Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002)
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002)
Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002)
oaốe ỉn ecumAccess for Dialysis:Surgical and Radiologic Procedures 2nd EditionIngemar J.A. Davidson, M.D., Ph.D., EA.C.S.Medical City Dallas Hospital Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) Dallas, Texas, U.S.A.LANDESGeorgetown, Texas Ư.S.A.Fig. 1.1. The Fnd stage renal disease (FSRD) limeline as il pertains Io renal transplantation. Patients with renal disease develop decreased renal function (I) and are followed by their primary physicians and later usually by a nephrologist. As ser Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) um creatinine rises Io 4-5 mg/dl in diabetics (GFR 15-20 rnl/min) or 7-8 mg/dl in patients with no comorbidily (GFR 10-15 ml/min) permanent vascular aIngemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002)
ccess or peritoneal catheter is placcxl in anticipation of hemodialysis or continuous ambulatory peritoneal dialysis (CARD) (2). Patients may remain ooaốe ỉn ecumAccess for Dialysis:Surgical and Radiologic Procedures 2nd EditionIngemar J.A. Davidson, M.D., Ph.D., EA.C.S.Medical City Dallas Hospital Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) organ excision (4), rtxiipienl surgery (5), a shorl 5-10 day hospital stay (6), lol lower! by close outpatient follow-up for 3-6 months (7), before reverting to their referring physician (8-9). At any time patients may lose the organ to rejection or technical problems and revert Io dialysis treatmen Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) t.Practical Guidelines for Vascular Access PlacementAc the beginning of 1999; 249.983 patients were on chronic hemodialysis. By (he end oi the year, 6Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002)
6,964 patients died and had been replaced with 79,482 new patients, resulting in an annual increase of about 12,000 dialysis patients, of all patientsoaốe ỉn ecumAccess for Dialysis:Surgical and Radiologic Procedures 2nd EditionIngemar J.A. Davidson, M.D., Ph.D., EA.C.S.Medical City Dallas Hospital Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) inadequate vascular access or complications related to vascular access as a major contributing factor.For patients on hemodialysis, die vascular access is literally their “lifeline." A well functioning access, whether a primary fistula, synthetic graft or peritoneal catheter, will enable the patient Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) to receive adequate dialysis treatment, minimizing metabolic complications associated with increased mortality.Timing of AccessVascular access and PeIngemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002)
ritoneal catheter insertion should be placed prior to the need for initiation of dialysis to allow maturation. This riming is guided by the individualoaốe ỉn ecumAccess for Dialysis:Surgical and Radiologic Procedures 2nd EditionIngemar J.A. Davidson, M.D., Ph.D., EA.C.S.Medical City Dallas Hospital Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) placement when the creatinine is 4-5 mg/dl. This corresponds to a creatinine clearance of about 20 ml/min. Patients with no additional contributing medical comorbidities shouldhave access placed when rhe creatinine approaches 6-7 mg/dl (creatinine clearance of 15 ml/min). Patients should be evaluate Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) d early, and measures taken to preserve native veins in an attempt to create primary AV fistulae. In fact, it is preferable to place primary (native)Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002)
AV ftstulae early (even 6 months to a year) before anticipated dialysis to allow time for optimal maturing. Even if a native vein does not enlarge enooaốe ỉn ecumAccess for Dialysis:Surgical and Radiologic Procedures 2nd EditionIngemar J.A. Davidson, M.D., Ph.D., EA.C.S.Medical City Dallas Hospital Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) (Appendix V, Fig. 5A).History and Physical ExamPrevious central venous catheters or pacemaker placement is associated with ra-diologically significant central venous stenosis formation in 30-50% of cases. Five percent will have clinical symptoms, i.e., arm edema. In these cases, examination with du Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) plex Doppler or venogram prior to access placement is recommended. An access placement in an arm with subclavian or innominate vein occlusion or severIngemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002)
e stenosis is destined for a disastrous outcome, often requiring emergent ligation or removal.rhe non-dominant arm is preferred lor vascular access ploaốe ỉn ecumAccess for Dialysis:Surgical and Radiologic Procedures 2nd EditionIngemar J.A. Davidson, M.D., Ph.D., EA.C.S.Medical City Dallas Hospital Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) previous ICU stays may preclude a native radial artery to cephalic vein fistula at the wrist.Individuals with diabetes mcllitus or advanced age with significant peripheral atherosclerosis are at increased risk of hand ischemia after access placement, often referred to as 'arterial ,stcal”(Appcndix 1 Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) , Case #28 for diagnosis and treatment). Patients with major comorbidity and decreased life expectancy may benefit from temporary access placement, suIngemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002)
