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haemodialysis access

Julien Al Shakarchi, C Day, N Inston
INTRODUCTION: Home haemodialysis has been advocated due to improved quality of life. However, there are very little data on the optimum vascular access for it. METHOD: A retrospective cohort study was carried on all patients who initiated home haemodialysis between 2011 and 2016 at a large university hospital. Access-related hospital admissions and interventions were used as primary outcome measures. RESULTS: Our cohort consisted of 74 patients...
March 1, 2018: Journal of Vascular Access
Victoria E Jackson, Helen Hurst, Sandip Mitra
INTRODUCTION: Arteriovenous fistulae remain the gold standard of vascular access in haemodialysis. There is currently no consensus on standardised methods of monitoring arteriovenous fistulae. Assessment techniques and practice remain widely variable. The purpose of this study is to determine whether existing evidence supports physical assessment as an effective tool and a good predictor of arteriovenous fistulae dysfunction to allow for timely intervention and improve outcomes. METHODS: A literature search was performed using CINAHL, PubMed, Medline and BNI databases and relevant search terms...
March 1, 2018: Journal of Vascular Access
Safauldeen A Alhajim
Chronic kidney disease requires life-long renal replacement therapy, which can greatly impair the quality of life (QOL) of patients. This cross-sectional study aimed to assess the QOL of patients on haemodialysis, and the factors affecting it, at the dialysis unit of Basra General Hospital. A total of 104 patients with end-stage renal disease on haemodialysis were included. Data were collected using the World Health Organization QOL questionnaire. Sociodemographic and clinical data were also collected. Of the 104 patients, 57% were male, 73% were older than 45 years, 87% were of middle and low socioeconomic status, 70% had been on dialysis for more than 1 year, 74% had arteriovenous fistula vascular access, 34% had diabetes and 48% were positive for hepatitis virus...
March 5, 2018: Eastern Mediterranean Health Journal, la Revue de Santé de la Méditerranée Orientale
Jessica Stevenson, Allison Tong, Katrina L Campbell, Jonathan C Craig, Vincent W Lee
OBJECTIVE: To describe the perspectives of healthcare providers on the nutritional management of patients on haemodialysis, which may inform strategies for improving patient-centred nutritional care. DESIGN: Face-to-face semistructured interviews were conducted until data saturation, and thematic analysis based on principles of grounded theory. SETTING: 21 haemodialysis centres across Australia. PARTICIPANTS: 42 haemodialysis clinicians (nephrologists and nephrology trainees (15), nurses (12) and dietitians (15)) were purposively sampled to obtain a range of demographic characteristics and clinical experiences...
March 8, 2018: BMJ Open
Kapila S Benaragama, Jennifer Barwell, Chris Lord, Biku J John, Adarsh Babber, Shella Sandoval, Ben Lindsey, Bimbi Fernando
PURPOSE: Primary arteriovenous fistula arterio venous fistula (AVF) formation has proven to be the best and optimal vascular access for the majority of haemodialysis patients. At present there are limited data to suggest which haemodynamic parameters most correlate with the likelihood of early failure. The aim of this study is to identify the haemodynamic predictors of early failure, hence identify which fistulae may benefit from timely pre-emptive intervention. MATERIAL AND METHODS: Retrospective analysis of data was performed of 201 patients undergoing native AVF creation over a one year period...
March 9, 2018: Journal of Renal Care
Eleanor Murray, Mahmoud Eid, Jamie P Traynor, Karen S Stevenson, Ram Kasthuri, David B Kingsmore, Peter C Thomson
Background: The modality by which haemodialysis (HD) is delivered [arteriovenous fistula (AVF), arteriovenous graft (AVG) or central venous catheter (CVC)] varies widely and is influenced by clinical evidence, patient factors and the prevailing service configuration. The aim of this study was to determine the outcome and impact of access strategy on patient outcome by mapping out the HD journey in a cohort of incident patients. Methods: A 2-year cohort of consecutive incident HD patients from the point of referral for first dialysis access to completion of the first 365 days of HD was prospectively reviewed...
February 1, 2018: Nephrology, Dialysis, Transplantation
Mick Kumwenda, Lisa Dougherty, Helen Spooner, Victoria Jackson, Sandip Mitra, Nicholas Inston
Tunnelled central venous access devices (CVADs) are defined as any intravenous multipurpose catheters placed within the central veins for use in haemodialysis and administration of blood products or chemotherapy in oncology and haematological conditions. Frequent complications include thrombosis and catheter-related infection, which may lead to significant adverse patient outcomes. Once thrombosis is suspected correction should be attempted empirically with thrombolytic agents. Commonly available thrombolytic agents in the UK include urokinase (Syner-Kinase) and alteplase (Cathflo)...
