This document discusses vascular access for hemodialysis and a programmatic approach. It covers the multidisciplinary care team involved, background on chronic kidney disease and end stage renal disease in the US, and options for vascular access at initiation of dialysis. The document reviews guidelines promoting arteriovenous fistulas over catheters, quality standards, and complications associated with different access types. It also discusses strategies for a systems approach to access management, including timing of access creation and cannulation, monitoring access, and interventions for access issues.
The document discusses complications that can arise with arteriovenous (AV) access for hemodialysis and their management. It covers types of complications such as hematomas, significant steal syndrome, non-maturing fistulas, venous outflow stenosis, aneurysmal degeneration, and central venous stenosis. It describes techniques for managing these complications, including balloon angioplasty, coil embolization, stent graft placement, and open surgery. The overall message is that timely intervention is important to address access complications in order to maintain patency and usability of AV access for hemodialysis.
Although large efforts are spent for creating fistula as the primary access, use of Hemodialysis Vascular catheters are still the major access on the first Hemodialysis session and after 4 month whether we would like it or not.
"USRDS 2013"
Arteriovenous vascular access complicationsReynel Dan
The document discusses various complications that can occur with arteriovenous vascular access for hemodialysis patients. It describes immediate post-surgery complications like hemorrhage and low venous flow. Late complications include infections, aneurysm formation, fistula vein stenosis, congestive heart failure, steal syndrome, ischemic neuropathy, and thrombosis. The document also outlines various physical findings that are associated with different forms of access dysfunction.
This document provides an overview and introduction to an atlas about dialysis vascular access. It discusses how dialysis depends on vascular access but it is often overlooked. The atlas aims to improve understanding of access anatomy and problems through images. It is intended for physicians, nurses and technicians involved in dialysis access care. The author thanks the groups and individuals who assisted with the project and hopes it leads to improved access care quality.
This document provides instructions for various vascular anastomosis techniques:
1) It describes basic principles such as minimal incisions, careful tissue handling, and proximal and distal vessel control.
2) Transverse arteriotomy and embolectomy are explained, involving making an incision, inserting a stay suture, and closing with interrupted sutures.
3) Longitudinal arteriotomy and patch closure involves using a vein patch graft sutured with an everting technique or wrapped around the vessel edge.
4) End-to-end and end-to-side anastomoses are demonstrated, with placement of pursestring or spatulated sutures to approximate the vessels.
Monitoring & surveillance of vascular accessAVATAR
This document discusses monitoring and surveillance of vascular access for dialysis patients. It defines monitoring as physical examination to detect dysfunction and surveillance as periodic evaluation using tests like ultrasound or blood flow measurements. Regular monitoring and surveillance is important to detect access issues early as dysfunction can limit adequate dialysis and increase health risks. Clinical monitoring involves examining the access for physical signs of issues. Surveillance methods discussed include measuring intra-access blood flow, static venous pressure, and ultrasound. Guidelines recommend different methods for monitoring grafts versus fistulas. While the role of surveillance is still debated, it aims to preserve vascular access by allowing pre-emptive intervention for issues.
This document discusses vascular access for hemodialysis and a programmatic approach. It covers the multidisciplinary care team involved, background on chronic kidney disease and end stage renal disease in the US, and options for vascular access at initiation of dialysis. The document reviews guidelines promoting arteriovenous fistulas over catheters, quality standards, and complications associated with different access types. It also discusses strategies for a systems approach to access management, including timing of access creation and cannulation, monitoring access, and interventions for access issues.
The document discusses complications that can arise with arteriovenous (AV) access for hemodialysis and their management. It covers types of complications such as hematomas, significant steal syndrome, non-maturing fistulas, venous outflow stenosis, aneurysmal degeneration, and central venous stenosis. It describes techniques for managing these complications, including balloon angioplasty, coil embolization, stent graft placement, and open surgery. The overall message is that timely intervention is important to address access complications in order to maintain patency and usability of AV access for hemodialysis.
Although large efforts are spent for creating fistula as the primary access, use of Hemodialysis Vascular catheters are still the major access on the first Hemodialysis session and after 4 month whether we would like it or not.
"USRDS 2013"
Arteriovenous vascular access complicationsReynel Dan
The document discusses various complications that can occur with arteriovenous vascular access for hemodialysis patients. It describes immediate post-surgery complications like hemorrhage and low venous flow. Late complications include infections, aneurysm formation, fistula vein stenosis, congestive heart failure, steal syndrome, ischemic neuropathy, and thrombosis. The document also outlines various physical findings that are associated with different forms of access dysfunction.
This document provides an overview and introduction to an atlas about dialysis vascular access. It discusses how dialysis depends on vascular access but it is often overlooked. The atlas aims to improve understanding of access anatomy and problems through images. It is intended for physicians, nurses and technicians involved in dialysis access care. The author thanks the groups and individuals who assisted with the project and hopes it leads to improved access care quality.
This document provides instructions for various vascular anastomosis techniques:
1) It describes basic principles such as minimal incisions, careful tissue handling, and proximal and distal vessel control.
2) Transverse arteriotomy and embolectomy are explained, involving making an incision, inserting a stay suture, and closing with interrupted sutures.
3) Longitudinal arteriotomy and patch closure involves using a vein patch graft sutured with an everting technique or wrapped around the vessel edge.
4) End-to-end and end-to-side anastomoses are demonstrated, with placement of pursestring or spatulated sutures to approximate the vessels.
Monitoring & surveillance of vascular accessAVATAR
This document discusses monitoring and surveillance of vascular access for dialysis patients. It defines monitoring as physical examination to detect dysfunction and surveillance as periodic evaluation using tests like ultrasound or blood flow measurements. Regular monitoring and surveillance is important to detect access issues early as dysfunction can limit adequate dialysis and increase health risks. Clinical monitoring involves examining the access for physical signs of issues. Surveillance methods discussed include measuring intra-access blood flow, static venous pressure, and ultrasound. Guidelines recommend different methods for monitoring grafts versus fistulas. While the role of surveillance is still debated, it aims to preserve vascular access by allowing pre-emptive intervention for issues.
- Short-term catheters should only be used for acute dialysis or limited hospital use. Non-cuffed femoral catheters are only for bed-bound patients.
- Long-term catheters should be used with a plan for permanent access and prefer those capable of high flow rates. Choice depends on local experience and goals.
- Long-term catheters should avoid the same side as a maturing arteriovenous access, if possible.
Vascular access in hemodialysis chaken 2018CHAKEN MANIYAN
This document provides guidelines and information about vascular access for hemodialysis. It discusses:
- Types of vascular access including arteriovenous fistulas, grafts, and catheters. Fistulas have the lowest risk of complications but the highest risk of early failure.
