Rescate de un acceso vascular para hemodiálisis. A propósito de un caso / Recuing a vascular Access for hemodialysis. Report of a case

El mejor acceso vascular (AV) para hemodiálisis (HD) es, sin duda, la fístula arteriovenosa interna nativa (FAVI) ya que presenta más ventajas y menos complicaciones que otros accesos vasculares. Enfermería, gracias a los protocolos de vigilancia del AV, juega un papel fundamental en la detección temprana de las complicaciones que puedan llevar a la pérdida del mismo. Realizamos este estudio con dos objetivos: 1) Dar a conocer un caso clínico de una FAVI en el que aparecieron sucesivamente varias complicaciones. 2) Analizar la importancia que tiene la existencia de un equipo multidisciplinar para los accesos vasculares, tanto en la realización y seguimiento del mismo como en el tratamiento de las complicaciones que pudieran aparecer. Se estudia a un paciente varón con enfermedad renal crónica estadio V, portador de una FAVI radiocefálica derecha que, en una inspección rutinaria del AV cuando acude a la sesión de HD, enfermería detecta disminución de soplo y thrill apareciendo primero una trombosis, seguida de una estenosis tratada quirúrgicamente y finalmente una grave infección en la herida quirúrgica por un germen Gram negativo. A lo largo del estudio se van presentando las sucesivas complicaciones que surgieron y las estrategias desarrolladas por los miembros del equipo multidisciplinar: enfermeras, nefrólogos y cirujanos vasculares, entre otros, para solventarlas, lo cual finalmente se consiguió llegando a rescatar un acceso vascular que, a priori, dábamos por perdido (AU)

The best vascular access (VA) for hemodialysis (HD) is undoubtedly the native arteriovenous fistula (AVF) as presents more advantages and fewer complications than other vascular access. Nursing, using surveillance protocols of vascular, plays an essential role in the early detection of complications that might lead to their loss. We conducted this study with two objectives: 1) To present a clinical case of an AVF in which appeared on several complications. 2) Analyze the importance of the existence of a multidisciplinary team for vascular access in the implementation and monitoring of the same and in the treatment of possible complications. A male patient in stage five of CKD is studied, bearing a right radiocephalic AVF, which during a routine inspection of the AV when he came to the HD session, nursing detected decreased murmur and thrill appearing thrombosis first followed by stenosis treated surgically and finally a serious infection in the surgical wound by a Gram negative germs. During the study, subsequent complications that emerged and the strategies developed by the members of the multidisciplinary team are being presented: nurses, nephrologists and vascular surgeons, among others, to solve them, which finally got coming to rescue a vascular access a priori lost (AU)

Solid tumours in newborns and infants.

Thirty two cases of solid tumours in newborns and infants were observed by the authors over a 15 year period. The most common type of tumours were soft tissue tumours (n = 8), neuroblastomas (n = 7), nephroblastomas (n = 5) and germ cell tumours (n = 5). Other types of embryonal tumours such as retinoblastoma and hepatoblastoma were observed in four children and non-Hodgkin's lymphomas in three children. Of 25 children followed up 18 survived. Five children died of their tumours and two children died of causes unrelated to their basic disease. Analysis of the fate of the patients and the effect of the therapy is made. It is concluded that malignant tumours prevail in infancy (90.6% of all cases). The percentage of patients treated successfully with insignificant risk for consequences from radiotherapy and chemotherapy is also high (72%).