ABSTRACT
Antecedentes y objetivo: Valorar la presión generada por una pinza ajustable en fístulas arteriovenosas (FAV) durante el proceso de hemostasia y compararla con la generada por la compresión manual. Evaluar las variaciones de la compresión manual durante el proceso de hemostasia. Métodos: Se analizaron los datos de 51 sesiones de hemodiálisis de 15 pacientes. Se utilizó la presión intraacceso como indicador indirecto de la presión generada por ambos métodos sobre la FAV. La misma se registró antes de retirar la aguja venosa (PBasal), tras retirar la aguja y colocar la pinza (P1), tras ajustar la pinza (P2), al comenzar el paciente a ejercer compresión manual (M0), a los 3min del inicio de la presión manual (M3) y a los 6min del inicio de la presión manual (M6). Resultados: La presión intraacceso fue menor al aplicar la pinza y ajustarla (P2) que al aplicar presión manual (M0), con una diferencia media de −9,43mmHg (variación −18,57%, IC95%: −14,09 a −4,77mmHg, p<0,001). La presión manual mostró una tendencia descendente durante el proceso de hemostasia (M3-M0: −8,82mmHg, p<0,001; M6-M0: −12,55mmHg, p<0,001). Conclusión: La compresión ejercida por una pinza ajustable es inferior o similar a la ejercida de forma manual por el paciente. Esta última muestra una intensidad decreciente durante el proceso de hemostasia. Estos datos sugieren que algunas de las premisas sobre las que se basan algunas de las recomendaciones presentes en las guías clínicas podrían ser imprecisas. (AU)
Background and objectives: To evaluate the pressure generated by an adjustable hemostasis clamp on arteriovenous fistulas (AVF) during the hemostasis proccess, and compare it with the direct two-finger pressure applied by the patient. To evaluate the variations of the direct two-finger pressure along the hemostasis process. Methods: We analyzed data obtained in 51 hemodialysis procedures from 15 patients. AVF intra-access pressure was used as indirect indicator of the pressure generated by both methods. It was recorded before venous needle removal (PBasal), at clamp application (P1), after clamp adjustement by a nurse (P2), at the beginning of the direct two-finger pressure by the patient (M0), after 3min of two-finger pressure (M3) and after 6min of two-finger pressure (M6). Results: Intra-access pressure was lower with the adjusted clamp (P2) than with the direct two-finger pressure by the patient (M0) (variation of −18.57%, 95%CI: −14.09 to −4.77mmHg, P<.001). Intra-access pressure generated by the direct two-finger pressure method showed a decreasing trend along the hemostasis process (M3-M0: −8.82mmHg, P<.001; M6-M0: −12.55mmHg, P<.001). Conclusion: An adjustable fistula arm clamp generates a lower pressure in AVF than the direct two-finger pressure applied by the patient. The latter showed a decreasing trend along the hemostasis process. These data suggest that some of the recommendations from clinical guidelines could be based on inaccurate premises. (AU)
Subject(s)
Humans , Hemostasis , Arteriovenous Fistula , Renal Dialysis , Cross-Sectional Studies , Epidemiology, Descriptive , Bleeding TimeABSTRACT
BACKGROUND AND OBJECTIVES: To evaluate the pressure generated by an adjustable hemostasis clamp on arteriovenous fistulas (AVF) during the hemostasis proccess, and compare it with the direct two-finger pressure applied by the patient. To evaluate the variations of the direct two-finger pressure along the hemostasis process. METHODS: We analyzed data obtained in 51 hemodialysis procedures from 15 patients. AVF intraaccess pressure was used as indirect indicator of the pressure generated by both methods. It was recorded before venous needle removal (PBasal), at clamp application (P1), after clamp adjustement by a nurse (P2), at the beginning of the direct two-finger pressure by the patient (M0), after 3â¯min of two-finger pressure (M3) and after 6â¯min of two-finger pressure (M6). RESULTS: Intra-access pressure was lower with the adjusted clamp (P2) than with the direct two-finger pressure by the patient (M0) (variation of -18.57%, 95%CI -14.09 to -4.77â¯mmHg, Pâ¯<â¯0.001). Intraaccess pressure generated by the direct two-finger pressure method showed a decreasing trend along the hemostasis process (M3-M0: -8.82â¯mmHg, Pâ¯<â¯0.001; M6-M0: -12.55â¯mmHg, Pâ¯<â¯0.001). CONCLUSION: An adjustable fistula arm clamp generates a lower pressure in AVF than the direct two-finger pressure applied by the patient. The latter showed a decreasing trend along the hemostasis process. These data suggest that some of the recommendations from clinical guidelines could be based on inaccurate premises.