- Evaluations for permanent access including history, physical exam, ultrasound of arteries and veins, and central vein evaluation.
- Placement of fistulas at least 6 months before starting dialysis to allow for maturation. Grafts can be placed 3-6 weeks before starting.
- Goals for types of access used - 50% of patients should have fistulas, 40% grafts, and no more than 10%
Vascular access care .. nephrology perspective - Dr. Tamer El saidMNDU net
This document discusses vascular access care from a nephrology perspective. It begins by noting the increasing number of ESRD patients requiring hemodialysis and the need for adequate vascular access to deliver treatment. It then describes the common types of vascular access and emphasizes the importance of planning, assessment, and surveillance to promote access patency and prevent complications like stenosis and infection. The document provides guidelines for physical examination, ultrasound, angiography, and other testing to monitor access and identify issues requiring intervention. The goal is early detection and treatment of problems to maximize vascular access lifespan and function.
This document provides information on inserting tunneled dialysis catheters. It discusses the preferred insertion sites being the right internal jugular vein. Potential acute complications during insertion include arterial puncture, pneumothorax, hemothorax, and air embolism. Subacute complications after insertion include suboptimal flow due to malposition, kinking, clots or fibrin sheath formation. Tunnel tract infection is also discussed as a complication requiring antibiotic treatment and catheter removal. The document provides guidance on preventing and managing these potential complications.
Vascular access for haemodialysis prof. ahmed halawaFarragBahbah
Vascular access for haemodialysis requires either an autogenous arteriovenous fistula, a PTFE graft, or a tunnelled line. A good fistula has adequate size, blood flow, and low complication rates. Formation of an arteriovenous fistula involves connecting an artery such as the radial or brachial to a vein like the cephalic or basilic. Complications include steal syndrome, aneurysms, pseudoaneurysms, venous hypertension, and infection. Steal syndrome is treated with distal reconstruction and interval ligation. Buttonhole and rope-ladder techniques are used for cannulating fistulas and have benefits over traditional needle cannulation.
This document provides an overview of the history and development of vascular access for hemodialysis. It discusses:
- The early development of hemodialysis and use of arteriovenous shunts by Scribner in the 1960s.
- Research in the 2000s that showed much higher rates of AV fistula use and better patient outcomes in Europe and Japan compared to the US. This led to the "Fistula First" initiative in the US to increase AV fistula rates.
- Guidelines for vascular access including the preference for autogenous AV fistulas over prosthetic grafts when possible, with radiocephalic fistulas as the first choice.
- Common complications of AV fist
Vascular access in Haemodialysis (2).pptxMithunAhmed5
national institute of kidney disease and urology (nikdu)
Dialysis access refers to the creation of an entrance way into the bloodstream so that the blood can be cleansed by the dialysis procedure. It is well established that dialysis cannot be provided without access.
The attainment and maintenance of a single reliable, long-lasting dialysis access with minimal complications continue to be challenging.
Achievement of such an access is associated with optimal patient clinical outcomes, superior quality of life, and minimal costs.
This procedure is knowledge required for the dialysis, in this PPT include introduction, definition, indication, Advantages, Disadvantages, Nursing care and complication of Arteriovenous graft.
Novel trends in hemodialysis vascular accessMoataz Fatthy
This document discusses novel trends in hemodialysis vascular access. It covers the history of dialysis, current modalities of vascular access including arteriovenous fistulas, arteriovenous grafts and central venous catheters. It also discusses imaging techniques like Doppler ultrasound and guidance for vascular access placement. Novel trends discussed include local drug therapies delivered endovascularly or perivascularly to prevent access failure, as well as bioengineered autologous grafts. Needleless dialysis is also mentioned as a novel trend. The key takeaway message is that vascular access is precious and needs careful handling to avoid access failure which can be a nightmare for patients.
This document discusses tunneled central vein catheters that are often used as temporary access for hemodialysis. It can describe where catheters are typically placed, including the right internal jugular vein, left internal jugular vein, and femoral vein. Complications of tunneled catheters discussed include malfunction, infection, and central vein stenosis. The goal of recognizing complications early is to prevent issues like inadequate dialysis or loss of the vascular site. Photographs in the document aim to help identify common catheter problems.
An arteriovenous fistula (AVF) is created by surgically connecting an artery directly to a vein, allowing blood to flow from the artery to the vein. This creates a continuous circuit from the heart. The most common sites for AVFs are the wrist, elbow, and upper arm.
Cannulation of the AVF is important to maintain patency and prevent complications. It can be done using either a rope ladder technique, which rotates sites, or a buttonhole technique, which uses the same site. Proper needle size, angle, and hemostasis are important to prevent issues like infiltration or bleeding.
Vascular access surgery by Dr. Ali MujtabaDr Ali MUJTABA
This document provides an introduction to vascular access surgery. It discusses the history and development of vascular access methods beginning in the late 19th century. The three primary methods used today are native arteriovenous fistulas, prosthetic arteriovenous grafts, and intravenous catheters. Arteriovenous fistulas are preferred when possible due to their longer lifespan and lower risk of complications compared to grafts and catheters. The document outlines considerations for patient evaluation, access selection, creation of arteriovenous anastomoses, maturation of fistulas, post-dialysis hemostasis, and frequent complications.
This document summarizes the surgical technique and complications of central venous catheters for hemodialysis. It discusses the basic concepts, pre-operative evaluation including imaging of central veins, catheter insertion technique, and perioperative and long-term care and complications. The best site for catheter placement is the right internal jugular vein to minimize risks of kinking and central vein stenosis. Ultrasound and fluoroscopy guidance are recommended for accurate placement and tunneling of cuffed catheters. Major perioperative risks include pneumothorax, hemothorax, and nerve injury, while long-term complications consist of infection, thrombosis, stenosis, and catheter malfunction.
New and Emerging Advanced Vascular & Interventional Radiology ProceduresAllina Health
Radiology
1) The document introduces 6 new and emerging advanced vascular and interventional radiology procedures: radiation segmentectomy, radial artery access for visceral interventions, prostate artery embolization, advanced tumor ablation, balloon-occluded retrograde transvenous obliteration, and thrombolysis for venous thromboembolic disease.
2) The procedures provide minimally invasive alternatives to open surgery with benefits of shorter hospital stays, fewer complications, and improved quality of life.
3) Case examples are presented for each procedure to illustrate clinical applications and outcomes.
- An arteriovenous fistula (AVF) is created by connecting an artery directly to a vein, allowing blood to flow directly from the arterial to venous system.
