探讨Donabedian质量理论干预模式对行血管通路术的血液透析患者血管通路并发症发生率的影响。方法选取福建医科大学附属第二医院2021年12月—2022年12月收治的160例血液透析患者作为研究对象,按照随机数字表法分为对照组(n=80,予以常规护理干预)与观察组(n=80,在对照组的基础上予以Donabedian质量理论干预)。比较2组血液透析患者的日常生活能力评定量表(activity of daily living scale,ADL)及血管通路并发症的发生率。结果在对行血管通路术的血液透析患者进行质量理论干预后,观察组ADL评分[(40.48±3.97)分]明显低于对照组[(44.07±2.51)分](P<0.05);观察组血管通路并发症的总发生率(2.50%)明显低于对照组(11.25%),差异有统计学意义(P<0.05)。结论行血管通路术的血液透析患者使用Donabedian质量理论的干预模式可改善日常生活能力,减少血管通路并发症。展开更多
文摘The number of patients with chronic kidney disease re-quiring renal replacement therapy has increased world-wide. The most common replacement therapy is hemo-dialysis （HD）. Vascular access （VA） has a key role for successful treatment. Despite the advances that have taken place in the feld of the HD procedure, few things have changed with regards to VA in recent years. Ar-teriovenous fstula （AVF）, polytetrafuoroethylene graft and the cuffed double lumen silicone catheter are the most common used for VA. In the long term, a number of complications may present and more than one VA is needed during the HD life. The most common com-plications for all of VA types are thrombosis, bleeding and infection, the most common cause of morbidity in these patients. It has been estimated that VA dysfunc-tion is responsible for 20% of all hospitalizations. The annual cost of placing and looking after dialysis VA in the United States exceeds 1 billion dollars per year. A good functional access is also vital in order to deliver adequate HD therapy. It seems that the native AVF that Brescia and Cimino described in 1966 still remains the frst choice for VA. The native forearm AVFs have the longest survival and require the fewest interventions. For this reason, the forearm AVF is the frst choice, fol-lowed by the upper-arm AVF, the arteriovenous graft and the cuffed central venous catheter is the final choice. In conclusion, VA remains the most importantissue for patients on HD and despite the technical im-provements, a number of problems and complications have to be resolved.
文摘Background: Chemotherapy in colorectal cancer is usually administered as continuous infusion of 5-fluorouracil, often in combination with oxaliplatin or irinotecan. Targeted drugs are most efficient and tolerable in conjunction with continuous infusion dosing. Implanted venous access devices (VAD) are the prerequisite for continuous infusion administration. The reported catheter migration frequency with VAD is 0% - 3.5%. The purpose of this case-control study was to evaluate the predisposing factors of catheter migration. Methods: We inserted VADs in 88 radically operated colorectal cancer patients randomized to adjuvant 48-hour-infusion chemotherapy repeated every 14 days, altogether 12 times over 24 weeks. Three out of 88 patients (3.4%) had a symptomatic catheter migration from the superior caval vein into the internal jugular vein. The fourth case had chemotherapy for osteosarcoma. These 4 cases were compared with 12 controls from the same 88 patient study population, matched for age, sex, body mass index (BMI), physical activity level and right subclavian insertion site. Tip position, port model, complications, catheter length and material was studied. The post insertion catheter tip position in the chest X-ray was numbered from 1 (in subclavia) to 8 (in atrium). Results: The four cases, all male, had a median position of 3 (range 3 - 4) and controls 6 (range 4 - 8), P = 0.004, median difference 3 (CI95% 1 - 5). At notification of migration the patients had experienced discomfort in the neck region starting 5 to15 days before at strenuous upper extremities activity with Valsalva maneuvers. Conclusion: Optimal catheter tip position when sitting is in the right atrium or low in the superior vena cava to avoid migration. Patients with VADs should avoid strenuous activity with Valsalva maneuvers.
文摘Objective:This paper mainly analyzes the effect of infrared radiation combined with external application nursing on maintenance of vascular access in hemodialysis patients.Methods:A total of 150 hemodialysis patients in our hospital from December 2019 to September 2020 were divided into the conventional group and the study group,75 cases in each group.The conventional group was given external application nursing alone,and the study group was given infrared radiation combined with external application nursing,and the effect on the maintenance of vascular access was counted.Results:After the intervention,the indexes of URR,kt/V and human albumin in the study group were higher than those in the routine group,and the indexes of β2-mg and MIS in the study group were lower than those in the routine group,P<0.05;The improvement of vascular elasticity and quality of life in the study group was higher than that in the conventional group,and the incidence of complications was lower than that in the conventional group,P<0.05.Conclusion:Infrared radiation combined with external application of nursing care in hemodialysis patients with vascular access maintenance effect is significant,can effectively improve vascular elasticity.
