The number of patients with chronic kidney disease re-quiring renal replacement therapy has increased world-wide. The most common replacement therapy is hemo-dialysis （HD）. Vascular access （VA） has a key role for ...The number of patients with chronic kidney disease re-quiring renal replacement therapy has increased world-wide. The most common replacement therapy is hemo-dialysis （HD）. Vascular access （VA） has a key role for successful treatment. Despite the advances that have taken place in the feld of the HD procedure, few things have changed with regards to VA in recent years. Ar-teriovenous fstula （AVF）, polytetrafuoroethylene graft and the cuffed double lumen silicone catheter are the most common used for VA. In the long term, a number of complications may present and more than one VA is needed during the HD life. The most common com-plications for all of VA types are thrombosis, bleeding and infection, the most common cause of morbidity in these patients. It has been estimated that VA dysfunc-tion is responsible for 20% of all hospitalizations. The annual cost of placing and looking after dialysis VA in the United States exceeds 1 billion dollars per year. A good functional access is also vital in order to deliver adequate HD therapy. It seems that the native AVF that Brescia and Cimino described in 1966 still remains the frst choice for VA. The native forearm AVFs have the longest survival and require the fewest interventions. For this reason, the forearm AVF is the frst choice, fol-lowed by the upper-arm AVF, the arteriovenous graft and the cuffed central venous catheter is the final choice. In conclusion, VA remains the most importantissue for patients on HD and despite the technical im-provements, a number of problems and complications have to be resolved.展开更多
Background: Chemotherapy in colorectal cancer is usually administered as continuous infusion of 5-fluorouracil, often in combination with oxaliplatin or irinotecan. Targeted drugs are most efficient and tolerable in c...Background: Chemotherapy in colorectal cancer is usually administered as continuous infusion of 5-fluorouracil, often in combination with oxaliplatin or irinotecan. Targeted drugs are most efficient and tolerable in conjunction with continuous infusion dosing. Implanted venous access devices (VAD) are the prerequisite for continuous infusion administration. The reported catheter migration frequency with VAD is 0% - 3.5%. The purpose of this case-control study was to evaluate the predisposing factors of catheter migration. Methods: We inserted VADs in 88 radically operated colorectal cancer patients randomized to adjuvant 48-hour-infusion chemotherapy repeated every 14 days, altogether 12 times over 24 weeks. Three out of 88 patients (3.4%) had a symptomatic catheter migration from the superior caval vein into the internal jugular vein. The fourth case had chemotherapy for osteosarcoma. These 4 cases were compared with 12 controls from the same 88 patient study population, matched for age, sex, body mass index (BMI), physical activity level and right subclavian insertion site. Tip position, port model, complications, catheter length and material was studied. The post insertion catheter tip position in the chest X-ray was numbered from 1 (in subclavia) to 8 (in atrium). Results: The four cases, all male, had a median position of 3 (range 3 - 4) and controls 6 (range 4 - 8), P = 0.004, median difference 3 (CI95% 1 - 5). At notification of migration the patients had experienced discomfort in the neck region starting 5 to15 days before at strenuous upper extremities activity with Valsalva maneuvers. Conclusion: Optimal catheter tip position when sitting is in the right atrium or low in the superior vena cava to avoid migration. Patients with VADs should avoid strenuous activity with Valsalva maneuvers.展开更多
In the daily nursing work, we can easily find that the one-sided physical nursing for patients with diabetic nephropathy and blood purification is almost unsatisfactory, and the medical mechanism has gradually changed...In the daily nursing work, we can easily find that the one-sided physical nursing for patients with diabetic nephropathy and blood purification is almost unsatisfactory, and the medical mechanism has gradually changed. Humanistic nursing is an important part of modern nursing. We know what the needs of patients are and what negative factors they have.Humanistic nursing can effectively help improve the quality of medical care.In the process of blood purification treatment for patients with nephropathy, the use of process management can effectively improve the quality of nursing. This scheme is worthy of clinical application and popularization.展开更多
Objective:This paper mainly analyzes the effect of infrared radiation combined with external application nursing on maintenance of vascular access in hemodialysis patients.Methods:A total of 150 hemodialysis patients ...Objective:This paper mainly analyzes the effect of infrared radiation combined with external application nursing on maintenance of vascular access in hemodialysis patients.Methods:A total of 150 hemodialysis patients in our hospital from December 2019 to September 2020 were divided into the conventional group and the study group,75 cases in each group.The conventional group was given external application nursing alone,and the study group was given infrared radiation combined with external application nursing,and the effect on the maintenance of vascular access was counted.Results:After the intervention,the indexes of URR,kt/V and human albumin in the study group were higher than those in the routine group,and the indexes of β2-mg and MIS in the study group were lower than those in the routine group,P<0.05;The improvement of vascular elasticity and quality of life in the study group was higher than that in the conventional group,and the incidence of complications was lower than that in the conventional group,P<0.05.Conclusion:Infrared radiation combined with external application of nursing care in hemodialysis patients with vascular access maintenance effect is significant,can effectively improve vascular elasticity.展开更多
