Clinical Study of Brachial Vein Transposition Fistulas for Hemodialysis / 日本心臓血管外科学会雑誌

Brachial vein transposition fistulas for hemodialysis are embloyed when the superficial veins in arms are not used. In our hospital, 28 patients have received brachial vein transposition fistula in the past 13 years. Post-operative complications were bleeding at the puncture sites in 2 patients, infection at the puncture site in 1, and aneurysm formation in the transposed vein in 1. Access related hand ischemia and venous hypertension were not recognized. For 3 patients of fistula stenosis, percutaneous catheter dilatation was performed. For 2 of 19 patients with fistula occlusion, surgical thrombectomy was performed. The primary patency rates were 76.8% at 1 year and 55.8% at 4 years. The secondary patency rates were 95.5% at 1 year and 66.3% at 4 years. The brachial vein transposition procedure is useful for long-term continuation of hemodialysis using autologous arm vessels.

Avaliação da técnica de curativo em cliente com acesso venoso para hemodiálise / Evaluación de la técnica de curativo en cliente con acceso venoso para hemodiálisis / Assessment of venous catheter dressing technique for patients in hemodialysis

Este artigo teve como objetivo verificar o desempenho de auxiliares e técnicos de enfermagem na realização de curativo em clientes com acesso venoso para hemodiálise. Estudo descritivo, com abordagem quantitativa, foi realizado numa clínica de nefrologia em Aracaju/SE. A coleta de dados seguiu um roteiro estruturado de observação, tendo sido observados a realização de curativos de 30 clientes e registros de enfermagem em seus prontuários. Ocorreu no período de agosto e setembro de 2007. A amostragem foi não probabilística intencional. Concluiu-se que os profissionais aplicam parcialmente a teoria em sua prática diária, durante a realização do curativo em clientes com acesso venoso para hemodiálise, pois não utilizam EPI completo, não lavam as mãos antes e após os procedimentos, não avaliam adequadamente os sinais e sintomas de infecção e não registram os procedimentos adequadamente. São necessários treinamento e supervisão constante desses profissionais por parte dos enfermeiros.

This paper examines how nursing auxiliaries and nursing technicians change venous catheter dressings in hemodyalisis patients. This descriptive, quantitative study took place at the Sergipe Nephrology Clinic from August to September 2007 using an intentional, non-probability sample. Data was collected, following a structured observation script, by observing 30 dressings and analyzing 30 patient record entries. It was concluded that, when dressing venous catheters for hemodialysis, these professionals apply theory only partly in practice, because they do not use complete Individual Protection Equipment (IPE), do not wash their hands before and after all procedures, do not check signs and symptoms of infection properly and do not record procedures correctly. These health workers thus need training and constant supervision by nurses.

Este artículo tuvo como objetivo verificar el desempeño de auxiliares y técnicos de enfermería en la realización de curativo en clientes con acceso venoso para hemodiálisis. Estudio descriptivo, con enfoque cuantitavo, fue cumplido en una clínica de nefrología de Aracaju-SE-Brasil. La recolección de datos siguió una ruta estructurada de observación, considerándose la ejecución de curativos en 30 clientes y de los registros de enfermería en SUS prontuarios. Eso acaeció en los meses de agosto y septiembre de 2007. La muestra fue no probabilista intencional. Se concluyó que los profesionales aplican la teoría parcialmente en su práctica cotidiana, durante la realización Del curativo en clientes con acceso venoso para hemodiálisis, pues que no usan EPI completo, no lavan las manos antes y después de los procedimientos, no evaluan adecuadamente los señales y síntomas de infencción y no registran los procedimientos correctamente. Son necesarios entrenamiento y supervisión constante de eses profesionales por parte de los enfermeros.

Use of a Dual-lumen Catheter with a Dacron Cuff as a Long-term Vascular Access for Hemodialysis in a Patient with Chronic Renal Failure: Influence on the Efficiency of Hemodialysis and Hemodynamics / 日本農村医学会雑誌

This report presents our experience in using a dual-lumen catheter with a Dacron cuff as longterm vascular access for homodialysis in an elderly patient. The female patient who at first treated with continuous ambulatory peritoneal dialysis for chronic renal failure, but the treatment could not be continued because she developed inveterate peritonitis. Thereafter, hemodialysis was performed. However, a lot of blood access troubles occurred and consequently peripheral access was exhausted. Therefore, we placed the catheter into a right internal jugular vein. This procedure made it possible to secure enough and stable blood flow during the hemodialysis session. Thus, the clearence ratios of blood urea nitrogen and serum creatinine and the value of KT/V increased. No complications have been observed since then. We further examined whether the placement of the catheter would affect hemodynamics in brain and upper extremities, using transcranial Doppler ultrasound and plethysmography. No remarkable difference in blood flow between right and left ophthalmic arteries and decrease in arterial blood flow of right finger tips were observed. Furthermore, venous dilatation, swelling in neck and right upper extremities, and facial edema were not found. The catheter, therefore, represents a significant advance, providing immediate, durable and relatively safe access for hemodialysis after repeated blood access troubles and exhausted peripheral access.