Seminars in dialysis
-
Seminars in dialysis · Sep 2005
Case ReportsCreation of secondary arteriovenous fistulas: maximizing fistulas in prevalent hemodialysis patients.
National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) guideline 29 suggests that a patient should be evaluated for a secondary arteriovenous fistula (AVF) following each episode of dialysis access failure. Regretfully, it does not appear that this approach is used, even though recent data have emphasized that veins suitable for the creation of a secondary AVF can be identified in dialysis patients who are receiving dialysis via a synthetic arteriovenous graft (AVG) or other type of potentially dysfunctional vascular access. In this study nine patients (five with an AVG and four with an AVF) with vascular access dysfunction undergoing percutaneous interventions were evaluated for secondary AVF creation. ⋯ In addition, it was possible to continue uninterrupted dialysis without the use of a tunneled dialysis catheter in three of the patients with AVGs. This experience demonstrates the validity and success of this approach to the management of dialysis access dysfunction. In the ongoing effort to optimize vascular health status, we suggest that during percutaneous interventions, patients should routinely have identification of vessels suitable for creation of a secondary AVF.
-
Seminars in dialysis · Sep 2005
Comparative StudyConversion of temporary hemodialysis catheters to permanent hemodialysis catheters: a retrospective study of catheter exchange versus classic de novo placement.
Many clinicians believe that de novo access is required when converting temporary hemodialysis (HD) catheters to long-term or permanent catheters. However, since vascular access sites are at a premium in the dialysis patient, it is important to preserve existing central venous catheters and conserve future access sites. In this retrospective study, data from 94 patients referred to interventional radiology for placement of long-term, tunneled HD catheters between July 2001 and September 2002 were reviewed. ⋯ There was no incidence of exit site infection, tunnel infection, or florid sepsis in either group. Likewise, no stenosis or bleeding complication was noted. Thus conversion of a temporary HD catheter to a tunneled catheter using the same venous insertion site is safe, does not increase the risk of infection, and allows conservation of other central venous access sites.
-
Seminars in dialysis · Jul 2005
Case ReportsRetrieval of a fractured piece of Tessio catheter with a snare using a transcutaneous transvenous approach.
Approximately 20% of end-stage renal disease patients requiring hemodialysis have central dialysis catheters as their vascular access. The major cause of central dialysis catheters removal or revision is infection or occlusion. Catheter occlusions may occur as a result of thrombosis or fibrin sheath formation. ⋯ Herein we present the case of a central dialysis catheter referred to us for malfunction. An incidental finding was a piece of catheter that had broken off the venous port and was seen in the right atrium. The retrieval and subsequent placement of a new central dialysis catheter are outlined.
-
Seminars in dialysis · Mar 2005
ReviewPalliative care in end-stage renal disease: focus on advance care planning, hospice referral, and bereavement.
The components of palliative care in end-stage renal disease (ESRD) include pain and symptom management, advance care planning, psychosocial and spiritual support, and ethical issues in dialysis. End-of-life care is not synonymous with, but rather a subset of palliative care. ⋯ It is incumbent upon dialysis care providers to include advance care planning in overall care plans for their patients. Factors contributing to the failure of advance care planning in ESRD patients will be discussed, as will hospice and ESRD, and opportunities for bereavement programs.
-
Seminars in dialysis · Mar 2005
ReviewHealth-related quality of life in nephrology research and clinical practice.
Physical, psychosocial, and lifestyle disturbances, along with physical and emotional symptoms, have been shown to impact the health-related quality of life (HRQOL) of those dependent on renal replacement therapy. The value of HRQOL measurement as a tool to improve clinical care has been recognized by patients, clinical investigators, and health care providers. The potential importance of HRQOL assessment lies in the additional information it provides and the impact it has on the clinical decision-making process between a patient and a physician. ⋯ Arguably, optimizing HRQOL may be the most substantial impact the health care team will have on the person with kidney failure. In order to implement HRQOL assessment at the point of care, providers may consider using computer adaptive testing and scoring algorithms using item response theory, which will allow adequate reliability for interpretation of change among individuals. Moreover, the effective assessment and interpretation of HRQOL will be aided by continued publication of norms, outcomes of randomized controlled trials, and continued experience of investigators and clinicians.