- The "Rule of 6" describes factors for an optimal AVF: the fistula should mature for at least 6 weeks, be at least 6 cm from the arterial anastomosis, the vein should enlarge to at least 6 mm in diameter, and have a blood flow rate of at least 600 ml/min.
- Complications of AVFs can be acute like thrombosis, bleeding, or hematoma, or chronic like aneurysms, pseudoaneurysms, skin necrosis, steal syndrome, or infections at the access site. Regular
Radiological placement is consistently more reliable than surgical placement. There are fewer placement complications and fewer catheter infections overall.
It is convenient for the patient, quick, time saving, and cost effective
Interventional radiologists
placement and
management
research and development of hemodialysis catheters
Management of steal syndrome || Dr Ravi BansalAVATAR
This document discusses steal syndrome, which is arterial insufficiency caused by an arteriovenous dialysis access. It can cause hand pain, numbness, and tissue damage. The document describes methods for assessing and classifying steal syndrome severity. Treatment options aim to reverse ischemia while preserving access function, and include percutaneous and surgical interventions like angioplasty, stenting, banding, and distal revascularization-interval ligation. Risk factors include diabetes, peripheral vascular disease, and brachial accesses. Monitoring access flows can help prevent steal syndrome.
Vascular access for hemodialysis( AVF )Irfan Elahi
There are three main types of vascular access for hemodialysis: arteriovenous fistulae (AVF), arteriovenous grafts, and catheters. AVFs have the lowest rate of failures and complications and are the preferred type of access.
For an AVF to be suitable for cannulation and dialysis, it must undergo a maturation process where the fistula develops adequate blood flow, wall thickness and diameter. A properly matured fistula will have a minimum diameter of 6mm, be less than 6mm deep, have a blood flow over 600ml/min, and be evaluated at 4-6 weeks after creation.
The physical exam is the best tool to determine if an AV
This document provides an overview of trans-catheter aortic valve implantation (TAVI). It discusses the indications for TAVI including symptomatic severe aortic stenosis in high-risk surgical patients. The pre-procedural workup involves imaging to assess anatomy and risk. The procedure involves accessing the femoral or other arteries and deploying a balloon-expandable or self-expanding bioprosthetic valve. Complications include conduction abnormalities, paravalvular regurgitation, and hypotension. Two clinical cases are presented of high-risk patients undergoing TAVI.
Molecular imaging techniques such as positron emission tomography (PET) and single photon emission computed tomography (SPECT) can help diagnose and monitor various vascular diseases. PET provides better resolution than SPECT but is more expensive. Tracers like 18-FDG are used to detect vascular inflammation. Molecular imaging helps assess atherosclerosis, aortic diseases, vasculitis, and vascular graft infections. Intravascular ultrasound (IVUS) provides high resolution imaging of blood vessels and plaque morphology. It helps with vascular interventions, aneurysm treatment, and diagnosing various aortic and venous conditions. Both molecular imaging and IVUS provide additional information to angiography with benefits for treatment planning and monitoring.
- Short-term catheters should only be used for acute dialysis or limited hospital use. Non-cuffed femoral catheters are only for bed-bound patients.
- Long-term catheters should be used with a plan for permanent access and prefer those capable of high flow rates. Choice depends on local experience and goals.
- Long-term catheters should avoid the same side as a maturing arteriovenous access, if possible.
Vascular access in hemodialysis chaken 2018CHAKEN MANIYAN
This document provides guidelines and information about vascular access for hemodialysis. It discusses:
- Types of vascular access including arteriovenous fistulas, grafts, and catheters. Fistulas have the lowest risk of complications but the highest risk of early failure.
- Evaluations for permanent access including history, physical exam, ultrasound of arteries and veins, and central vein evaluation.
- Placement of fistulas at least 6 months before starting dialysis to allow for maturation. Grafts can be placed 3-6 weeks before starting.
- Goals for types of access used - 50% of patients should have fistulas, 40% grafts, and no more than 10%
Vascular access care .. nephrology perspective - Dr. Tamer El saidMNDU net
This document discusses vascular access care from a nephrology perspective. It begins by noting the increasing number of ESRD patients requiring hemodialysis and the need for adequate vascular access to deliver treatment. It then describes the common types of vascular access and emphasizes the importance of planning, assessment, and surveillance to promote access patency and prevent complications like stenosis and infection. The document provides guidelines for physical examination, ultrasound, angiography, and other testing to monitor access and identify issues requiring intervention. The goal is early detection and treatment of problems to maximize vascular access lifespan and function.
This document provides information on inserting tunneled dialysis catheters. It discusses the preferred insertion sites being the right internal jugular vein. Potential acute complications during insertion include arterial puncture, pneumothorax, hemothorax, and air embolism. Subacute complications after insertion include suboptimal flow due to malposition, kinking, clots or fibrin sheath formation. Tunnel tract infection is also discussed as a complication requiring antibiotic treatment and catheter removal. The document provides guidance on preventing and managing these potential complications.
Vascular access for haemodialysis prof. ahmed halawaFarragBahbah
Vascular access for haemodialysis requires either an autogenous arteriovenous fistula, a PTFE graft, or a tunnelled line. A good fistula has adequate size, blood flow, and low complication rates. Formation of an arteriovenous fistula involves connecting an artery such as the radial or brachial to a vein like the cephalic or basilic. Complications include steal syndrome, aneurysms, pseudoaneurysms, venous hypertension, and infection. Steal syndrome is treated with distal reconstruction and interval ligation. Buttonhole and rope-ladder techniques are used for cannulating fistulas and have benefits over traditional needle cannulation.
This document provides an overview of the history and development of vascular access for hemodialysis. It discusses:
- The early development of hemodialysis and use of arteriovenous shunts by Scribner in the 1960s.
- Research in the 2000s that showed much higher rates of AV fistula use and better patient outcomes in Europe and Japan compared to the US. This led to the "Fistula First" initiative in the US to increase AV fistula rates.
- Guidelines for vascular access including the preference for autogenous AV fistulas over prosthetic grafts when possible, with radiocephalic fistulas as the first choice.
- Common complications of AV fist
Vascular access in Haemodialysis (2).pptxMithunAhmed5
national institute of kidney disease and urology (nikdu)
Dialysis access refers to the creation of an entrance way into the bloodstream so that the blood can be cleansed by the dialysis procedure. It is well established that dialysis cannot be provided without access.
The attainment and maintenance of a single reliable, long-lasting dialysis access with minimal complications continue to be challenging.
Achievement of such an access is associated with optimal patient clinical outcomes, superior quality of life, and minimal costs.
