Buttonhole Cannulation Technique Power PointKelley Stanley
The document discusses the buttonhole cannulation technique for vascular access in dialysis patients. It provides background on dialysis patients and costs in the US. The buttonhole technique creates fixed puncture sites in an arteriovenous fistula to reduce complications from cannulation. The literature review found the technique reduces pain and complications compared to the rope-ladder technique and has been used successfully in Europe for over 30 years. The document proposes evaluating the buttonhole technique for reducing cannulation pain, anxiety, and complications compared to the rope-ladder technique in outpatient dialysis clinics.
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.
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.
There are three main types of cannulation for vascular access:
1. Rope ladder method is the most recommended as it helps prevent infections, stenosis, aneurysms and extends the life of the fistula.
2. Area puncture method is easiest but puncturing the same area each time can lead to aneurysms, stenosis and bleeding.
3. Button hole method punctures the exact same spot each time, which is less painful, extends the fistula life, and prevents complications but requires more training.
This document provides an introduction, history, and indications for continuous renal replacement therapy (CRRT). It summarizes that CRRT was developed as an alternative to intermittent hemodialysis for critically ill patients. CRRT allows for slow, continuous removal of waste and fluid over many hours compared to brief, intermittent hemodialysis sessions. The document reviews the components of CRRT systems and indications for its use in critically ill patients with conditions like fluid overload, acidosis, hyperkalemia, or multi-organ dysfunction.
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 discusses exit site infections in peritoneal dialysis patients. It defines acute and chronic exit site infections and notes that approximately one fifth of peritonitis episodes are associated with exit or tunnel infections. Exit site infections are commonly caused by Staphylococcus aureus or Gram-negative bacteria like Pseudomonas. Treatment depends on the severity and causative organism but may include antibiotics, changing the exit site dressing, or catheter removal in severe cases. Preventing exit site infections through good catheter care and possibly antibiotic prophylaxis can help reduce risks of peritonitis and catheter loss.
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.
Buttonhole Cannulation Technique Power PointKelley Stanley
The document discusses the buttonhole cannulation technique for vascular access in dialysis patients. It provides background on dialysis patients and costs in the US. The buttonhole technique creates fixed puncture sites in an arteriovenous fistula to reduce complications from cannulation. The literature review found the technique reduces pain and complications compared to the rope-ladder technique and has been used successfully in Europe for over 30 years. The document proposes evaluating the buttonhole technique for reducing cannulation pain, anxiety, and complications compared to the rope-ladder technique in outpatient dialysis clinics.
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.
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.
There are three main types of cannulation for vascular access:
1. Rope ladder method is the most recommended as it helps prevent infections, stenosis, aneurysms and extends the life of the fistula.
2. Area puncture method is easiest but puncturing the same area each time can lead to aneurysms, stenosis and bleeding.
3. Button hole method punctures the exact same spot each time, which is less painful, extends the fistula life, and prevents complications but requires more training.
This document provides an introduction, history, and indications for continuous renal replacement therapy (CRRT). It summarizes that CRRT was developed as an alternative to intermittent hemodialysis for critically ill patients. CRRT allows for slow, continuous removal of waste and fluid over many hours compared to brief, intermittent hemodialysis sessions. The document reviews the components of CRRT systems and indications for its use in critically ill patients with conditions like fluid overload, acidosis, hyperkalemia, or multi-organ dysfunction.
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 discusses exit site infections in peritoneal dialysis patients. It defines acute and chronic exit site infections and notes that approximately one fifth of peritonitis episodes are associated with exit or tunnel infections. Exit site infections are commonly caused by Staphylococcus aureus or Gram-negative bacteria like Pseudomonas. Treatment depends on the severity and causative organism but may include antibiotics, changing the exit site dressing, or catheter removal in severe cases. Preventing exit site infections through good catheter care and possibly antibiotic prophylaxis can help reduce risks of peritonitis and catheter loss.
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.
Continuous renal replacement therapy (CRRT) involves using extracorporeal blood purification therapies to slowly remove waste and fluid from patients with impaired kidney function over an extended period of time, typically 24 hours per day. CRRT aims to closely mimic the native kidney and is well-tolerated by hemodynamically unstable patients. It allows for gentle removal of large amounts of fluid and waste products while also controlling electrolytes, acid-base balance, and removal of sepsis mediators. CRRT has advantages over intermittent dialysis in managing fluid overload and maintaining hemodynamic stability.
This document discusses hemodialysis for acute kidney injury (AKI). It provides information on:
1. Hemodialysis is a form of renal replacement therapy that uses a dialyzer and extracorporeal circuit to partially replace kidney functions like fluid balance and waste removal when kidney function is insufficient.