January 25, 2018: British Journal of Nursing: BJN
Daisuke Atomura, Junko Aihara, Makoto Omori, Hiroto Terashi
Arteriovenous access ischaemic steal is a serious complication following arteriovenous fistula (AVF) construction. The aim of treatment is to improve distal circulation without impairing the function of the fistula. Therefore, any repair should be performed with intraoperative monitoring. We report 2 cases of this disorder treated using perioperative measurement of skin perfusion pressure (SPP) for preoperative surgical planning and intraoperative guidance. A 73-year-old woman with a left cubital AVF developed gangrene of the tip of the left little finger...
January 22, 2018: International Wound Journal
Jurij Janež
Peritoneal dialysis (PD) is a generally accepted method for treatment of patients with the end-stage renal disease. A larger proportion of PD patients transfer to haemodialysis every year than the converse. Many of the underlying causes of transfer to haemodialysis are preventable. Infectious complications still remain the most common reason for transfer of PD patients to haemodialysis, catheter-related problems are the second most common cause. For PD to be effective it is very important to provide a quality peritoneal access with the insertion of PD catheter with minimum complications...
January 10, 2018: Journal of Minimal Access Surgery
José Ibeas, Ramon Roca-Tey, Joaquín Vallespín, Teresa Moreno, Guillermo Moñux, Anna Martí-Monrós, José Luis Del Pozo, Enrique Gruss, Manel Ramírez de Arellano, Néstor Fontseré, María Dolores Arenas, José Luis Merino, José García-Revillo, Pilar Caro, Cristina López-Espada, Antonio Giménez-Gaibar, Milagros Fernández-Lucas, Pablo Valdés, Fidel Fernández-Quesada, Natalia de la Fuente, David Hernán, Patricia Arribas, María Dolores Sánchez de la Nieta, María Teresa Martínez, Ángel Barba
Vascular access for haemodialysis is key in renal patients both due to its associated morbidity and mortality and due to its impact on quality of life. The process, from the creation and maintenance of vascular access to the treatment of its complications, represents a challenge when it comes to decision-making, due to the complexity of the existing disease and the diversity of the specialities involved. With a view to finding a common approach, the Spanish Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five scientific societies involved (nephrology [S...
November 2017: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Behzad Kiani, Nasser Bagheri, Ahmad Tara, Benyamin Hoseini, Hamed Tabesh, Mahmood Tara
Poor access to haemodialysis facilities is associated with high mortality and morbidity rates. This study investigated factors affecting revealed access to the haemodialysis facilities considering patients living in rural and urban areas without any haemodialysis facility (Group A) and those living urban areas with haemodialysis facilities (Group B). This study is based on selfreported Actual Access Time (AAT) to referred haemodialysis facilities and other information regarding travel to haemodialysis facilities from patients...
November 7, 2017: Geospatial Health
Dinesh Bansal, Vijay Kher, Krishan Lal Gupta, Debasish Banerjee, Vivekanand Jha
INTRODUCTION: Despite the growing number of haemodialysis (HD) patients in India, little is known about vascular access practice. We investigated the use and cost of different vascular accesses by Indian nephrologists. METHODS: An online survey was emailed to 920 Indian nephrologists and 388 (42.1%) responded; 98.5% of whom were responsible for managing dialysis patients, 98% in hospitals. RESULTS: Sixty-four percent of patients initiated renal replacement therapy with HD, 7% with peritoneal dialysis, 10% kidney transplantation and 19% conservative care...
November 25, 2017: Journal of Vascular Access
Patrick B Trotter, Dominic M Summers, Ines Ushiro-Lumb, Matthew Robb, J Andrew Bradley, James Powell, Christopher J E Watson, James Neuberger
BACKGROUND: Organs from hepatitis C virus (HCV) seropositive (HCVpos) individuals are seldom used for transplantation because of the risk of disease transmission. Because transmitted HCV is now amenable to effective treatment we estimated the potential impact of using HCVpos deceased donor organs for transplantation. METHODS: The Potential Donor Audit (PDA) of patients (<80years) dying in UK critical care units and the UK Transplant Registry (UKTR) was searched to identify HCVpos potential and proceeding deceased donors...
