Validation of the inverse method for the determination of the access flow with thermodilution.

INTRODUCTION: Thermodiluction is a widely used method for measuring vascular access flow (QA). Among the possibilities of TD, the reverse method (MI) can be beneficial in the execution time, without impact on the dialysis efficacy (Kt). However, it is not a sufficiently studied technique. METHOD: Transversal study of 117 arteriovenous fistulas (AVF). Two QA measurements were taken with the method described by the manufacturer (MR) and another with MI. MI is bases in the obtention of an inverted recirculation registry at the beginning of the session and a single subsequent recirculation measurement with the lines in normal position. In the concordance analysis, the Bland-Altman method and Cohen's Kappa index were used. RESULTS: Very good concordance between MR and MI was evidenced for QA below 700 ml/min, but it worsens as flow increases. The median variability between the MR measurements (intra-method variability) was 3.4% (-17.13). This value did not differ from the median variability generated between MR and MI (inter-method variability), which was 2% (-14, 12) (P = 0.287). The degree of agreement between the two to identify AVFs susceptible to intervention was very good (K = 0.834). The time spent using the MI was significantly shorter (P = 0.000) without evidence of variations in the Kt of the measurement sessions (P = 0.201). CONCLUSIONS: The thermodiluction MI is valid to determine the flow of the vascular access, especially in Qa lower than 700 ml/min, with great time savings, simplification of the procedure and without modifying the dialysis efficiency. The variability between the measurement by MR and MI is similar to that of MR. The concordance between methods in identifying potentially pathological AVFs is very good.

Validación del método inverso para la determinación del flujo de acceso con termodilución / Validation of the inverse method for the determination of the access flow with thermodilution

Introducción: La termodilución es un método ampliamente usado para la medición del flujo de acceso vascular (QA). Entre las posibilidades de la termodilución, el método inverso (MI) puede ser beneficioso en el tiempo de ejecución, sin repercusión en la eficacia dialítica (Kt). Sin embargo, no es una técnica lo suficientemente estudiada.MétodoEstudio transversal sobre 117 fístulas arteriovenosas. Se realizaron 2 mediciones de QA con el método descrito por el fabricante (MR) y otra con MI. El MI se basa en la obtención del registro de recirculación invertida al iniciar la sesión y una única medición posterior de recirculación con las líneas en posición normal. En el análisis de concordancia se utilizó el método Bland-Altman y el índice kappa de Cohen.ResultadosSe evidenció muy buena concordancia entre MR y MI para QA inferiores a 700ml/min, pero empeora a medida que aumenta el flujo. La variabilidad mediana entre las mediciones con MR (variabilidad intramétodo) fue del 3,4% (−17,13). Este valor no difirió de la variabilidad mediana generada entre MR y MI (variabilidad intermétodo), que fue del 2% (−14,12) (p=0,287). El grado de acuerdo entre ambos para identificar fístulas arteriovenosas susceptibles de intervención fue muy bueno (kappa=0,834). El tiempo empleado utilizando el MI fue significativamente menor (p=0,000), sin evidenciarse variaciones en el Kt de las sesiones de medida (p=0,201).ConclusionesEl MI de termodilución es válido para determinar el flujo del acceso vascular, especialmente en QA inferiores a 700ml/min, con gran ahorro de tiempo, simplificación del procedimiento y sin modificar la eficacia de diálisis. La variabilidad entre la medición por MR y MI es similar a la propia del MR. La concordancia entre métodos a la hora de identificar fístulas arteriovenosas potencialmente patológicas es muy buena. (AU)