Objective: to implement the whole process follow-up nursing intervention in the continuous quality improvement of vascular access in maintenance hemodialysis and observe the application effect. Methods: the selected p...Objective: to implement the whole process follow-up nursing intervention in the continuous quality improvement of vascular access in maintenance hemodialysis and observe the application effect. Methods: the selected personnel were selected from dialysis patients who received treatment in our hospital in recent one year ( January 2021- January 2022), and were given whole process follow-up nursing intervention. Results: after the corresponding nursing intervention, hemodialysis was carried out smoothly, the level of coagulation indexes showed a good trend, and the incidence of complications was low, which further promoted the improvement of their quality of life. Conclusion: in the continuous quality improvement of vascular access in maintenance hemodialysis, the application value of whole process follow-up nursing is obvious. It plays a positive role in improving the treatment effect and improving the medical experience of patients, which is worthy of popularization.展开更多
Objective: for patients with chronic renal failure to use different vascular access methods, and then to explore the effect of different methods. Methods: thirty patients with chronic renal failure (CRF) from January ...Objective: for patients with chronic renal failure to use different vascular access methods, and then to explore the effect of different methods. Methods: thirty patients with chronic renal failure (CRF) from January to December 2018 were selected and divided into two groups. The application of different vascular access methods. Results: the results showed that the recirculation rate of blood urea nitrogen and creatinine in the observation group was better than that in the control group. Conclusion: by treating chronic renal failure patients with intravenous fistula, it can effectively prevent the occurrence of other concurrent symptoms in patients, which is worthy of extensive clinical promotion.展开更多
To investigate the safety and efficacy of chitosan ( Anscare,Daxon) in reducing vascular ac cess complications compared to a kind of radial compression device( TR-BAND,Terumo) . Method: We studied 128 patients who had...To investigate the safety and efficacy of chitosan ( Anscare,Daxon) in reducing vascular ac cess complications compared to a kind of radial compression device( TR-BAND,Terumo) . Method: We studied 128 patients who had undergone transradial angiography in our center from December 2009 to April 2010. Among them,64 patients were randomly treated with radial compression device ( TR-BAND,Terumo) when the procedure was over ( CD group) . The other 64 patients were dealt with chitosan ( CS group) . The compression time,the major and minor access site bleeding complications and the errhysis were observed. Results: There were no statistical differences in the baseline clinical characteristics of the patients between two groups. The compression time in CS group was significantly shorter than that of CD group ( P < 0. 001) . There were 12 patients suffering from minor access site bleeding while only 3 patients experienced these minor complications in CS group( 19% vs 4% ,P < 0. 05) . At the same time 20 patients had er- rhysis in CD group and 4 patients in CS group ( 31% vs 6% ,P < 0. 001) . Conclusion: Chitosan,compared to radial compression device ( TR-BAND,Terumo) ,can not only shorten the compression time,but also significantly reduce the rate of minor access site bleeding and puncture-site errhyis.展开更多
Transcatheter aortic valve implantation(TAVI) using stent-based bioprostheses has recently emerged as a promising alternative to surgical valve replacement in selected patients. The main route for TAVI is retrograde a...Transcatheter aortic valve implantation(TAVI) using stent-based bioprostheses has recently emerged as a promising alternative to surgical valve replacement in selected patients. The main route for TAVI is retrograde access from the femoral artery using large sheaths(16-24 F). Vascular access complications are a clinically relevant issue in TAVI procedures since they are reported to occur in up to one fourth of patients and are strongly associated with adverse outcomes. In the present paper, we review the different types of vascular access site complications associated with transfemoral TAVI. Moreover, we discuss the possible optimal management strategies with particular attention to the relevance of early diagnosis and prompt treatment using endovascular techniques.展开更多