ch as culled, tunneled dual lumen catheters (Appendix I, Case #48).Previous vascular access surgeries will limit sites and options. This patient categoaốe ỉn ecumAccess for Dialysis:Surgical and Radiologic Procedures 2nd EditionIngemar J.A. Davidson, M.D., Ph.D., EA.C.S.Medical City Dallas Hospital Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) ppler is not conclusive, venogram of central veins is rhe next recommended step. Likewise, previous neck surgery or open chest surgery may have resulted in central vein anatomy distortion, excluding involved arm. A venogram will clarify such cases.In patients with renal transplantation anticipated i Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) n the near future, Ĩ.C., living donor, temporary dialysis catheter access may suffice.The Effective Dialysis Access Teamrhe end stage renal disease (EIngemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002)
SRD) patient population is a captive audience and therefore an excellent study population. By survival instinct most patients come regularly three timoaốe ỉn ecumAccess for Dialysis:Surgical and Radiologic Procedures 2nd EditionIngemar J.A. Davidson, M.D., Ph.D., EA.C.S.Medical City Dallas Hospital Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) the treatment team owe the patient the best medical management. The total care of the ESRD patient requires a ream, where each member has a specific role or duty at certain times and under specific circumstances. Each member of the learn often belongs to or represents a specific group or medical spe Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) cialty or academic department with its own agenda, rules and regulations. This multifaceted structure inevitably lends itself to a number of system prIngemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002)
oblems related to riming of service, overlapping duties or responsibilities. The current system does not work well in a hierarchy setting. A flat or woaốe ỉn ecumAccess for Dialysis:Surgical and Radiologic Procedures 2nd EditionIngemar J.A. Davidson, M.D., Ph.D., EA.C.S.Medical City Dallas Hospital Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) used, (he rules and regulations must be structured around the patient’s needs.Strategics to improve (he outcome and longevity of access is deeply entrenched in the access teams level of knowledge, skills and attitude. The access team in this context includes (he referring nephrologist or internist, Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) (he dialysis unit members, the surgeon and the interventional radiologist. The most important team member is the patient.It is easy to understand dieIngemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002)
need for skills and knowledge in die context of choosing and creating optimal access. What is less obvious is that altitude may represent up to 80% ofoaốe ỉn ecumAccess for Dialysis:Surgical and Radiologic Procedures 2nd EditionIngemar J.A. Davidson, M.D., Ph.D., EA.C.S.Medical City Dallas Hospital Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) rs' "territory” (duties). It involves spending time to educate die patient about treatment options, making the patient (and family) part of the decision making. Altitude is to make rhe right choice/recommendation for rhe patient based on patient, not on provider (team member), convenience or profit. Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) I low do we make this happen? Il is a matter of attitude change, self-confidence, doing die right thing at rhe right rime for the right reason, at thIngemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002)
e right moment, modeled by your skills and knowledge-filtered through the laws and societal constraints in which you live.Physical ExamAssessmentExamioaốe ỉn ecumAccess for Dialysis:Surgical and Radiologic Procedures 2nd EditionIngemar J.A. Davidson, M.D., Ph.D., EA.C.S.Medical City Dallas Hospital Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) Rite1*) ( fable 1.1) and a duplex Doppler as indicated. For instance, an abnormal Allen test may warrant a more extensive duplex Doppler examination and linger pressure determination. Bilateral blood pressures of upper arms are part of die arterial inflow examinations. The level of derailed knowled Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) ge of the extremity artery size and How rate is determined based on patients’ needs as parr of preoperative evaluation for vascular access placement.Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002)
Definitive determination whether an access will induce distal ischemia or arterial steal after placement is hard to assess or prevent with current praoaốe ỉn ecumAccess for Dialysis:Surgical and Radiologic Procedures 2nd EditionIngemar J.A. Davidson, M.D., Ph.D., EA.C.S.Medical City Dallas Hospital Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) 28).Examination of the Venous SystemThe lack of an adequate outflow vein is more often the limiting factor as opposed to an unacceptable artery, rhe presence of acute or chronic swelling or edema suggests outflow problems and warrants a venogram or duplex Doppler of central veins, rhe small, portabl Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002) e ultrasound device, Site-Rite® (Table 1.1) has a number of usable applications, in the office, operating room and radiology suite (Chapter 5, Figs. 5Ingemar davidson access for dialysis surgical and radiologic procedures 2nd ed vademecum (2002)
.4 and 5.8, Table 1.1). The authors strongly recommend rhe use of this device in all cases of dialysis dual lumen catheter placement; also to furtherGọi ngay
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