Introduction: Thermodilution is a widely used method for measuring vascular access flow (QA). Among the possibilities of thermodilution, the reverse method (RM) can be beneficial in the execution time, without impact on the dialysis efficacy (Kt). However, it is not a sufficiently studied technique.MethodTransversal study of 117 arteriovenous fistulas. Two QA measurements were taken with the method described by the manufacturer (MR) and another with RM. RM is based on the obtention of an inverted recirculation registry at the beginning of the session and a single subsequent recirculation measurement with the lines in normal position. In the concordance analysis, the Bland-Altman method and Cohen's Kappa index were used.ResultsVery good concordance between MR and RM was evidenced for QA below 700ml/min, but it worsens as flow increases. The median variability between the MR measurements (intra-method variability) was 3.4% (−17.13). This value did not differ from the median variability generated between MR and RM (inter-method variability), which was 2% (−14,12) (P=.287). The degree of agreement between the 2 to identify arteriovenous fistulas susceptible to intervention was very good (Kappa=0.834). The time spent using the RM was significantly shorter (P=.000) without evidence of variations in the Kt of the measurement sessions (P=.201).ConclusionsThe thermodilution RM is valid to determine the flow of the vascular access, especially in QA lower than 700ml/min, with great time savings, simplification of the procedure and without modifying the dialysis efficiency. The variability between the measurement by MR and RM is similar to that of MR. The concordance between methods in identifying potentially pathological arteriovenous fistulas is very good. (AU)

Validation of the inverse method for the determination of the access flow with thermodilution. / Validación del método inverso para la determinación del flujo de acceso con termodilución.

INTRODUCTION: Thermodilution is a widely used method for measuring vascular access flow (QA). Among the possibilities of thermodilution, the reverse method (RM) can be beneficial in the execution time, without impact on the dialysis efficacy (Kt). However, it is not a sufficiently studied technique. METHOD: Transversal study of 117 arteriovenous fistulas. Two QA measurements were taken with the method described by the manufacturer (MR) and another with RM. RM is based on the obtention of an inverted recirculation registry at the beginning of the session and a single subsequent recirculation measurement with the lines in normal position. In the concordance analysis, the Bland-Altman method and Cohen's Kappa index were used. RESULTS: Very good concordance between MR and RM was evidenced for QA below 700ml/min, but it worsens as flow increases. The median variability between the MR measurements (intra-method variability) was 3.4% (-17.13). This value did not differ from the median variability generated between MR and RM (inter-method variability), which was 2% (-14,12) (P=.287). The degree of agreement between the 2 to identify arteriovenous fistulas susceptible to intervention was very good (Kappa=0.834). The time spent using the RM was significantly shorter (P=.000) without evidence of variations in the Kt of the measurement sessions (P=.201). CONCLUSIONS: The thermodilution RM is valid to determine the flow of the vascular access, especially in QA lower than 700ml/min, with great time savings, simplification of the procedure and without modifying the dialysis efficiency. The variability between the measurement by MR and RM is similar to that of MR. The concordance between methods in identifying potentially pathological arteriovenous fistulas is very good.

Actuación de enfermería ante un paciente con calcifilaxis / No disponible

No disponible

Manifestaciones dérmicas en hemodiálisis. Cuidados de enfermería ¿nuevo enfoque? / Dermic manifestations in haemodialysis. Nursing care - a new approach?

Las lesiones vasculares periféricas son frecuentes en pacientes de edad avanzada y con insuficiencia renal de larga evolución, asociadas o no con hiperparatiroidismo y/o alteraciones metabólicas. El progresivo envejecimiento de la población en hemodiálisis nos hace suponer, que en los próximos años se produzca un incremento en la aparición de lesiones dermatológicas asociadas a patología vascular. Este estudio observacional y retrospectivo intenta registrarla prevalencia en nuestra unidad de lesiones cutáneas durante los últimos tres años y reflejar los cuidados de enfermería, que sin un protocolo previo establecido, se han desarrollado. Nuestros resultados muestran que el 15% de los pacientes presentaron lesiones cutáneas. El 27% eran diabéticos, 27% presentaban patología vascular periférica, 29% hiperparatiroidismo, de los que el 40% desarrollaron lesiones de calcifilaxia. Observamos desde una pequeña pápula hasta lesiones más evolucionadas de ulceras con tejido necrótico que empezamos a tratar de forma empírica con curas locales, cobertura profiláctica antibiótica y analgesia oral o iv, sila precisaba el paciente. El diagnóstico etiológico confirmó que el 47% ya presentaban isquemia grado IV y un 33% lesión histológica de calcifilaxis. Por ello, nos planteamos incorporar protocolos para el cuidado de lesiones dérmicas en hemodiálisis

