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Your search term(s) "vascular access" and "hemodialysis" returned 10 results.

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2005 CPMs Regarding Vascular Access Create Opportunities for Improving Care. Nephrology News & Issues. 21(12): 34-35. November 2007.

This article discusses the information from the 2005 Clinical Performance Measures (CPM) Project on vascular access. Vascular access is one of the clinical indicators reviewed each year as part of the CPM Project, which is produced by the End-Stage Renal Disease Networks. The sample for 2005 included about 9,000 randomly selected, in-center, hemodialysis patients who dialyzed during the last quarter of that calendar year. Data from 803 pediatric patients from that same time period are included. The three CPMs for vascular access measured the number of new patients dialyzing with an arteriovenous fistula (AVF), the number of continuing patients dialyzing with an AVF, the percentage of continuing patients dialyzing with a catheter continuously for 90 days or longer, and the percentage of patients whose grafts were routinely monitored for stenosis. In 2005, the data showed that 54 percent of new patients and 44 percent of continuing patients were dialyzed using an AVF, up from 27 percent and 30 percent, respectively, in 2000. The author notes that this is the extent of the positive news from the 2005 report. For example, catheter usage, known to be a major cause of morbidity, mortality, and increased end-stage renal disease (ESRD) expenditure, has not been reduced. Nearly three-quarters of all patients beginning hemodialysis in 2005 did so via a catheter, some 38 percent of these patients with catheters had no surgical access created or planned, and 65 percent of those patients preferred not to have surgery for access. The author reviews the data, discussing CPM goals, monitoring patients for stenosis, the situation with pediatric patients, and strategies to increase the use of AVF for vascular access for hemodialysis. Readers are referred to the complete 2005 Clinical Performance Measures Report, available at www.cms.hhs.gov/CPMProject. 1 reference.

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Vascular Access for Hemodialysis. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2007. 4 p.

When the kidneys fail, harmful wastes build up in the body, blood pressure may rise, and the body may retain excess fluid and not make enough red blood cells. When this happens, treatment is required to replace the work of the failed kidneys. Hemodialysis is the most common method used to treat advanced and permanent kidney failure. This fact sheet helps readers recently diagnosed with kidney failure understand the vascular access that is required for hemodialysis. Topics include the need for establishing vascular access a few weeks or months before dialysis is started, the arteriovenous fistula, the arteriovenous graft, a venous catheter that is used for temporary access, what to expect during hemodialysis, possible complications that may be encountered, and how to take care of the vascular access. Additional sections describe some of the research projects currently underway in this area, as well as the availability of a patient education series titled the NIDDK Kidney Failure Series. The brochure concludes with the contact information for the National Kidney Foundation (www.kidney.org) and a brief description of the activities of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 3 figures.

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Vascular Access for Hemodialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 27-46.

Successful hemodialysis requires access to large blood vessels capable of supporting rapid extracorporeal blood flow. This chapter on vascular access (VA) for hemodialysis is from a textbook on the clinical care of dialysis patients. There are three general situations in which hemodialysis is required: acute renal failure, poisonings, and end stage renal disease (ESRD). In the first two situations, immediate and perhaps only temporary access to the circulation system is required. These requirements are best met by the percutaneous insertion of dual-lumen hemodialysis catheters into large central veins. In ESRD, reliable, long-term access to the circulation system is essential for adequate dialysis therapy. Long-term access is best accomplished by the construction of an endogenous arteriovenous fistula. The authors discuss patient care management, surgical techniques, and the complications of VA, which can include thrombosis, infection of native and synthetic fistulas, cuffed catheter-related infection, problems with antibiotics, congestive heart failure, hand ischemia, aneurysms and pseudoaneurysms, and venous stenoses. The authors conclude that the morbidity of a maintenance hemodialysis patient is in large part determined by the ability of the nephrologists, vascular surgeon, and vascular radiologist to establish and maintain adequate vascular access. 7 figures. 143 references.

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Your Access: A Choice for a Better Life. In Control. 1(1): P1, P4. March 2004.

