Vascular Access Placement Order and Outcomes in Hemodialysis Patients: A Longitudinal Study.
CONCLUSIONS: HD vascular access outcomes differ based on the sequence of placement. In spite of frequent AVA placements, only half of patients effectively achieved a "permanent" vascular access and used an AVA for the majority of HD treatments. PMID: 28930719 [PubMed - as supplied by publisher]
Conclusion: High ScvO2 variability during dialysis is associated with increased all-cause mortality.Blood Purif
Conclusion: Our results indicate the potential utility of ScvO2 and eUBBF to track the hemodynamic response to AVF maturation. To what extent these insights translate into shortening of the time between AVF creation and successful cannulation warrants further investigations.Blood Purif
Conclusion: The infection rate in CVC HD is not more frequent in HIV-infected patients, provided that CD4+ count is ≥ 200 cells/µL and the patient is virologically suppressed. Outcomes following intravenous antibiotic and removal of the CVC are similar in HIV-infected and non-infected patients but response to treatment is slower in HIV-infected patients. A high index of suspicion is needed in detecting CVC-related bacteraemia.
CONCLUSION:: Immature arteriovenous fistulas can be successfully salvaged by aggressive and timely endovascular intervention. Mixed stenosis is associated with poor access outcomes. PMID: 30444167 [PubMed - as supplied by publisher]
Conclusions: Central venous access device complications and device failure is a prevalent and significant problem in the adult ICU, leading to substantial patient harm and increased healthcare costs. The high proportion of central venous access devices removed due to suspicion of infection, despite low overall central line-associated bloodstream infection and catheter-related bloodstream infection rates, indicates a need for robust practice guidelines to inform decision-making surrounding removal of central venous access devices suspected of infection.
ConclusionsGiven our decision-making threshold, both open and endovascular procedures are associated with relatively low morbidity and high efficacy for treatment of central venous occlusion in both symptomatic VTOS and AV access-associated subclavian vein disease. Restenosis is common in patients with a patent ipsilateral hemodialysis access.
Authors: Piccoli GB, Cabiddu G, Gallieni M Abstract Pregnancy in dialysis patients is a rare but important event that challenges our knowledge and demands re-thinking many aspects of our practice, including vascular access. This editorial briefly discusses some open questions on vascular access in this situation that challenge the motto 'fistula first' and underline the need for personalised approaches. Information on vascular access in pregnant women is scant. Different approaches may be considered between women on dialysis already on a well-functioning tunnelled catheter and newly placed catheters: while a tunnel...
AbstractTunneled central venous catheters used for the provision of hemodialysis are associated with excess morbidity and mortality. Catheter related exit site and blood stream infections are major risks of their use. Although catheter ‐avoidance is the best strategy to reduce infections and mortality in the hemodialysis population, the use of catheters remains unacceptably high.In this review, the existing clinical practice guidelines for the prevention of hemodialysis catheter associated infections are outlined, and a comprehensive evidenced ‐based summary of interventions is provided. This includes details about the...
Uninsured patients who start in-center hemodialysis with a central venous catheter are less likely than those already on Medicare or Medicaid to obtain arteriovenous fistulas (AVF) or grafts (AVG) by their fourth month of dialysis, when they become Medicare eligible, according to a new study.Reuters Health Information
Rationale: Lithium has been used to treat bipolar disorder. Lithium has a narrow therapeutic index, with a therapeutic level between 0.6 and 1.5 mEq/L. The possible complications of lithium overdose include altered mental status, hand tremor, muscle weakness, nausea, vomiting, diarrhea, seizure, syncope, and arrhythmia. Lithium intoxication can be fatal and is difficult to diagnose in patients without a history of lithium intake. The occurrence of serious cardiac arrhythmias is rare in lithium intoxication. Patient concerns: An 81-year-old man was brought to the emergency department because of consciousness disturba...