This procedure is knowledge required for the dialysis, in this PPT include introduction, definition, indication, Advantages, Disadvantages, Nursing care and complication of Arteriovenous graft.
Novel trends in hemodialysis vascular accessMoataz Fatthy
This document discusses novel trends in hemodialysis vascular access. It covers the history of dialysis, current modalities of vascular access including arteriovenous fistulas, arteriovenous grafts and central venous catheters. It also discusses imaging techniques like Doppler ultrasound and guidance for vascular access placement. Novel trends discussed include local drug therapies delivered endovascularly or perivascularly to prevent access failure, as well as bioengineered autologous grafts. Needleless dialysis is also mentioned as a novel trend. The key takeaway message is that vascular access is precious and needs careful handling to avoid access failure which can be a nightmare for patients.
This document discusses tunneled central vein catheters that are often used as temporary access for hemodialysis. It can describe where catheters are typically placed, including the right internal jugular vein, left internal jugular vein, and femoral vein. Complications of tunneled catheters discussed include malfunction, infection, and central vein stenosis. The goal of recognizing complications early is to prevent issues like inadequate dialysis or loss of the vascular site. Photographs in the document aim to help identify common catheter problems.
An arteriovenous fistula (AVF) is created by surgically connecting an artery directly to a vein, allowing blood to flow from the artery to the vein. This creates a continuous circuit from the heart. The most common sites for AVFs are the wrist, elbow, and upper arm.
Cannulation of the AVF is important to maintain patency and prevent complications. It can be done using either a rope ladder technique, which rotates sites, or a buttonhole technique, which uses the same site. Proper needle size, angle, and hemostasis are important to prevent issues like infiltration or bleeding.
Vascular access surgery by Dr. Ali MujtabaDr Ali MUJTABA
This document provides an introduction to vascular access surgery. It discusses the history and development of vascular access methods beginning in the late 19th century. The three primary methods used today are native arteriovenous fistulas, prosthetic arteriovenous grafts, and intravenous catheters. Arteriovenous fistulas are preferred when possible due to their longer lifespan and lower risk of complications compared to grafts and catheters. The document outlines considerations for patient evaluation, access selection, creation of arteriovenous anastomoses, maturation of fistulas, post-dialysis hemostasis, and frequent complications.
This document summarizes the surgical technique and complications of central venous catheters for hemodialysis. It discusses the basic concepts, pre-operative evaluation including imaging of central veins, catheter insertion technique, and perioperative and long-term care and complications. The best site for catheter placement is the right internal jugular vein to minimize risks of kinking and central vein stenosis. Ultrasound and fluoroscopy guidance are recommended for accurate placement and tunneling of cuffed catheters. Major perioperative risks include pneumothorax, hemothorax, and nerve injury, while long-term complications consist of infection, thrombosis, stenosis, and catheter malfunction.
New and Emerging Advanced Vascular & Interventional Radiology ProceduresAllina Health
Radiology
1) The document introduces 6 new and emerging advanced vascular and interventional radiology procedures: radiation segmentectomy, radial artery access for visceral interventions, prostate artery embolization, advanced tumor ablation, balloon-occluded retrograde transvenous obliteration, and thrombolysis for venous thromboembolic disease.
2) The procedures provide minimally invasive alternatives to open surgery with benefits of shorter hospital stays, fewer complications, and improved quality of life.
3) Case examples are presented for each procedure to illustrate clinical applications and outcomes.
- An arteriovenous fistula (AVF) is created by connecting an artery directly to a vein, allowing blood to flow directly from the arterial to venous system.
- The "Rule of 6" describes factors for an optimal AVF: the fistula should mature for at least 6 weeks, be at least 6 cm from the arterial anastomosis, the vein should enlarge to at least 6 mm in diameter, and have a blood flow rate of at least 600 ml/min.
- Complications of AVFs can be acute like thrombosis, bleeding, or hematoma, or chronic like aneurysms, pseudoaneurysms, skin necrosis, steal syndrome, or infections at the access site. Regular
Radiological placement is consistently more reliable than surgical placement. There are fewer placement complications and fewer catheter infections overall.
It is convenient for the patient, quick, time saving, and cost effective
Interventional radiologists
placement and
management
research and development of hemodialysis catheters
Management of steal syndrome || Dr Ravi BansalAVATAR
This document discusses steal syndrome, which is arterial insufficiency caused by an arteriovenous dialysis access. It can cause hand pain, numbness, and tissue damage. The document describes methods for assessing and classifying steal syndrome severity. Treatment options aim to reverse ischemia while preserving access function, and include percutaneous and surgical interventions like angioplasty, stenting, banding, and distal revascularization-interval ligation. Risk factors include diabetes, peripheral vascular disease, and brachial accesses. Monitoring access flows can help prevent steal syndrome.
Vascular access for hemodialysis( AVF )Irfan Elahi
There are three main types of vascular access for hemodialysis: arteriovenous fistulae (AVF), arteriovenous grafts, and catheters. AVFs have the lowest rate of failures and complications and are the preferred type of access.
For an AVF to be suitable for cannulation and dialysis, it must undergo a maturation process where the fistula develops adequate blood flow, wall thickness and diameter. A properly matured fistula will have a minimum diameter of 6mm, be less than 6mm deep, have a blood flow over 600ml/min, and be evaluated at 4-6 weeks after creation.
The physical exam is the best tool to determine if an AV
This document provides an overview of trans-catheter aortic valve implantation (TAVI). It discusses the indications for TAVI including symptomatic severe aortic stenosis in high-risk surgical patients. The pre-procedural workup involves imaging to assess anatomy and risk. The procedure involves accessing the femoral or other arteries and deploying a balloon-expandable or self-expanding bioprosthetic valve. Complications include conduction abnormalities, paravalvular regurgitation, and hypotension. Two clinical cases are presented of high-risk patients undergoing TAVI.
Molecular imaging techniques such as positron emission tomography (PET) and single photon emission computed tomography (SPECT) can help diagnose and monitor various vascular diseases. PET provides better resolution than SPECT but is more expensive. Tracers like 18-FDG are used to detect vascular inflammation. Molecular imaging helps assess atherosclerosis, aortic diseases, vasculitis, and vascular graft infections. Intravascular ultrasound (IVUS) provides high resolution imaging of blood vessels and plaque morphology. It helps with vascular interventions, aneurysm treatment, and diagnosing various aortic and venous conditions. Both molecular imaging and IVUS provide additional information to angiography with benefits for treatment planning and monitoring.