Aim(s): Complex Arteriovenous fistula (AVF) poses challenges to cannulation. Ultrasound (US)-guided cannulation may promote successful cannulation and prevent AVF-related complications. Renal nurses performing US-guid...Aim(s): Complex Arteriovenous fistula (AVF) poses challenges to cannulation. Ultrasound (US)-guided cannulation may promote successful cannulation and prevent AVF-related complications. Renal nurses performing US-guided cannulation may improve successful cannulation and reduce complications associated with unnecessary punctures. The study aims to conduct the meta-analyze to examine the effectiveness of renal nurse-performed US-guided cannulation to improve successful cannulation and reduce AVF-related complications in difficult AVF access. Design: A meta-analysis of randomised controlled trials. Methods: A systemic search was performed on electronic databases including CINAHL Plus, Web of Science, and PubMed from inception to October 2023. Risk ratios (RR) and standardized mean differences (SMD) were estimated using random-effect models for considerable homogeneity, and the Scottish Intercollegiate Guidelines Network (SIGN) methodology was adopted for critical appraisal. Results: Four RCTs were included. The results showed US-guided AVF cannulation had a significant effect in improving successful cannulation (RR: 0.19, 95% CI: 0.06 to 0.63, p = 0.007), and was favorable in reducing cannulation-associated complications (RR: 0.44, 95% CI: 0.10 to 1.93, p = 0.28), compared with blind needle cannulation. Conclusion: US-guided cannulation performed by renal nurses has the potential to improve successful cannulation, and fewer complications in hemodialysis patients with difficult arteriovenous access. Relevance to Clinical Practice: The results suggest the value of further training for renal nurses in US-guided cannulation, and broader implementation of US-guided cannulation to improve patient outcomes. Future studies could explore the optimal nursing training and longer-term benefits of US-guided cannulation by renal nurses in difficult AVF access. Patient or Public Contribution: No Patient or Public Contribution as this is a meta-analysis using the secondary data published in the RCTs.展开更多
Although drug-coated balloons(DCBs)were initially used for treating peripheral vascular diseases,with the growing popularity of the implant-free concept,they have gained increasing attention as a novel therapeutic str...Although drug-coated balloons(DCBs)were initially used for treating peripheral vascular diseases,with the growing popularity of the implant-free concept,they have gained increasing attention as a novel therapeutic strategy for coronary atherosclerotic heart disease.The clinical application scope of DCBs,represented by paclitaxel-coated balloons(PCBs),is constantly expanding.Their application fields are no longer limited to lesions of coronary artery and peripheral vascular diseases,and relevant research is also being actively advanced.In the field of arterial diseases,the application of PCBs has significantly extended.They are used in lower extremity arteries and hemodialysis access and play a role in renal artery fibromuscular dysplasia,and carotid/vertebrobasilar/intracranial arteries.PCBs also show unique value in the treatment of Takayasu arteritis,Kawasaki disease,coronary myocardial bridge,and pulmonary artery diseases.In the venous sys-tem,PCBs also have therapeutic potential,with research and clinical investig-ations now extending to lower extremity,central,and pulmonary vein diseases,and innovative solutions for graft stenosis.The application of PCBs is no longer confined to vascular diseases.They are gradually breaking through traditional boundaries in treating luminal disorders such as urethral,biliary,and esophageal strictures.This mini-review synthesizes existing clinical evidence and basic research findings to concisely analyze the mechanisms of action and biological effects of PCBs in noncoronary applications.A comprehensive analysis of current studies provides a reference for subsequent research and clinical practice in this field and explicitly identifies the challenges faced by current research,explores future directions,and facilitates the in-depth extension of DCB applications.展开更多
文摘The number of patients with chronic kidney disease re-quiring renal replacement therapy has increased world-wide. The most common replacement therapy is hemo-dialysis （HD）. Vascular access （VA） has a key role for successful treatment. Despite the advances that have taken place in the feld of the HD procedure, few things have changed with regards to VA in recent years. Ar-teriovenous fstula （AVF）, polytetrafuoroethylene graft and the cuffed double lumen silicone catheter are the most common used for VA. In the long term, a number of complications may present and more than one VA is needed during the HD life. The most common com-plications for all of VA types are thrombosis, bleeding and infection, the most common cause of morbidity in these patients. It has been estimated that VA dysfunc-tion is responsible for 20% of all hospitalizations. The annual cost of placing and looking after dialysis VA in the United States exceeds 1 billion dollars per year. A good functional access is also vital in order to deliver adequate HD therapy. It seems that the native AVF that Brescia and Cimino described in 1966 still remains the frst choice for VA. The native forearm AVFs have the longest survival and require the fewest interventions. For this reason, the forearm AVF is the frst choice, fol-lowed by the upper-arm AVF, the arteriovenous graft and the cuffed central venous catheter is the final choice. In conclusion, VA remains the most importantissue for patients on HD and despite the technical im-provements, a number of problems and complications have to be resolved.