2. The decision to start renal replacement therapy like hemodialysis for AKI is based on clinical signs of issues like volume overload or biochemical abnormalities rather than single thresholds, though emergencies require immediate dialysis.
3. The optimal timing of dialysis initiation for AKI is unclear, but observational studies suggest earlier initiation may improve outcomes compared to waiting for more severe clinical indications.
This document discusses evaluating the adequacy of hemodialysis treatment. It states that numerous studies have shown a correlation between the delivered dose of hemodialysis and patient mortality and morbidity. The urea reduction ratio (URR), which measures the percentage reduction of urea levels pre- and post-dialysis, is one way to evaluate adequacy, with a URR over 60% generally associated with better outcomes. Equilibrated Kt/V is also discussed as a standard measure of dialysis dose, with a minimum of 1.4 recommended. The document outlines factors that influence adequacy, including treatment time and frequency, dialyzer characteristics, blood and dialysate flow rates, and dialysis solution composition
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.
Monitoring and surveillance_of_vascular_accessNaveen Kumar
This document discusses surveillance of vascular access in hemodialysis patients. It notes that while arteriovenous fistulas and grafts are superior to catheters, vascular access complications are common. Guidelines suggest various surveillance methods to maintain access patency, including monitoring physical signs and using tests like access flow measurements and ultrasound imaging to detect stenosis early. Randomized controlled trials on the benefits of surveillance vs monitoring alone have shown conflicting results, but surveillance is generally associated with fewer thrombotic events, hospitalizations, and missed treatments. However, there is no conclusive evidence yet that surveillance prolongs overall access lifespan.
The document discusses the history and development of hemodialysis adequacy measures. It describes how Frank Gotch and John Sargent developed the Kt/V measure in the 1970s to more accurately assess dialysis dose based on urea clearance. This resolved issues with prior methods that used target BUN levels. The document outlines the benefits of Kt/V over BUN and notes minimum recommended levels of Kt/V and URR to ensure adequate dialysis.
This study analyzed risk factors and allograft outcomes for recurrent glomerulonephritis (GN) after kidney transplantation using data from the Australia and New Zealand Dialysis and Transplant registry. The results showed that the overall recurrence rate of the four most common GN subtypes (IgA nephropathy, MPGN, FSGS, MGN) was approximately 10% within 5 years of transplantation, and 45% of recipients with recurrent GN lost their allografts within 5 years. Recurrence significantly increased the risk of allograft failure. MPGN recurrence had the worst allograft survival rates. Regular surveillance of at-risk recipients is needed to detect recurrence early and prevent allograft loss
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.
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"
This document discusses permanent vascular access for hemodialysis. It describes the formation and types of arteriovenous fistulae (AVF) and synthetic grafts. AVFs involve surgically connecting an artery and vein and are the preferred permanent access. Synthetic grafts are used when vessels are unsuitable for an AVF. Complications of access include stenosis, thrombosis, ischemia, pseudoaneurysms and infection. Care of the access involves monitoring for complications, proper needle placement and infection prevention.
The patient is a 49-year-old woman with end-stage renal disease and diabetes who presented with altered mental status. She receives hemodialysis three times per week for a few years. Recently, she has been increasingly tired, weak, and unable to perform daily activities with poor appetite and nausea. On examination, she was pale and swollen with low hemoglobin. Tests found elevated creatinine, BUN, and electrolyte abnormalities. The most probable diagnosis is inadequate hemodialysis, as her symptoms and labs are consistent with worsening uremia due to insufficient solute clearance from her dialysis sessions. Kt/V is a measure of dialysis adequacy that accounts for urea clearance and patient
This procedure is knowledge required for the dialysis, in this PPT include introduction, definition, indication, Advantages, Disadvantages, Nursing care and complication of Arteriovenous graft.
The document discusses continuous renal replacement therapy (CRRT) in critical care units. It begins with definitions and history of renal replacement therapy. It then covers principles, techniques, applications, results and complications of CRRT. The techniques discussed include continuous venovenous hemofiltration (CVVH), hemodialysis (CVVHD) and hemodiafiltration (CVVHDF). Advantages include hemodynamic stability, precise volume control and removal of toxins and cytokines. Complications can include bleeding, infection and electrolyte imbalances. CRRT remains the preferred technique for critically ill patients with acute kidney injury in many intensive care settings.