Av fistula 3 al mansoura aldawly - nephrolody day dr aboelfotohFarragBahbah
This document provides guidance on using color Doppler ultrasound to assess arteriovenous (AV) fistulas in hemodialysis patients. It outlines the objectives of teamwork, patient respect, and basic clinical knowledge. It describes the strategy for color Doppler exams in three stages: preoperative mapping, postoperative assessment of maturity and function, and assessment of complications. The basics of Doppler are reviewed, and the normal and abnormal ultrasound findings for each stage are presented, including criteria for fistula maturity. Complications such as stenosis, thrombosis, aneurysm, steal syndrome, and high output cardiac failure are described. The importance of clinical findings and interdisciplinary teamwork to prevent, predict, and early manage fistula complications is emphasized.
This document provides an overview of invasive procedures including peripheral venous cannulation, central lines, arterial lines, and intraosseous infusion. It discusses indications, contraindications, equipment needed, and techniques for each procedure. Complications are also reviewed. Key points include choosing the appropriate cannula size based on intended use, selecting sites that provide optimal venous access, using sterile technique to minimize infection risk, and being prepared for emergencies by having the skills for intraosseous infusion when intravenous access cannot be quickly obtained.
Basics of Coronary Angiography Hewad Gulzai.pptxHewad Gulzai
Basics of Coronary Angiography for beginners, MD, DNB, DM students, Nurses, cathlab technicians, physicians and other healthcare members .
hope you will learn something from this ppt. 😀
This document discusses Doppler ultrasound of the carotid arteries. It begins with an introduction describing how carotid artery disease can cause strokes and how ultrasound is used to diagnose stenosis to determine surgical candidates. It then describes the anatomy of the carotid arteries and outlines the normal ultrasound appearance. Key points of a carotid ultrasound exam are described including using grayscale, color Doppler, power Doppler and spectral analysis. Different types of carotid plaques are defined as well as how they appear ultrasonographically. Methods for evaluating stenosis and differentiating true from pseudo-spectral broadening are also covered.
Varicose veins and superficial venous insufficiency are conditions caused by abnormal blood flow in the veins leading to damage. Risk factors include family history, age, obesity, prolonged standing, and prior deep vein thrombosis. Treatment options include conservative compression therapy, sclerotherapy to destroy veins chemically, and newer minimally invasive techniques like endovenous laser ablation which uses laser heat to close veins. While varicose veins cannot be cured, many treatment options have high success rates in closing veins and relieving symptoms with few complications. Ongoing management focuses on preventing recurrence through lifestyle changes and compression therapy.
Diagnostic procedure of dsa and management of itsNeurologyKota
This document provides information on diagnostic cerebral angiography procedures and managing complications. It begins with a brief history and overview, then discusses indications, materials, and steps for the procedure. Potential neurological complications discussed include ischemic stroke, transient global amnesia, cortical blindness, and aneurysm rupture. Risk factors and treatments for complications are outlined. Non-neurological complications like hematoma, pseudoaneurysm, and contrast-induced nephropathy are also summarized. The document provides detailed information on performing angiography safely and managing various potential issues.
The document summarizes techniques and complications of arteriovenous (A-V) fistulas used for hemodialysis. It discusses types of fistulas including autogenous and graft fistulas. It describes surgical techniques for creating different types of fistulas such as side-to-side, end-to-side, and end-to-end anastomoses. Common complications include early failure from thrombosis, aneurysm formation, infection, ischemic changes causing steal syndrome, and venous hypertension. Care of the fistula involves exercises and avoiding blood pressure checks or intravenous lines in the fistula arm.
Hemodialysis procedure dr. mohamed kamalFarragBahbah
This document discusses various types of vascular access for hemodialysis patients, including central lines, arteriovenous fistulas, and grafts. It notes that without adequate vascular access, hemodialysis efficiency is reduced and morbidity and mortality increase. Short-term catheters should only be used short-term, while long-term catheters require a plan for permanent access. Fistulas are the preferred permanent access but have high failure rates, especially in older patients and those with comorbidities. Early identification of failing fistulas allows for interventions like angioplasty and stent placement to salvage the access. Overall access-related problems account for half of hospitalizations in hemodialysis patients, emphasizing
This document provides guidelines for performing and interpreting a carotid Doppler ultrasound study. It describes optimal patient positioning and transducer selection. All carotid arteries should be thoroughly imaged using B-mode, color Doppler, power Doppler, and spectral Doppler. Limitations and techniques to avoid are outlined. Proper scanning techniques including Doppler settings, sample volume placement, and angle correction are explained. Normal carotid artery waveform patterns are demonstrated. Indications for carotid ultrasound and common carotid pathologies like plaque and stenosis are described.
Transradial coil embolization of coronary artery fistulas (CAF) and left internal mammary artery (LIMA) side branches from radial approach. A case series - Zoltan Ruzsa
This document presents a case of traumatic liver injury in a 17-year old male patient who was in a motorcycle accident. He presented with abdominal pain and vomiting. Imaging showed a liver laceration and bleeding in the abdomen. He underwent an exploratory laparotomy where a left lobe liver laceration and diaphragm perforation were found and repaired. He recovered well after surgery with drain removal after one week and was discharged. Traumatic liver injuries can range from minor injuries treated non-operatively to severe injuries requiring surgery like lobectomy or packing to control bleeding. Both non-operative and surgical management were discussed.
Trans-radial access (TRad) is commonly used for coronary interventions due to lower complication rates compared to femoral access. This study evaluated the safety and feasibility of TRad for non-coronary and peripheral vascular interventions in 24 cases over 3 years. TRad was successful in all cases with no access complications. Indications included absent femoral pulses, morbid obesity, femoral bypass, and groin infections. Procedures included diagnostic angiograms and interventions like iliac angioplasty/stenting and femoral anastomosis angioplasty. 31% had asymptomatic radial artery occlusion. Larger sheath sizes were associated with higher occlusion rates. TRad is a safe alternative to femoral access for select peripheral cases
1. Abdominal trauma accounts for a significant portion of trauma mortality and morbidity. Computed tomography is the gold standard for evaluation but ultrasound and radiography also play roles.
2. Blunt abdominal trauma causes injury through rapid deceleration forces while penetrating trauma results from stab or gunshot wounds. The organs most commonly injured are the spleen, liver, and kidney.
3. CT signs of injury include hematomas, lacerations, active bleeding, and pneumoperitoneum. Grading systems exist for injuries to specific organs to guide management. With advances in imaging and conservative approaches, many injuries can now be managed non-operatively.