This newsletter article helps readers understand the role of the vascular access in hemodialysis. The article explains the different types of vascular access (VA), including fistulas, grafts, and catheters, noting that the fistula is the best type of VA, resulting in longest life and fewest complications. A fistula is made by linking two blood vessels: a fast-flowing artery and an easy-to-reach vein. Fistulas are less prone to infections and blood clots than either grafts or catheters. A checklist of strategies for preparing to get a fistula is included. Patients are advised to plan for ongoing treatment changes, which may happen when a fistula or other VA fails. The article concludes with a list of recommended resources for readers wanting more information and a quiz for readers to self-test their knowledge about fistulas. 1 figure. 4 references.

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Vascular Access for Hemodialysis. In: Johnson, R.J. and Feehally, J. Comprehensive Clinical Nephrology. 2nd ed. Orlando, FL: Mosby, Inc. 2003. p. 957-965.

The maintenance of adequate, durable vascular access for hemodialysis is essential for the well being of the patient with end stage renal disease (ESRD). The provision of extracorporeal (outside the body) hemodialysis therapy requires repetitive vascular access that can achieve a blood flow in excess of 350 milliliters per minute. If vascular access cannot be achieved for even short periods of time, the patient will die from uremia. Hemodialysis is employed in chronic maintenance hemodialysis, acute renal failure, and, less commonly, for assisting in the elimination of poisons from the body. This chapter on vascular access for dialysis is from a comprehensive textbook that covers every clinical condition encountered in nephrology (the study of kidney disease). The author of this chapter discusses vascular access for acute hemodialysis, permanent vascular access, the problem of access failure, strategies to prolong the life of AV access, and strategies for working with the difficult patient. The chapter is clinically focused and extensively illustrated in full color. 8 figures. 5 tables. 25 references.

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Back to Basics: The Arteriovenous Graft: How to Use it Effectively in the Dialysis Unit. Nephrology News and Issues. 16(12): 41-42, 44,46, 48-49. December 2002.

Compared to the arteriovenous (AV) fistula (using the patient's own veins and arteries), the use of an AV graft (made from polytetrafluoroethylene) as a patient's dialysis lifeline leads to a shorter life span for the access, with more complications and potentially more procedures to keep the access functional. However, many patients still require the placement of an AV graft as their vascular access for hemodialysis. An AV graft requires special care and use to help prolong its life span and prevent complications. This article reviews basic nursing care and cannulation (insertion of the tube for dialysis) of an AV graft. Topics include materials, implantation, puncturing, physical assessment (inspection, palpation, auscultation), direction of blood flow, the National Kidney Foundation quality guidelines, cannulation of the AV graft, and hemostasis. One sidebar lists a sample dialysis policy and procedure format that combines all the graft cannulation information into a procedure for dialysis staff for use in proper AV graft cannulation. 2 tables. 7 references.

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Delayed Nephrologist Referral and Inadequate Vascular Access in Patients with Advanced Chronic Kidney Failure. Journal of Epidemiology. 55(7): 711-716. July 2002.

This article reports on a study undertaken to determine whether late referral to a nephrologist in patients with chronic renal (kidney) failure (CRF) influences the adequacy of vascular access for hemodialysis (HD). The authors analyzed data describing all health care encounters for all Medicare and Medicaid patients with end stage renal disease (ESRD) in New Jersey between January 1991 and June 1996. Patients were required to have been diagnosed with renal disease at least 1 year prior to onset of HD. In the resulting cohort of 2,398 incident (new) HD patients, 35 percent had their first nephrologist consultation less than 90 days prior to initiation of dialysis. After controlling for demographic characteristics, socioeconomic status, and underlying renal disease, the authors found that patients who were referred to a nephrologist more than 90 days prior to the onset of HD were 38 percent more likely to have undergone predialysis vascular access surgery than those who were referred to a nephrologist less than 90 days before dialysis. Similarly, patients referred late were 42 percent more likely to require central venous access for HD compared to those seen by a nephrologist early. The authors conclude that inadequate development of vascular access for renal replacement therapy in patients with late nephrologist referral unnecessarily contributes to the burden of disease experienced by this vulnerable patient population. 4 tables. 19 references.

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Dialysis Therapy. Philadelphia, PA: Hanley and Belfus, Inc. 2002. 561 p.