Rrt in icu dr said khamis zagazig april 2018 latestFarragBahbah
The document provides an overview of renal replacement therapy (RRT) modalities for critically ill patients with acute kidney injury (AKI). It discusses the history and evolution of RRT, including intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT). The pros and cons of IHD and CRRT are presented. Key considerations for RRT include which modality to use, anticoagulation options, dialysate buffers, and membranes. Guidelines for determining therapy dose and duration and criteria for discontinuing RRT are summarized. Outcomes with IHD versus CRRT remain unclear due to limitations of existing studies. Overall, the document reviews best practices for delivering RRT to critically ill AK
This document summarizes key aspects of hemodialysis adequacy and dose. It discusses:
- Early studies that showed a correlation between dialysis dose and patient outcomes. The NCDS study in 1981 was the first randomized controlled trial showing higher Kt/V values were associated with better outcomes.
- Methods for measuring dialysis dose including Kt/V, eKt/V, URR. The preferred method is formal kinetic urea modeling.
- Guidelines recommend a minimum Kt/V of 1.2 or eKt/V of 1.2. Studies like HEMO showed no additional benefit to higher doses above 1.3-1.4.
- Maximizing
The document outlines the objectives and key concepts of a training course on continuous renal replacement therapy (CRRT). It defines CRRT and discusses the basic principles of CRRT, including solute transport mechanisms, clinical indications, machine setup and safety features, and fluid balance principles. It also summarizes evidenced-based research showing improved patient survival with early CRRT initiation and adequate dose delivery.
The history of dialysis began in the 18th century with advances in materials like collodion membranes that could be used for diffusion. In the early 20th century, researchers like Abel and Kolff began developing early dialysis machines. Kolff's 1943 dialyzer was the first working machine used to treat acute renal failure. In 1945, Kolff treated the first patient with end-stage renal disease using hemodialysis, allowing her to regain consciousness. Throughout the 1950s and 1960s, dialysis treatment expanded but demand still far exceeded capacity, with challenges in finding long-term treatment for chronic kidney disease patients.
Sindrome de reabsorcion post reseccion transuretral de prostataSandra Careaga Cortes
El documento describe el tratamiento quirúrgico de la hiperplasia benigna de próstata mediante resección transuretral. Este procedimiento utiliza irrigación con líquidos para mejorar la visión, pero estos líquidos pueden ser absorbidos y causar alteraciones hemodinámicas. Se recomienda monitorear la absorción de líquidos y no sobrepasar los 60 minutos de duración para reducir riesgos.
This document discusses different types of vascular access for hemodialysis including arteriovenous fistulae (AVF), polytetrafluoroethylene grafts, and temporary and tunnelled dialysis catheters. It provides details on AVF maturation criteria, cannulation techniques, and care. Complications of fistulae and grafts like clotting, infection, and steal syndrome are outlined. The use of temporary catheters, characteristics of tunnelled catheters, and management of catheter malfunction are summarized.
Continuous renal replacement therapy (CRRT) involves using extracorporeal blood purification therapies to slowly remove waste and fluid from patients with impaired kidney function over an extended period of time, typically 24 hours per day. CRRT aims to closely mimic the native kidney and is well-tolerated by hemodynamically unstable patients. It allows for gentle removal of large amounts of fluid and waste products while also controlling electrolytes, acid-base balance, and removal of sepsis mediators. CRRT has advantages over intermittent dialysis in managing fluid overload and maintaining hemodynamic stability.
This document discusses hemodialysis for acute kidney injury (AKI). It provides information on:
1. Hemodialysis is a form of renal replacement therapy that uses a dialyzer and extracorporeal circuit to partially replace kidney functions like fluid balance and waste removal when kidney function is insufficient.
2. The decision to start renal replacement therapy like hemodialysis for AKI is based on clinical signs of issues like volume overload or biochemical abnormalities rather than single thresholds, though emergencies require immediate dialysis.
3. The optimal timing of dialysis initiation for AKI is unclear, but observational studies suggest earlier initiation may improve outcomes compared to waiting for more severe clinical indications.
This document discusses evaluating the adequacy of hemodialysis treatment. It states that numerous studies have shown a correlation between the delivered dose of hemodialysis and patient mortality and morbidity. The urea reduction ratio (URR), which measures the percentage reduction of urea levels pre- and post-dialysis, is one way to evaluate adequacy, with a URR over 60% generally associated with better outcomes. Equilibrated Kt/V is also discussed as a standard measure of dialysis dose, with a minimum of 1.4 recommended. The document outlines factors that influence adequacy, including treatment time and frequency, dialyzer characteristics, blood and dialysate flow rates, and dialysis solution composition
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.
Monitoring and surveillance_of_vascular_accessNaveen Kumar
This document discusses surveillance of vascular access in hemodialysis patients. It notes that while arteriovenous fistulas and grafts are superior to catheters, vascular access complications are common. Guidelines suggest various surveillance methods to maintain access patency, including monitoring physical signs and using tests like access flow measurements and ultrasound imaging to detect stenosis early. Randomized controlled trials on the benefits of surveillance vs monitoring alone have shown conflicting results, but surveillance is generally associated with fewer thrombotic events, hospitalizations, and missed treatments. However, there is no conclusive evidence yet that surveillance prolongs overall access lifespan.