文摘Background: Chemotherapy in colorectal cancer is usually administered as continuous infusion of 5-fluorouracil, often in combination with oxaliplatin or irinotecan. Targeted drugs are most efficient and tolerable in conjunction with continuous infusion dosing. Implanted venous access devices (VAD) are the prerequisite for continuous infusion administration. The reported catheter migration frequency with VAD is 0% - 3.5%. The purpose of this case-control study was to evaluate the predisposing factors of catheter migration. Methods: We inserted VADs in 88 radically operated colorectal cancer patients randomized to adjuvant 48-hour-infusion chemotherapy repeated every 14 days, altogether 12 times over 24 weeks. Three out of 88 patients (3.4%) had a symptomatic catheter migration from the superior caval vein into the internal jugular vein. The fourth case had chemotherapy for osteosarcoma. These 4 cases were compared with 12 controls from the same 88 patient study population, matched for age, sex, body mass index (BMI), physical activity level and right subclavian insertion site. Tip position, port model, complications, catheter length and material was studied. The post insertion catheter tip position in the chest X-ray was numbered from 1 (in subclavia) to 8 (in atrium). Results: The four cases, all male, had a median position of 3 (range 3 - 4) and controls 6 (range 4 - 8), P = 0.004, median difference 3 (CI95% 1 - 5). At notification of migration the patients had experienced discomfort in the neck region starting 5 to15 days before at strenuous upper extremities activity with Valsalva maneuvers. Conclusion: Optimal catheter tip position when sitting is in the right atrium or low in the superior vena cava to avoid migration. Patients with VADs should avoid strenuous activity with Valsalva maneuvers.
文摘In the daily nursing work, we can easily find that the one-sided physical nursing for patients with diabetic nephropathy and blood purification is almost unsatisfactory, and the medical mechanism has gradually changed. Humanistic nursing is an important part of modern nursing. We know what the needs of patients are and what negative factors they have.Humanistic nursing can effectively help improve the quality of medical care.In the process of blood purification treatment for patients with nephropathy, the use of process management can effectively improve the quality of nursing. This scheme is worthy of clinical application and popularization.
文摘Objective:This paper mainly analyzes the effect of infrared radiation combined with external application nursing on maintenance of vascular access in hemodialysis patients.Methods:A total of 150 hemodialysis patients in our hospital from December 2019 to September 2020 were divided into the conventional group and the study group,75 cases in each group.The conventional group was given external application nursing alone,and the study group was given infrared radiation combined with external application nursing,and the effect on the maintenance of vascular access was counted.Results:After the intervention,the indexes of URR,kt/V and human albumin in the study group were higher than those in the routine group,and the indexes of β2-mg and MIS in the study group were lower than those in the routine group,P<0.05;The improvement of vascular elasticity and quality of life in the study group was higher than that in the conventional group,and the incidence of complications was lower than that in the conventional group,P<0.05.Conclusion:Infrared radiation combined with external application of nursing care in hemodialysis patients with vascular access maintenance effect is significant,can effectively improve vascular elasticity.
文摘Objective: to implement the whole process follow-up nursing intervention in the continuous quality improvement of vascular access in maintenance hemodialysis and observe the application effect. Methods: the selected personnel were selected from dialysis patients who received treatment in our hospital in recent one year ( January 2021- January 2022), and were given whole process follow-up nursing intervention. Results: after the corresponding nursing intervention, hemodialysis was carried out smoothly, the level of coagulation indexes showed a good trend, and the incidence of complications was low, which further promoted the improvement of their quality of life. Conclusion: in the continuous quality improvement of vascular access in maintenance hemodialysis, the application value of whole process follow-up nursing is obvious. It plays a positive role in improving the treatment effect and improving the medical experience of patients, which is worthy of popularization.
文摘Objective: for patients with chronic renal failure to use different vascular access methods, and then to explore the effect of different methods. Methods: thirty patients with chronic renal failure (CRF) from January to December 2018 were selected and divided into two groups. The application of different vascular access methods. Results: the results showed that the recirculation rate of blood urea nitrogen and creatinine in the observation group was better than that in the control group. Conclusion: by treating chronic renal failure patients with intravenous fistula, it can effectively prevent the occurrence of other concurrent symptoms in patients, which is worthy of extensive clinical promotion.