It has recently been estimated that the end stage renal (kidney) disease (ESRD) population in the United States alone will approach 700,000 by the end of 2010. The trend for patients to be older and to have significant comorbidities (other diseases at the same time) such as diabetes and hypertension (high blood pressure) is continuing and unlikely to change. Children continue to be treated with extended dialysis, especially in-center hemodialysis, despite the increased use of living related donors and being given priority for cadaver donor kidneys. So argue the editors of this textbook on dialysis therapy, which focuses on changes in the field of nephrology over the past decade. In the text, recognized experts in the field have written concise, focused chapters, emphasizing practical approaches to dialysis and management. Chapters are categorized into 33 sections: demographics, vascular access for hemodialysis, peritoneal access devices, the mechanical aspects of dialysis, dialyzers, kinetic modeling in hemodialysis, improving outcomes in dialysis patients, the hemodialysis procedure, complications during hemodialysis, reuse of hemodialyzers, alternative hemodialytic techniques, the clinical practice of peritoneal dialysis (PD), infectious complications of PD, noninfectious complications of PD, intraabdominal pressure related complications of PD, acid-base homeostasis, the nutritional management of dialysis patients, gastrointestinal disease, care of the HIV positive dialysis patient, anemia and Epoetin (erythropoietin) use, cardiovascular disease, metabolic abnormalities, the neurologic aspects of uremia (excessive waste products in the blood), uremic osteodystrophy (bone disease associated with kidney disease), dialysis amyloidosis, acquired cystic kidney disease, diabetes, drug therapy in uremia, rehabilitation and psychosocial issues, pediatric dialysis, surgery in end stage renal disease (ESRD) patients, the pregnant patient on dialysis, and the use of dialysis for drug overdose. Each chapter includes charts and diagrams; each section offers a selected reading list; and the text concludes with a subject index.

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Trends in Access Selection and Placement. Nephrology News and Issues. 16(6): 60-62, 64. May 2002.

This article presents clinical and economic information related to the creation and maintenance of vascular access (VA) for hemodialysis patients in the United States. The authors also review steps for the potential improvement of vascular access. The information in this article is excerpted from the report, 'Clinical and Economic Issues in Vascular Access for Hemodialysis,' a white paper researched and written by Balwit and Associates, Inc., of Madison, Wisconsin, with an educational grant from Vasca, Inc. (A full copy of the report can be found at www.ahrensbalwit.com). In this article, the authors focus on access selection and placement; an additional article (June 2002) focuses on economics, complications of VA, and ways to improve access placement and management. The authors review trends in VA selection and placement, note that catheter use is increasing faster than fistula use, report that catheter use is highest at initiation of hemodialysis, describe how synthetic grafts have been heavily relied on to provide permanent access, and stress that early referral to a nephrologist is critically important. 1 figure. 22 references.

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Temporary Vascular Access for Hemodialysis Patients: Applications and Complications. Dialysis and Transplantation. 29(12): 797-798, 800-802. December 2000.

During everyday practice, the nephrologist is frequently faced with cases of acute or chronic renal (kidney) failure that require urgent dialysis for a variety of indications. This article discusses temporary vascular access (VA) for hemodialysis patients, reporting the authors' experience with 100 dual lumen catheters that were inserted into 79 patients over a 3 month period. There were 66 patients (83.5 percent) with chronic renal failure (CRF) and 13 (16.5 percent) with acute renal failure (ARF). Twenty-one catheters needed to be replaced in 8 patients (10.1 percent) for various reasons including changing the site, for example, from the femoral vein to either the subclavian or internal jugular vein (23.8 percent of cases); an obstructed or kinked catheter (57.1 percent of cases); infection (9.5 percent of cases); and the catheter slipping out (9.5 percent of cases). Sixty catheters were inserted into the subclavian vein (41 in the right, 19 in the left), 18 into the internal jugular (16 in the right, 2 in the left), and 22 in the femoral vein (17 in the right, 5 in the left). Complications encountered were arterial puncture (5 cases), inability to cannulate the innominate vein despite successful vascular puncture (3 cases), and multiple attempts (8 cases). Early infection (within 1 week) was seen in 2 cases; after 1 week of insertion, infection was seen in 11 cases, and an obstructed or kinked catheter was seen in 13 cases. Mean duration was 32.1 days for the subclavian route, 31.9 days for the internal jugular route, and 8.8 days for the femoral route. The authors conclude that percutaneous, dual lumen central venous catheter insertion for hemodialysis is valuable, relatively easy to perform, durable, and safe, with a minimal rate of complications. 4 tables. 32 references.

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