Peripheral vascular injuries are common in elderly patients with chronic renal failure, whether or not associated to hyperparathyroidism and/or metabolic alterations. The progressive ageing of the populations on haemodialysis leads us to assume that in future years an increase will occur in the appearance of dermatological injuries associated to vascular pathology. This observational and retrospective study tries to record the prevalence in our unit of skin injuries during the last three years and to reflect the nursing care that has been developed, without a previously established protocol. Our results show that 15% of patients showed skin injuries.27% were diabetic, 27% suffered from peripheral vascular pathology, 29% had hyperparathyroidism, of whom 40%developed calciphylaxia. We observed from a small papule to more developed ulcers with necrotic tissue which we started to treat empirically with local treatment, preventive antibiotic cover and oral or IV analgesic, if the patient needed it. The etiological diagnosis confirmed that 47% already had 4th degree ischemia and 33% calciphylaxis histologicalinjury. Accordingly, we considered introducing protocols for the care of skin injuries in hemodialysis

Cumplimiento de las actividades preventivas y de promoción de la salud en un centro de hemodiálisis / Fulfilment of the activities of prevention and health promotion in a haemodialysis unit

Las actividades de prevención y promoción de la salud son abordadas en la población general por el Programa de Actividades Preventivas y de Promoción de la Salud (PAPPS). Los pacientes en hemodiálisis (HD), por su elevada comorbilidad y alteración inmunológica deberían tener un elevado cumplimento de las mismas. El objetivo de nuestro trabajo fue conocer mediante un estudio observacional transversal en 72 pacientes en HD extrahospitalaria el cumplimiento de algunas actividades del subprograma del adulto de los PAPPS. Resultados. Recomendaciones sobre el estilo de vida: tabaquismo, el 19.4% fumaban una media de 14.78 cigarrillos/día. Alcohol, el 41.7% eran consumidores con una media de 106.08+/-87.1gr/semana en varones y 79.6+/-91 gr/semana en mujeres. Programa de prevención del cáncer: cáncer de mama, la media de cumplimiento global fue del 54.4%; el 42.8% de forma completa, el35.7% de forma incompleta y el 21.4% no tenía ninguna mamografía. Cáncer de cerviz, la media de cumplimiento global fue 59%; el 56.2% con cumplimiento del 100%, el 43.7% de forma incompleta y el 18.75% de pacientes no se había realizado ninguna citología cervico-vaginal. Programa de prevención de enfermedades infecciosas: un19.4% estaban vacunados frente al neumococo;22.2% frente al tétanos-difteria; 73.6% frente a la gripe y el 97.7% frente a la Hepatitis B. Actividades preventivas de alteraciones de la visión en los mayores: la media de cumplimiento fue del30.34%; el 13.6% de forma completa; el 52.3% deforma incompleta y el 34.1 % no tenía ninguna revisión oftalmológica. El cumplimiento de las recomendaciones de lo sPAPPS en HD es bajo. Enfermería debería tomar un papel activo en el incremento de estas actividades

Prevention and health promotion activities are dealt with in the general population by the Programme of Preventive Activities and Health Promotion (PAPPS).Given their high joint morbility and immunological alteration, patients in haemodialysis (HD) should be highly compliant. The aim of our work was to use a transversal observational study on 72 patients in out patientHD to see the fulfilment of some activities of the adult sub-programme of the PAPPS. Results. Recommendations on lifestyle: smoking, 19.4% smoked an average 14.78 cigarettes/day. Alcohol, 41.7% were consumers of an average106.08+/-87.1 g/week in men and 79.6+/-91 g/week in women. Cancer prevention programme: breast cancer, average overall fulfilment was 54.4%; 42.8% completely, 35.7% incompletely and 21.4%had no mammography. Cervical cancer, average overall fulfilment was 59%; 56.2% fulfilling 100%, 43.7%incompletely and 18.75% of patients had had no kind of cervico-vaginal cytology. Infectious disease prevention programme: 19.4% were vaccinated against pneumococo; 22.2% against tetanus-diphtheria; 73.6% against influenza and 97.7% against Hepatitis B. Activities to prevent alternations in the vision of the elderly: average fulfilment was30.34%; 13.6% completely; 52.3% incompletely and34.1 % had no ophthalmologic revision. Compliance with the recommendations of the PAPPS in HD is low. Nursing should take an active role in increasing these activities