文摘To investigate the safety and efficacy of chitosan ( Anscare,Daxon) in reducing vascular ac cess complications compared to a kind of radial compression device( TR-BAND,Terumo) . Method: We studied 128 patients who had undergone transradial angiography in our center from December 2009 to April 2010. Among them,64 patients were randomly treated with radial compression device ( TR-BAND,Terumo) when the procedure was over ( CD group) . The other 64 patients were dealt with chitosan ( CS group) . The compression time,the major and minor access site bleeding complications and the errhysis were observed. Results: There were no statistical differences in the baseline clinical characteristics of the patients between two groups. The compression time in CS group was significantly shorter than that of CD group ( P < 0. 001) . There were 12 patients suffering from minor access site bleeding while only 3 patients experienced these minor complications in CS group( 19% vs 4% ,P < 0. 05) . At the same time 20 patients had er- rhysis in CD group and 4 patients in CS group ( 31% vs 6% ,P < 0. 001) . Conclusion: Chitosan,compared to radial compression device ( TR-BAND,Terumo) ,can not only shorten the compression time,but also significantly reduce the rate of minor access site bleeding and puncture-site errhyis.
文摘Transcatheter aortic valve implantation(TAVI) using stent-based bioprostheses has recently emerged as a promising alternative to surgical valve replacement in selected patients. The main route for TAVI is retrograde access from the femoral artery using large sheaths(16-24 F). Vascular access complications are a clinically relevant issue in TAVI procedures since they are reported to occur in up to one fourth of patients and are strongly associated with adverse outcomes. In the present paper, we review the different types of vascular access site complications associated with transfemoral TAVI. Moreover, we discuss the possible optimal management strategies with particular attention to the relevance of early diagnosis and prompt treatment using endovascular techniques.
文摘BACKGROUND Although the number of patients who need central venous ports for permanent vascular access is increasing,there is still no“gold standard”for the implantation technique.AIM To identify the implantation technique that should be favored.METHODS Two hundred central venous port-implanted patients in a tertiary hospital were retrospectively evaluated.Patients were assigned into two groups according to the access method.The first group comprised patients whose jugular veins were used,and the second group comprised patients whose subclavian veins were used.Groups were evaluated regarding age,sex,application side,primary diagnosis,active follow-up period in the hospital,chemotherapy agents administered,number of complications,and the Clavien-Dindo severity score.The distribution of the variables was tested with the Kolmogorov-Smirnov test and the Mann-Whitney U test.Theχ^(2) test was used to analyze the variables.RESULTS There was no statistically significant difference between the groups regarding age,sex,side,number of chemotherapy drugs,and duration of port usage(P>0.05).Only 2 patients in group 1 had complications,whereas in group 2 we observed 19 patients with complications(P<0.05).No port occlusion was found in group 1,but the catheters of 4 patients were occluded in group 2.One port was infected in group 1 compared to three infected ports in group 2.Two port ruptures,two pneumothorax,one revision due to a mechanical problem,one tachyarrhythmia during implantation,and four suture line problems were also recorded in group 2 patients.We also showed that it would be sufficient to evaluate and wash ports once every 2 mo.CONCLUSION Our results robustly confirm that the jugular vein route is safer than the subclavian vein approach for central venous port implantation.
文摘目的探讨Donabedian质量理论干预模式对行血管通路术的血液透析患者血管通路并发症发生率的影响。方法选取福建医科大学附属第二医院2021年12月—2022年12月收治的160例血液透析患者作为研究对象,按照随机数字表法分为对照组(n=80,予以常规护理干预)与观察组(n=80,在对照组的基础上予以Donabedian质量理论干预)。比较2组血液透析患者的日常生活能力评定量表(activity of daily living scale,ADL)及血管通路并发症的发生率。结果在对行血管通路术的血液透析患者进行质量理论干预后,观察组ADL评分[(40.48±3.97)分]明显低于对照组[(44.07±2.51)分](P<0.05);观察组血管通路并发症的总发生率(2.50%)明显低于对照组(11.25%),差异有统计学意义(P<0.05)。结论行血管通路术的血液透析患者使用Donabedian质量理论的干预模式可改善日常生活能力,减少血管通路并发症。
