Optimal timing for vascular access creation

2017 ◽  
Vol 18 (1_suppl) ◽  
pp. S29-S33 ◽  
Author(s):  
Tamara K. Jemcov ◽  
Wim Van Biesen
Keyword(s):  
Vascular Access ◽  
Prediction Models ◽  
Venous Catheter ◽  
Successful Outcome ◽  
Easy Access ◽  
Patient Specific ◽  
Optimal Timing ◽  
Vascular Surgeon ◽  
Local Conditions ◽  
Number Of Patients

Many guidelines recommend that end-stage renal disease (ESRD) patients should have a permanent vascular access, preferably an autologous arteriovenous fistula (AVF), at the start of renal replacement therapy. Nevertheless, a large proportion of patients still start hemodialysis with a central venous catheter (CVC). On the other hand, there are increasing numbers of patients in whom an AVF has been created, but who never actually end up on dialysis, as well as a substantial number of patients in whom creation of a vascular access has been attempted unsuccessfully. To improve this situation, timely exploration to assess suitability for and creation of preemptive AVF should be promoted. Decision to construct an AVF should depend on the likelihood and rate of progression to ESRD. For this goal, some reliable prediction models are available. Also, the likelihood that such an attempt will result in a successful outcome should be taken into account, but suitable validated models to accurately make such estimates are lacking. Next to patient-specific factors, some local conditions such as easy access to a vascular surgeon should also be incorporated in the decision-making process between the nephrology team and the patient.

scholarly journals Indwelling Device-Associated Biofilms in Critically Ill Cancer Patients—Study Protocol

Pathogens ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 306
Author(s):  
Olguta Lungu ◽  
Ioana Grigoras ◽  
Olivia Simona Dorneanu ◽  
Catalina Lunca ◽  
Teodora Vremera ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Critically Ill ◽  
Pathogen Detection ◽  
Venous Catheter ◽  
Successful Outcome ◽  
Patient Specific ◽  
Clinical Value ◽  
Current Standard ◽  
Sepsis Management ◽  
Microorganism Identification

Health care-associated infections are a leading cause of inpatient complications. Rapid pathogen detection/identification is a major challenge in sepsis management that highly influences the successful outcome. The current standard of microorganism identification relies on bacterial growth in culture, which has several limitations. Gene sequencing research has developed culture-independent techniques for microorganism identification, with the aim to improve etiological diagnosis and, therefore, to change sepsis outcome. A prospective, observational, non-interventional, single-center study was designed that assesses biofilm-associated pathogens in a specific subpopulation of septic critically ill cancer patients. Indwelling device samples will be collected in septic patients at the moment of the removal of the arterial catheter, central venous catheter, endotracheal tube and urinary catheter. Concomitantly, clinical data regarding 4 sites (nasal, pharyngeal, rectal and skin) of pathogen colonization at the time of hospital/intensive care admission will be collected. The present study aims to offer new insights into biofilm-associated infections and to evaluate the infection caused by catheter-specific and patient-specific biofilm-associated pathogens in association with the extent of colonization. The analysis relies on the two following detection/identification techniques: standard microbiological method and next generation sequencing (NGS). Retrospectively, the study will estimate the clinical value of the NGS-based detection and its virtual potential in changing patient management and outcome, notably in the subjects with missing sepsis source or lack of response to anti-infective treatment.

scholarly journals High rate of native arteriovenous fistulas: How to reach this goal?

2015 ◽  
Vol 143 (3-4) ◽  
pp. 226-229
Author(s):  
Tamara Jemcov ◽  
Marija Milinkovic ◽  
Igor Koncar ◽  
Ilija Kuzmanovic ◽  
Nenad Jakovljevic ◽  
...  
Keyword(s):  
Vascular Access ◽  
Continuous Process ◽  
Venous Catheter ◽  
Medical Personnel ◽  
High Rate ◽  
Central Venous ◽  
Vascular Surgeon ◽  
Arteriovenous Fistulas ◽  
Clinical Center

The types of vascular accesses for hemodialysis (HD) include the native arteriovenous fistula (AVF), arteriovenous graft (AVG) and central venous catheter (CVC). Adequately matured native AVF is the best choice for HD patients and a high percentage of its presence is the goal of every nephrologist and vascular surgeon. This paper analyses the number and type of vascular accesses for HD performed over a 10-year period at the Clinical Center of Serbia, and presents the factors of importance for the creation of such a high number of successful native AVF (over 80%). Such a result is, inter alia, the consequence of the appointment of the Vascular Access Coordinator, whose task was to improve the quality of care of blood vessels in the predialysis period as well as of functional vascular accesses, and to promote the cooperation among different specialists within the field. Vascular access is the ?lifeline? for HD patients. Thus, its successful planning, creation and monitoring of vascular access is a continuous process that requires the collaboration and cooperation of the patient, nephrologist, vascular surgeon, radiologist and medical personnel.