This document provides an overview of central venous catheter (CVC) insertion. It discusses the indications and contraindications for CVC placement, potential complications, relevant anatomy, ultrasound use, the Seldinger technique for insertion, and aftercare considerations. Sites for placement include the internal jugular, subclavian, and femoral veins. Ultrasound is used to visualize the vessels and guide needle insertion. The Seldinger technique involves inserting a needle into the vessel, placing a guidewire, dilating the tract, and sliding the catheter over the wire into position. Post-procedure care includes chest x-rays to check placement and routine line maintenance to reduce infection and thrombosis risks.
This document summarizes various types of aneurysms and vasculitis. It discusses abdominal aortic aneurysms as the most common type of aneurysm. The main risk factors, presentations, diagnostic modalities, and surgical treatments are described. It also discusses other peripheral aneurysms such as popliteal aneurysms. Several types of vasculitis are briefly covered including Buerger's disease, temporal arteritis, and Takayasu arteritis.
This document provides an overview of venography, which is an imaging technique used to examine veins. It discusses the basic principles of venography, including ascending and descending techniques. It describes the anatomy of veins and provides diagrams. It also covers indications, contraindications, techniques, and potential complications of lower limb, upper limb, and peripheral varicography venography procedures. The goal of venography is to accurately diagnose conditions like deep vein thrombosis.
Procurement and packaging of Donor Heartsanyal1981
history of cardiac transplant, dr christian bernard, Groote schuur hospital,denise darvall, louis washansky, donor surgery, preservation solutions for harvested organs, organ transport systems
This document describes a case of a 31-year-old male patient who presented with chronic abdominal pain and pain in both lower limbs for 6 months. Investigations revealed complete occlusion of the infrarenal aorta and celiac and superior mesenteric arteries. The patient underwent an open surgical bypass grafting procedure involving an aorto-mesenteric graft to restore blood flow to the celiac and superior mesenteric arteries. The procedure was technically successful and the patient was discharged after an uneventful post-operative recovery. Chronic mesenteric ischemia can be treated through open surgical or endovascular methods, with endovascular interventions demonstrating better long-term outcomes in many cases.
This document describes various diagnostic modalities used to evaluate esophageal diseases. It discusses barium swallow, esophagoscopy, esophageal manometry, pH monitoring, impedance pH monitoring, endoscopic ultrasound, and Bilitec 2000. Details provided include indications, contraindications, techniques, measurements obtained, and example images for each test. The modalities allow examination of esophageal anatomy and function, identification and staging of conditions like gastroesophageal reflux disease and cancer.
ICMR guidelines on antimicrobial use in Sepsis and SSI's in Indiasanyal1981
Sepsis, septic shock, sepsis induced hypotension, SIRS, common pathogens, trends of antimicrobial resistance. Emperical antibiotic therapy, Classification of surgical site infections with specifications regarding site specific pathogens and peri-operative prophylaxis
This document provides an overview of median nerve injuries, including anatomy, types of injuries, clinical examination findings, and management principles. It describes the anatomy of the median nerve from its origins in the brachial plexus through the arm, forearm, and hand. It discusses high and low median nerve injuries. Key examination techniques are outlined, including tests for specific muscle function. Surgical management principles include nerve repair, decompression, and tendon transfers. Common compression neuropathies like carpal tunnel syndrome and pronator teres syndrome are also summarized, including their symptoms, diagnosis, and treatment.
gastric resection, reconstruction and post gastrectomy syndromessanyal1981
discussion regarding history of gastrectomy, types of gastrectomy, billroth I, billroth II and roux en y gastrojejunostomy........discussion of post gastrectomy syndromes
surgery, minimally invasive techniques, continuous closed ;lavage, necrosectomy, VARD, ideal time for intervention, role of antibiotics , laparoscpic surgery
Melanoma clinical features, pathology and managementsanyal1981
This document discusses malignant melanoma, including its pathogenesis, epidemiology, risk factors, clinical features, histological types, staging, management, and prevention. Key points include:
- Melanoma arises from the malignant transformation of melanocytes. It most commonly occurs on the skin.
- Incidence is highest in fair-skinned populations with a lifetime risk of 1 in 56 for Caucasian males. Risk factors include sun exposure, family history, and numerous moles.
- Clinical features depend on location and include changes to existing moles. Staging uses Breslow depth and Clark level to assess prognosis.
- Management involves wide local excision with sentinel lymph node biopsy for early stages and lymphadenectomy
Vesicoureteral reflux (VUR) is retrograde flow of urine from the bladder to the upper urinary tract. It can be primary due to deficiencies in the ureterovesical junction or secondary due to bladder dysfunction. Diagnosis involves urine tests, ultrasound, VCUG, DMSA scan and urodynamic studies. Most low-grade reflux resolves spontaneously while high-grade reflux is less likely to resolve. Management includes antibiotics and watchful waiting or surgical correction via open or endoscopic techniques like injection of bulking agents. The goal is to prevent urinary tract infections and renal damage.
Wilms' tumor is the most common pediatric renal tumor. It has an annual incidence of 7.6 cases per million children under 15 years of age in the US. The mean age of diagnosis is 46.9 months for females and 41.5 months for males. Treatment involves nephrectomy followed by chemotherapy and possibly radiation therapy depending on stage. Staging is based on tumor size, involvement of surrounding structures, and presence of metastases. Prognosis depends on stage and histology, with 5-year survival rates over 90% for favorable histology stage I-III disease. Intensive multimodal therapy has resulted in significantly improved survival outcomes over the past decades.
Levels of evidence, recommendations & phases ofsanyal1981
This document discusses levels of evidence and phases of clinical trials. It defines evidence-based medicine as using current best evidence from systematic research to make decisions about patient care. Levels of evidence are ranked from 1A to 5 based on study design, with systematic reviews and randomized controlled trials ranked highest. Clinical trials progress through four phases to test safety, efficacy, and optimal use of new drugs or devices. Phase 1 assesses safety, phase 2 establishes efficacy, phase 3 confirms safety and efficacy in larger groups, and phase 4 studies monitor risks and benefits after marketing.
This document discusses cleft lip and palate including embryogenesis, classification systems, incidence, etiology, management, and timing of surgery. It describes how the lip and palate form during embryogenesis. It covers several classification systems including Nagpur, LAHSHAL, Davis & Ritchie, and Veau systems. It provides statistics on incidence. It discusses etiology such as familial factors, nutrition, infections, radiation, and genetic syndromes. It outlines primary and secondary management including feeding, airway, surgery, and secondary concerns like hearing, speech, dental issues, and potential additional surgeries.
Sugical anatomy of hand and its infectionssanyal1981
1. The document discusses the anatomy and clinical infections of the hand. It describes the parts of the hand and their blood supply, nerves and fascial spaces.
2. Common infections like paronychia, felon, herpes simplex virus infection and flexor tenosynovitis are explained in terms of their causes, presentations, and treatments.