文摘To investigate the safety and efficacy of chitosan ( Anscare,Daxon) in reducing vascular ac cess complications compared to a kind of radial compression device( TR-BAND,Terumo) . Method: We studied 128 patients who had undergone transradial angiography in our center from December 2009 to April 2010. Among them,64 patients were randomly treated with radial compression device ( TR-BAND,Terumo) when the procedure was over ( CD group) . The other 64 patients were dealt with chitosan ( CS group) . The compression time,the major and minor access site bleeding complications and the errhysis were observed. Results: There were no statistical differences in the baseline clinical characteristics of the patients between two groups. The compression time in CS group was significantly shorter than that of CD group ( P < 0. 001) . There were 12 patients suffering from minor access site bleeding while only 3 patients experienced these minor complications in CS group( 19% vs 4% ,P < 0. 05) . At the same time 20 patients had er- rhysis in CD group and 4 patients in CS group ( 31% vs 6% ,P < 0. 001) . Conclusion: Chitosan,compared to radial compression device ( TR-BAND,Terumo) ,can not only shorten the compression time,but also significantly reduce the rate of minor access site bleeding and puncture-site errhyis.
文摘Transcatheter aortic valve implantation(TAVI) using stent-based bioprostheses has recently emerged as a promising alternative to surgical valve replacement in selected patients. The main route for TAVI is retrograde access from the femoral artery using large sheaths(16-24 F). Vascular access complications are a clinically relevant issue in TAVI procedures since they are reported to occur in up to one fourth of patients and are strongly associated with adverse outcomes. In the present paper, we review the different types of vascular access site complications associated with transfemoral TAVI. Moreover, we discuss the possible optimal management strategies with particular attention to the relevance of early diagnosis and prompt treatment using endovascular techniques.
文摘Aim(s): Complex Arteriovenous fistula (AVF) poses challenges to cannulation. Ultrasound (US)-guided cannulation may promote successful cannulation and prevent AVF-related complications. Renal nurses performing US-guided cannulation may improve successful cannulation and reduce complications associated with unnecessary punctures. The study aims to conduct the meta-analyze to examine the effectiveness of renal nurse-performed US-guided cannulation to improve successful cannulation and reduce AVF-related complications in difficult AVF access. Design: A meta-analysis of randomised controlled trials. Methods: A systemic search was performed on electronic databases including CINAHL Plus, Web of Science, and PubMed from inception to October 2023. Risk ratios (RR) and standardized mean differences (SMD) were estimated using random-effect models for considerable homogeneity, and the Scottish Intercollegiate Guidelines Network (SIGN) methodology was adopted for critical appraisal. Results: Four RCTs were included. The results showed US-guided AVF cannulation had a significant effect in improving successful cannulation (RR: 0.19, 95% CI: 0.06 to 0.63, p = 0.007), and was favorable in reducing cannulation-associated complications (RR: 0.44, 95% CI: 0.10 to 1.93, p = 0.28), compared with blind needle cannulation. Conclusion: US-guided cannulation performed by renal nurses has the potential to improve successful cannulation, and fewer complications in hemodialysis patients with difficult arteriovenous access. Relevance to Clinical Practice: The results suggest the value of further training for renal nurses in US-guided cannulation, and broader implementation of US-guided cannulation to improve patient outcomes. Future studies could explore the optimal nursing training and longer-term benefits of US-guided cannulation by renal nurses in difficult AVF access. Patient or Public Contribution: No Patient or Public Contribution as this is a meta-analysis using the secondary data published in the RCTs.
基金Supported by Mianyang Health Commission 2019 Scientific Research Encouragement Project,No.201948.
文摘Although drug-coated balloons(DCBs)were initially used for treating peripheral vascular diseases,with the growing popularity of the implant-free concept,they have gained increasing attention as a novel therapeutic strategy for coronary atherosclerotic heart disease.The clinical application scope of DCBs,represented by paclitaxel-coated balloons(PCBs),is constantly expanding.Their application fields are no longer limited to lesions of coronary artery and peripheral vascular diseases,and relevant research is also being actively advanced.In the field of arterial diseases,the application of PCBs has significantly extended.They are used in lower extremity arteries and hemodialysis access and play a role in renal artery fibromuscular dysplasia,and carotid/vertebrobasilar/intracranial arteries.PCBs also show unique value in the treatment of Takayasu arteritis,Kawasaki disease,coronary myocardial bridge,and pulmonary artery diseases.In the venous sys-tem,PCBs also have therapeutic potential,with research and clinical investig-ations now extending to lower extremity,central,and pulmonary vein diseases,and innovative solutions for graft stenosis.The application of PCBs is no longer confined to vascular diseases.They are gradually breaking through traditional boundaries in treating luminal disorders such as urethral,biliary,and esophageal strictures.This mini-review synthesizes existing clinical evidence and basic research findings to concisely analyze the mechanisms of action and biological effects of PCBs in noncoronary applications.A comprehensive analysis of current studies provides a reference for subsequent research and clinical practice in this field and explicitly identifies the challenges faced by current research,explores future directions,and facilitates the in-depth extension of DCB applications.