P1366THE ROLE OF A NEPHROLOGIST IN THE CREATION OF VASCULAR ACCESS FOR HEMODIALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Gennadii Fomenko
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vascular Access ◽  
Kidney Diseases ◽  
Kidney Injury ◽  
Venous Catheter ◽  
Vascular Surgeon ◽  
Dialysis Unit ◽  
The Creation ◽  
Set Up

Abstract Background and Aims The creation of vascular access: has it anything to do with a nephrologist ? At first glance, the concept of vascular access is the responsibility of surgical specialists. However, a nephrologist has started executing some of the common intensive treatment methods, using the equipment and techniques, specific to the field of dialysis. In this case, a nephrology specialist sets up different kinds of vascular access, namely the AV (arteriovenous) fistula, the AV graft, and the venous catheter; he/she is, therefore, responsible for its assessment and congruent correction. Method the usage of statistical data, gathered by the medical specialists of the dialysis unit of the Regional Chernihiv Hospital; the analysis of the possible nephrologist’s contribution to the creation of vascular access in patients with kidney diseases. Results During 2017-2019, 332 catheterizations were performed, during each of them vascular access was established: Conclusion 1. A nephrologist, in collaboration with a vascular surgeon, is particularly interested in the creation of vascular access in a patient with chronic kidney disease at the pre-dialysis stage; 2. In most cases, a nephrologist can set up temporary or permanent vascular access in patients with chronic kidney disease or acute kidney injury, which improves the quality of hemodialysis by making him an active participant of the treatment process.

scholarly journals Vascular access parameters among prevalent dialysis patients: a single center survey

2020 ◽  
Vol 10 (2) ◽  
pp. 120-124
Author(s):  
Tanveer Bin Latif ◽  
Tanvir Rahman
Keyword(s):  
Vascular Access ◽  
Venous Catheter ◽  
Maintenance Hemodialysis ◽  
Similar Data ◽  
Age Group ◽  
Dialysis Unit ◽  
Medical Graduates ◽  
Number Of Patients ◽  
Venous Fistula ◽  
Access Surgery

Background: Vascular access is one of the most important outcome determinant of patients on hemodialysis. In Bangladesh increasingly more patients are started on hemodialysis as a lifesaving procedure. But we lack organized data on different aspects of dialysis practice. Data related to vascular access is even more scanty. Method: A survey was undertaken in one of the busy dialysis centers in Dhaka with a large number of patients on maintenance hemodialysis .Data were collected by doctors in dialysis units from patients along with records kept in the dialysis unit during November and December 2017. Results: Total 143 patients were included. 53% of these patients belonged to age group 61 to 80 years, 39% to age group 41 to 60 years; 56.6 % female and 43.4% male. 73.4% of the study patients received dialysis via central venous catheter at the initiation. But among the prevalent patients during study period, 84% patient were receiving dialysis via arterio-venous fistula and 5% via arterio-venous graft as permanent vascular access. Among these permanent vascular access left forearm was used in 47% and left upper arm in 33% of cases. Vascular ultrasound mapping before permanent access creation was done in only about 40% of cases. Almost 56 % of the vascular access surgery was done by experienced medical graduates in vascular access creation without any post graduate surgical qualifications. Conclusion: Vascular access data should be collected in a structured manner so that dialysis practice pattern of different centers and regions of the country can be compared. Similar data from several centers around the country will increase scope of improvement . Birdem Med J 2020; 10(2): 120-124

Options for end stage vascular access: Translumbar catheter, arterial-arterial access or right atrial graft?