3. Surgical management of hand infections is outlined, emphasizing the importance of adequate drainage while avoiding injury to critical structures like nerves and tendons. Post-operative splinting and irrigation are also discussed.
2024 HIPAA Compliance Training Guide to the Compliance OfficersConference Panel
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Unlocking the Secrets to Safe Patient Handling.pdfLift Ability
Furthermore, the time constraints and workload in healthcare settings can make it challenging for caregivers to prioritise safe patient handling Australia practices, leading to shortcuts and increased risks.
At Apollo Hospital, Lucknow, U.P., we provide specialized care for children experiencing dehydration and other symptoms. We also offer NICU & PICU Ambulance Facility Services. Consult our expert today for the best pediatric emergency care.
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Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...nirahealhty
The South Beach Coffee Java Diet is a variation of the popular South Beach Diet, which was developed by cardiologist Dr. Arthur Agatston. The original South Beach Diet focuses on consuming lean proteins, healthy fats, and low-glycemic index carbohydrates. The South Beach Coffee Java Diet adds the element of coffee, specifically caffeine, to enhance weight loss and improve energy levels.
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardso...rightmanforbloodline
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
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Comprehensive Rainy Season Advisory: Safety and Preparedness Tips.pdfDr Rachana Gujar
The "Comprehensive Rainy Season Advisory: Safety and Preparedness Tips" offers essential guidance for navigating rainy weather conditions. It covers strategies for staying safe during storms, flood prevention measures, and advice on preparing for inclement weather. This advisory aims to ensure individuals are equipped with the knowledge and resources to handle the challenges of the rainy season effectively, emphasizing safety, preparedness, and resilience.
Let's Talk About It: Breast Cancer (What is Mindset and Does it Really Matter?)bkling
Your mindset is the way you make sense of the world around you. This lens influences the way you think, the way you feel, and how you might behave in certain situations. Let's talk about mindset myths that can get us into trouble and ways to cultivate a mindset to support your cancer survivorship in authentic ways. Let’s Talk About It!
10. Pre-operative evaluation
1. Early referral:
- GFR < 30ml/min
- 06 months prior to anticipated HD
- s.creat < 4m/dl
2. History and physical examination:
- prior access procedures, revisions,
complications, CV thrombosis and arm edema
- Examination of pulses, Allen’s test
17. Surgical technique
• A 3-cm incision is made in the distal forearm midway
between the radial artery and the cephalic vein
• Skin flaps created
• Cephalic vein and radial artery are dissected free
• Sufficient length of vein (approximately 3 cm) should
be mobilized to facilitate its transposition onto the
artery
• Vein is transected, gently distended with saline, and
then spatulated to enlarge the anastomosis
• Artery is occluded with two clamps
• 7- to 8-mm arteriotomy is created
• End-to-side anastomosis is performed using a running
6-0/7-0 monofilament vascular suture
19. Surgical technique
• Transverse incision is made across through the
antecubital crease over the brachial artery and cephalic
vein
• The cephalic vein (or median antecubital vein) is
dissected free for sufficient length to facilitate
transposing it onto the brachial artery
• Brachial artery is exposed by incision of the overlying
bicipital aponeurosis
• Sufficient length is dissected free for the anastomosis
and occluding clamps
• 7- to 10-mm incision is created in the artery and a
• Anastomosis constructed
21. Surgical technique
- Incision made over ante cubital fossa
- Skin incision and the dissection are
extended proximally to the axilla
- Basilic vein courses adjacent to the medial
antecubital cutaneous nerve in the
upperarm
- Distended vein is then gently draped over the
upper arm in an arc, and the future course of the
transposed vein is marked on the skin
- Brachial artery is dissected at the site of anastomosis
- A tunnel is created along the course marked on the skin
- End to side anastomosis is created
24. Surgical technique
- Incision over antecubital fossa
- Brachial artery and Median antecubital vein
dissected
- Proposed course of graft drawn on skin
- Graft draped over the skin
- Counter incision given distally
- Graft( 6mm PTFE) passed after passsage of
tunneling device
- Anastomosis created
26. Surgical technique
- Incision over the antecubital fossa to expose
brachial artery
- Proximal incision at axilla( not involving
axillary crease) to expose the axillary vein
- 6mm PTFE graft tunneled and anastomosis
performed
28. Salient points
- To be considered only if conventional access
methods have failed
- venography/venous mapping prior to the
procedure
- Autogenous better than prosthetic
- Upper extremity better than lower
- Exotic and complicated but better than
tunnelled dialysis catheter
29. KDOQI Guidelines
• HD with tunneled catheter/ PD as a bridge to
transplant if:
- weight < 20 kgs
- Time to transplant < 12 months
39. Post-op care
• General principles:
- Check Hb, electrolytes
- Consider dialysis if indicated
- Early drain removal and discharge
- Follow up 2 weeks and 4-6 weeks
- Discharge and referral to dialysis unit with a
schematic diagram of AV access
40. Post-op care
• Strategies to promote maturation:
- Imaging to monitor maturation
- Balloon angioplasty maturation(BAM)
- Access elevation
- Accessory branch ligation
- Medical mgt: Clopidogrel/Aspirin/Warfain
41. Complications
• KDOQI Clinical outcome goals:
- Thrombosis rate of 0.25 episodes/patient-year and life
expectancy of more than 3 years for autogenous accesses and
a thrombosis rate of 0.5 episodes/patient-year and a life
expectancy of more than 2 years for prosthetic accesses
- Infectious complication rates should not exceed 1% and 10%
over the functional life of an autogenous and prosthetic
access, respectively
42. Complications
1. Failure:
- Early: A fistula which was never usable for dialysis/
fails within 03 months of creation
- Causes:
a. Inflow:-
Pre-existing – Small calibre, atherosclerosis
Acquired – Juxta-anastomotic stenosis
b. Outflow:-
Side branches
Anatomically small
Stenotic
44. Complications
- Late: Occurs after 03 months of creation
- Causes:
a. Venous stenosis:- At pressue points and
bifurcations
b. Arterial lesions
c. Thrombosis
47. Complications
2. Steal syndrome:
- Occurs in 1-8% cases
- May lead to severe ischaemia
- Presentation: Chronic pain, tissue loss,
extremity loss
- Pathology:
a. High flow
b. Arterial stenosis
c. Poor collateral perfusion(diabetics)
49. Steal syndome
Duplex Doppler ultrasound of the left antecubital fossa demonstrating a
significant steal syndrome. Blood enters the proximal brachial artery
(1) and >70% is shunted through the PTFE graft (3) with <30% flow
through the native distal artery (2).