November 22, 2017: Transplantation
Weng Jun Tang, Arman Zaharil Mat Saad
INTRODUCTION: Arteriovenous fistula is a lifeline for end-stage kidney disease patients on dialysis. The quality of the vein and artery to be used plays a crucial role in attaining a functioning, reliable and long-lasting arteriovenous fistula. The aim of the study is to present an alternative for haemodialysis access to preserve the upper arm vasculature for future use - the forearm loop arteriovenous fistula. METHODS: From October 2015 to September 2016, 202 patients with chronic kidney disease (CKD), stages 4 and 5, underwent arteriovenous fistula creation at the Universiti Sains Malaysia Hospital, Malaysia...
November 13, 2017: Journal of Vascular Access
Matthew J Grima, Bianca Vriens, Peter J Holt, Eric Chemla
INTRODUCTION: All arteriovenous fistula/grafts options should be exhausted before haemodialysis is carried out via central venous catheters (CVC). CVCs carry high morbidity and mortality risks and in some patients, the central veins could be exhausted. In these patients, an arterioarterial prosthetic loop (AAPL) or straight graft can be the only option for haemodialysis. A systematic review was thus carried out to look at the use of arterioarterial graft for haemodialysis, with regards to dialysis adequacy, complications, and patency rates...
November 10, 2017: Journal of Vascular Access
A M de Villiers, A T McBride, B D Reddy, T Franz, B S Spottiswoode
The flow rate inside arteriovenous fistulas is many times higher than physiological flow and is accompanied by high wall shear stress resulting in low patency rates. A fluid-structure interaction finite element model is developed to analyse the blood flow and vessel mechanics to elucidate the mechanisms that can lead to failure. The simulations are validated against flow measurements obtained from magnetic resonance imaging data.
November 14, 2017: Biomechanics and Modeling in Mechanobiology
María Dolores Arenas Jiménez, Gabriel Ferre, Fernando Álvarez-Ude
BACKGROUND: Haemodialysis (HD) patients are a high-risk population group. For these patients, an error could have catastrophic consequences. Therefore, systems that ensure the safety of these patients in an environment with high technology and great interaction of the human factor is a requirement. OBJECTIVES: To show a systematic working approach, reproducible in any HD unit, which consists of recording the complications and errors that occurred during the HD session; defining which of those complications could be considered adverse event (AE), and therefore preventable; and carrying out a systematic analysis of them, as well as of underlying real or potential errors, evaluating their severity, frequency and detection; as well as establishing priorities for action (Failure Mode and Effects Analysis system [FMEA systems])...
November 2017: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Alice L Kennard, Giles D Walters, Simon H Jiang, Girish S Talaulikar
BACKGROUND: Adequate haemodialysis (HD) in people with end-stage kidney disease (ESKD) is reliant upon establishment of vascular access, which may consist of arteriovenous fistula, arteriovenous graft, or central venous catheters (CVC). Although discouraged due to high rates of infectious and thrombotic complications as well as technical issues that limit their life span, CVC have the significant advantage of being immediately usable and are the only means of vascular access in a significant number of patients...
October 26, 2017: Cochrane Database of Systematic Reviews
David Fulker, Bogdan Ene-Iordache, Tracie Barber
Arteriovenous fistulae (AVF) are the preferred choice of vascular access in hemodialysis patients; however, complications such as stenosis can lead to access failure or recirculation, which reduces dialysis efficiency. This study utilized computational fluid dynamics on a patient-specific radiocephalic fistula under hemodialysis treatment to determine the dynamics of access recirculation and identify the presence of disturbed flow. Metrics of transverse wall shear stress (transWSS) and oscillatory shear index (OSI) were used to characterize the disturbed flow acting on the blood vessel wall, while a power spectral density (PSD) analysis was used to calculate the any turbulence within the access...
March 1, 2018: Journal of Biomechanical Engineering
Ankush Jairath, Abhishek Singh, Ravindra Sabnis, Arvind Ganpule, Mahesh Desai
OBJECTIVE: To devise a minimally invasive, less morbid yet effective alternative technique for basilic vein transposition (BVT) in the arm/forearm and to compare perioperative outcomes with the conventional technique. PATIENTS AND METHODS: Patients undergoing BVT in the last two years (June 2013 to June 2015) were included in the study and the results were analysed. All patients were preoperatively evaluated using colour Doppler ultrasonography performed by the operating surgeon himself...
June 2017: Arab Journal of Urology
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