2019 ◽  
Vol 21 (1) ◽  
pp. 7-18 ◽  
Author(s):  
Nicholas Inston ◽  
Aurangzaib Khawaja ◽  
Hiren Mistry ◽  
Robert Jones ◽  
Domenico Valenti
Keyword(s):  
Vascular Access ◽  
Treatment Options ◽  
Venous Catheter ◽  
Right Atrial ◽  
Secondary Patency ◽  
Dialysis Access ◽  
Arterial Access ◽  
Secondary Patency Rate ◽  
Number Of Patients ◽  
End Stage

Background: Running out of vascular access for dialysis is thankfully rare, but despite this, most units will have a number of patients with few options and in a precarious state. The increasing longevity of dialysis patients portends more patients will reach minimal access options. End stage vascular access is poorly defined but classification may enable assessment and comparison of treatment options. Three options for patients with end stage access are a central venous catheter through a translumbar or transhepatic route, arterial-arterial prosthetic loop or a right atrial graft. Aims: The aims of this study are to provide a structured review of evidence for these procedures to allow application and guide practice for patients with end stage vascular access. Methods: A standardised search of published literature was performed of relevant studies. In addition, the references cited in those papers were assessed for any further available articles. All study types were included and reviewed by two authors independently. Primary outcomes were patient survival and secondary patency rate at 3 and 12 months. Secondary outcomes were long-term patency rates, mean time to cannulation and complications such as access dysfunction, thrombosis and infection. Summary: Based on the available evidence, it would appear that arterial-arterial prosthetic loop is a definitive option for maintaining dialysis access in patients with no more arteriovenous access options. Translumbar and transhepatic dialysis catheters may offer short- and medium-term options and right atrial grafts may also be suitable as an option where arterial-arterial prosthetic loop is unsuitable.

Secondary medical prevention in patients with peripheral arterial disease - Prescriptions of vascular surgeons and medical doctors (angiologists) in a multidisciplinary vascular centre

VASA ◽  
2010 ◽  
Vol 39 (2) ◽  
pp. 145-152 ◽  
Author(s):  
Klein-Weigel ◽  
Gutsche-Petrak ◽  
Wolbergs ◽  
Köning ◽  
Flessenkamper
Keyword(s):  
Peripheral Arterial Disease ◽  
Oral Anticoagulants ◽  
Arterial Disease ◽  
Disease Stage ◽  
Channel Blockers ◽  
Medical Doctors ◽  
Vascular Surgeon ◽  
Medical Prevention ◽  
Number Of Patients ◽  
Peripheral Arterial

Background: We compared medical secondary prevention in patients with peripheral arterial disease stage II (Fontaine) located in the femoro-popliteal artery managed by vascular surgeons and medical doctors / angiologists in our multidisciplinary vascular center. Patients and methods: We retrospectively analyzed demission protocols of in-hospital treatments between 01.01.2007 and 20.06.2008. Results: We surveyed 264 patients (54.2 % women; mean age 67.52 ± 8.98 yrs), 179 (67.8 %) primarily treated by medical doctors / angiologists and 85 (32.2 %) primarily managed by vascular surgeons. Medical doctors / angiologists treated more women (n = 109) than men (n = 34), (p = 0.002) and documented smoking and diabetes mellitus more often (p < 0.001) than vascular surgeons. Besides, patients had similar cardiovascular risk profiles and concomitant diseases, vascular surgeons prescribed 5.47 ± 2.26 drugs, medical doctors / angiologists 6.37 ± 2.67 (p = 0.005). Overall, 239 (90.5 %) patients were on aspirin, 180 (68.2 %) on clopidogrel, and 18 (6.9 %) on oral anticoagulants. Significantly more patients treated by medical doctors / angiologists received clopidogrel (169 versus 11; p < 0.001), significantly more surgical patients received oral anticoagulants (11 versus 7; p = 0.016). The number of patients without prescriptions for any antithrombotic therapy was 6 (6.9 %) in patients treated by vascular surgeons and 0 (0 %) in patients managed by medical doctors / angiologists (p = 0.001). Prescription-rates of β-blockers, ACE-inhibitors, Angiotensin II-antangonists, calcium channel blockers, and diuretics were statistically not different between the two disciplines, but statins were prescribed significantly more often by medical doctors / angiologists (139 versus 49; p < 0001). With the exceptions of Clopidogrel (women > men) and diuretics (men > women) we observed no gender-specific prescriptions. Conclusions: We observed high prescriptions rates of secondary medical prevention in patients primarily treated by medical doctors / angiologists and vascular surgeons. We believe that this result is highly influenced by our multidisciplinary approach. Nevertheless, efforts have to be made to raise vascular surgeon’s awareness of statin use and complete prescription of antithrombotic and antiplatelet drugs.

scholarly journals Current status of vascular access in Japan—from Dialysis Access Symposium 2017

2019 ◽  
Vol 20 (1_suppl) ◽  
pp. 38-44
Author(s):  
Mizuya Fukasawa
Keyword(s):  
Vascular Access ◽  
Current Status ◽  
Good Survival ◽  
Chronic Glomerulonephritis ◽  
Dialysis Access ◽  
Dialysis Patients ◽  
Survival Prognosis ◽  
Access Methods ◽  
Number Of Patients ◽  
Wide Range