51. Management of Steal syndrome
Distal reconstruction and
interval ligation (DRIL)/
RUDI
• Preferable to use vein
• Increased risk thrombosis
PTFE
• 9 case series
• Symptoms resolved 33 to
100%
• Improved 17 to 66%
• DRIL patency 86 to 100%
52. Complications
3. Aneurysm and Pseudo-aneurysm formation:
- Indications for aneurysm repair:
a. Skin overlying the fistula is (ischemic)
compromised
b. Risk of rupture
c. Available puncture sites are limited
53. Complications
- Indications for pseudo-aneurysm repair:
a. Symptomatic or threatens the viability of the
overlying skin
b. Evidence of infection
c. Enlarging in size or > than twice the diameter of the
graft
d. Limited number of cannulation sites
57. Complications
5. Infections:
- Incidence:-
a. Autogenous: 0-3%
b. Prosthetic grafts: 6-25%
- Present as vasculitis
- May even have septic emboli
- Culture based antibiotic therapy x 06 wks
- Drainage
- Excision of infected prosthetic material
59. Catheters
• Indications:
- Acute renal failure.
- Dialysis for overdose.
- ESRD with no access.
- ESRD with failure of access.
- Peritoneal dialysis with complications.
- Cardiac failure patients.
- Plasmapharesis
60. Pre-procedural evaluation
• History & Physical Examiantion:
- H/O previous tunneled catheter, central line,
AVF and pacemaker insertions
- H/o coagulation disorders
- Examination of neck and chest
- Ipsilateral facial and upper extremity edema,
distended veins and collaterals
61. Pre-procedural evaluation
• Imaging:
- Colour flow venous duplex imaging:
First line
Has limited role in the imaging of chest
veins
- Magnetic Resonance venography :
94% sensitivity for > 50% occlusion
Concerns with Gadolinium
- CT Venography:
Readily available
Faster acquisition
Safer contrast
- Catheter based venography:
Gold standard
62. Technical considerations
• Arterial lumen:
- Outflow to HD machine
• Venous lumen:
- inflow from HD machine
• Catheter dysfunction:
- Qb < 300ml/min.
- Art. Pressure <-250.
- Ven. Pressure > 250.
- Unable to aspirate blood freely. (Late sign).
- Frequent pressure alarms
63. Types
• Cuffed / non Cuffed
- longevity
• Luminal design
- Split tip, Step tip, Symmetric tip and Dual
catheters
• Material
- Silicon, Silastic, Polyurethane
• Antiseptic impregnated.
64. Non cuffed catheters
• Short.
• More rigid.
• Easy and fast insertion.
• Immediate use.
• Higher infection rate.
• Preferred IJ or femoral.
• Avoid subclavian.
• < 3wks for IJ.
• <5 days for femoral
69. Complications
• Peri-operative:
1. Pneumothorax
2. Haemothorax
3. SC haematoma
4. Wire embolism
5. Arrhythmias: Cardioversion 0.9%
6. Cardiac perforation
- due to dilators, guide wires and rigid introducers
7. Thoracic duct laceration
- Small chance
- Cirrhotics are more prone
- Resolves spontaneously
8. Catheter misplacement
- Venous/arterial
70. Complications
• Late:
1. Air embolism:
- Rare but potentially lethal
- Due to disconnection/ cracks
- Sudden haemodynamic collapse
- Left lateral decubitus
- Aspiration
2. Catheter embolism:
- Due to fractures at points of stress
- Diagnosed due to incomplete removal
- Angiographic retrieval
71. Complications
3. Catheter occlusion:
- 30-40% with tunneled devices
-Due to formation of fibrin sheath
- Management:
> Heparin flush(1ml=5000U) 3times/wk
> Warfain
> Aspirin
> rtpa (Alteplase) flush
> Angiographic snare based retrieval
> Catheter change
73. Complications
4. Central venous thrombosis:
- Occurs in conjunction with S. aureus
infection
- Facial, neck and arm swelling
- Duplex USS is diagnostic
- Anticoagualtion and arm elevation
- May require catheter removal
74. Complications
5. Central Venous stenosis:
- Due to subclavian cannulation
- Intimal injury
- May involve brachiocephalic and SVC
- Asymptomatic/ Upper limb edema
- Limb elevation
- Presence of ipsilateral access complicates the
scenario
- Angioplasty +/- stent placement
- Multiple procedures
75. Complications
6. Catheter related infection:
- Incidence: 0.6 to 6.5 episodes per 1000 catheter
days.
- Types
a. Exit site: Inflammation confined to the area surrounding the
catheter exit site, not extending superiorly beyond the cuff if the catheter
is tunneled, with exudate culture confirmed to be positive.
b. Tunnel site: The catheter tunnel superior to the cuff is
inflamed, painful, and may have drainage through the exit site that
is culture positive
c. Bacteraemia: Blood cultures are positive for the
presence of bacteria with or without the accompanying
symptom of fever (Blood Cx > 15CFU. From peripheral and catheter)
76. Complications
- Bacteriology:
a. gram-positive (52%-84%), with S.aureus
making up 21% - 43%. MRSA in 12%-38% of
cases.
b. gram-negative: Pseudomonas species,
K.pneumoniae, E.coli and Enterobacter
c. Fungal: Candida
77. Complications
- Treatment:
> Emperical broad spectrum antibiotics
followed by culture specific regimen
> Gram+ve 4-6 wks
> Gram –ve 7-14 days
> Caspofungin/Amphotericin B
> Topical Mupirocin
> Antibiotic lock: Cephazolin, vancomycin
78. Complications
- Complications of catheter related infections:
1. Osteomyelitis
2. Septic arthritis
3. Spinal epidural abscess
4. Endocarditis
79. Advantages
• Universal Application.
• No maturation time.
• Short term Hemodynamic consequence.
• Lower initial cost.
• Provide time for fistula maturation.
80. Disadvantages
• Associated with higher mortality risk than fistula
• Thrombosis.
• Infection.
• Central venous thrombosis.
• Discomfort.
• Cosmetic.
• Shorter expected using time.
• Lower Qb.
81. Haemodialysis Reliable Outflow
(HeRO) Device
• Indications:
- Upper extremity access precluded by central
venous stenosis or occlusion
- Alternative to lower limb access techniques
• Relative contraindications:
- Brachial artery diameter < 3mm
- SBP< 100mmHg
- EF < 20%
- Presence of active infection
82. Haemodialysis Reliable Outflow
(HeRO) Device
• Components:
- Graft: 6mm PTFE
- Catheter: Into RA via SVC/ Subclavian
• Outcomes:
- Lower infection rates
- Higher patency