At the second Dialysis Access Symposium held in Nagoya, Japan, a proposal was made to investigate the differences in vascular access methods used in different countries. In this article, we describe the management of vascular access in Japan. The Japanese population is rapidly aging, and the proportion of elderly patients on dialysis is also increasing. There were 325,000 dialysis patients in Japan at the end of 2015, of whom 65.1% were aged 65 years or above. The number of patients with diabetic nephropathy or nephrosclerosis as the underlying condition is also increasing, whereas the number with chronic glomerulonephritis is steadily decreasing. The Japanese health insurance system enables patients to undergo medical treatment at almost no out-of-pocket cost. Percutaneous transluminal angioplasty suffers from a severe device lag compared with other countries, but although there are limitations on permitted devices, the use of those that have been authorized is covered by medical insurance. One important point that is unique to Japan is that vascular access is performed and managed by doctors involved in dialysis across a wide range of disciplines, including nephrologists, surgeons, and urologists. This may be one factor contributing to the good survival prognosis of Japanese dialysis patients.

scholarly journals Perioperative Management of Chronic Antithrombotic Agents in Elective Hip and Knee Arthroplasty

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 188
Author(s):  
Daniel C. Santana ◽  
Matthew J. Hadad ◽  
Ahmed Emara ◽  
Alison K. Klika ◽  
Wael Barsoum ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Perioperative Management ◽  
Recent Literature ◽  
Patient Specific ◽  
Antithrombotic Agents ◽  
Coronary Syndrome ◽  
Risk Of Bleeding ◽  
Post Operative Period ◽  
Number Of Patients ◽  
Hip And Knee Arthroplasty

Total hip and knee arthroplasty are common major orthopedic operations being performed on an increasing number of patients. Many patients undergoing total joint arthroplasty (TJA) are on chronic antithrombotic agents due to other medical conditions, such as atrial fibrillation or acute coronary syndrome. Given the risk of bleeding associated with TJAs, as well as the risk of thromboembolic events in the post-operative period, the management of chronic antithrombotic agents perioperatively is critical to achieving successful outcomes in arthroplasty. In this review, we provide a concise overview of society guidelines regarding the perioperative management of chronic antithrombotic agents in the setting of elective TJAs and summarize the recent literature that may inform future guidelines. Ultimately, antithrombotic regimen management should be patient-specific, in consultation with cardiology, internal medicine, hematology, and other physicians who play an essential role in perioperative care.

scholarly journals Bayesian adaptive design of early-phase clinical trials for precision medicine based on cancer biomarkers

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Shinjo Yada
Keyword(s):  
Neural Network ◽  
Clinical Trials ◽  
Precision Medicine ◽  
Early Phase ◽  
Patient Specific ◽  
Specific Gene ◽  
Cancer Type ◽  
Background Characteristics ◽  
Number Of Patients ◽  
Early Phase Clinical Trials

Abstract Cancer tissue samples obtained via biopsy or surgery were examined for specific gene mutations by genetic testing to inform treatment. Precision medicine, which considers not only the cancer type and location, but also the genetic information, environment, and lifestyle of each patient, can be applied for disease prevention and treatment in individual patients. The number of patient-specific characteristics, including biomarkers, has been increasing with time; these characteristics are highly correlated with outcomes. The number of patients at the beginning of early-phase clinical trials is often limited. Moreover, it is challenging to estimate parameters of models that include baseline characteristics as covariates such as biomarkers. To overcome these issues and promote personalized medicine, we propose a dose-finding method that considers patient background characteristics, including biomarkers, using a model for phase I/II oncology trials. We built a Bayesian neural network with input variables of dose, biomarkers, and interactions between dose and biomarkers and output variables of efficacy outcomes for each patient. We trained the neural network to select the optimal dose based on all background characteristics of a patient. Simulation analysis showed that the probability of selecting the desirable dose was higher using the proposed method than that using the naïve method.

Hemodynamics Alterations Induced by Central Venous Catheter in Vascular Access for Hemodialysis

2021 ◽  
Author(s):  
Saulo Gonçalves ◽  
Mário Silva ◽  
Matheus Costa ◽  
Thabata Lucas ◽  
Rudolf Huebner
Keyword(s):  
Central Venous Catheter ◽  
Vascular Access ◽  
Venous Catheter ◽  
Central Venous
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