The document discusses the history and development of hemodialysis adequacy measures. It describes how Frank Gotch and John Sargent developed the Kt/V measure in the 1970s to more accurately assess dialysis dose based on urea clearance. This resolved issues with prior methods that used target BUN levels. The document outlines the benefits of Kt/V over BUN and notes minimum recommended levels of Kt/V and URR to ensure adequate dialysis.
This study analyzed risk factors and allograft outcomes for recurrent glomerulonephritis (GN) after kidney transplantation using data from the Australia and New Zealand Dialysis and Transplant registry. The results showed that the overall recurrence rate of the four most common GN subtypes (IgA nephropathy, MPGN, FSGS, MGN) was approximately 10% within 5 years of transplantation, and 45% of recipients with recurrent GN lost their allografts within 5 years. Recurrence significantly increased the risk of allograft failure. MPGN recurrence had the worst allograft survival rates. Regular surveillance of at-risk recipients is needed to detect recurrence early and prevent allograft loss
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.
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"
This document discusses permanent vascular access for hemodialysis. It describes the formation and types of arteriovenous fistulae (AVF) and synthetic grafts. AVFs involve surgically connecting an artery and vein and are the preferred permanent access. Synthetic grafts are used when vessels are unsuitable for an AVF. Complications of access include stenosis, thrombosis, ischemia, pseudoaneurysms and infection. Care of the access involves monitoring for complications, proper needle placement and infection prevention.
The patient is a 49-year-old woman with end-stage renal disease and diabetes who presented with altered mental status. She receives hemodialysis three times per week for a few years. Recently, she has been increasingly tired, weak, and unable to perform daily activities with poor appetite and nausea. On examination, she was pale and swollen with low hemoglobin. Tests found elevated creatinine, BUN, and electrolyte abnormalities. The most probable diagnosis is inadequate hemodialysis, as her symptoms and labs are consistent with worsening uremia due to insufficient solute clearance from her dialysis sessions. Kt/V is a measure of dialysis adequacy that accounts for urea clearance and patient
This procedure is knowledge required for the dialysis, in this PPT include introduction, definition, indication, Advantages, Disadvantages, Nursing care and complication of Arteriovenous graft.
The document discusses continuous renal replacement therapy (CRRT) in critical care units. It begins with definitions and history of renal replacement therapy. It then covers principles, techniques, applications, results and complications of CRRT. The techniques discussed include continuous venovenous hemofiltration (CVVH), hemodialysis (CVVHD) and hemodiafiltration (CVVHDF). Advantages include hemodynamic stability, precise volume control and removal of toxins and cytokines. Complications can include bleeding, infection and electrolyte imbalances. CRRT remains the preferred technique for critically ill patients with acute kidney injury in many intensive care settings.
Rrt in icu dr said khamis zagazig april 2018 latestFarragBahbah
The document provides an overview of renal replacement therapy (RRT) modalities for critically ill patients with acute kidney injury (AKI). It discusses the history and evolution of RRT, including intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT). The pros and cons of IHD and CRRT are presented. Key considerations for RRT include which modality to use, anticoagulation options, dialysate buffers, and membranes. Guidelines for determining therapy dose and duration and criteria for discontinuing RRT are summarized. Outcomes with IHD versus CRRT remain unclear due to limitations of existing studies. Overall, the document reviews best practices for delivering RRT to critically ill AK
This document summarizes key aspects of hemodialysis adequacy and dose. It discusses:
- Early studies that showed a correlation between dialysis dose and patient outcomes. The NCDS study in 1981 was the first randomized controlled trial showing higher Kt/V values were associated with better outcomes.
- Methods for measuring dialysis dose including Kt/V, eKt/V, URR. The preferred method is formal kinetic urea modeling.
- Guidelines recommend a minimum Kt/V of 1.2 or eKt/V of 1.2. Studies like HEMO showed no additional benefit to higher doses above 1.3-1.4.
- Maximizing
The document outlines the objectives and key concepts of a training course on continuous renal replacement therapy (CRRT). It defines CRRT and discusses the basic principles of CRRT, including solute transport mechanisms, clinical indications, machine setup and safety features, and fluid balance principles. It also summarizes evidenced-based research showing improved patient survival with early CRRT initiation and adequate dose delivery.
The history of dialysis began in the 18th century with advances in materials like collodion membranes that could be used for diffusion. In the early 20th century, researchers like Abel and Kolff began developing early dialysis machines. Kolff's 1943 dialyzer was the first working machine used to treat acute renal failure. In 1945, Kolff treated the first patient with end-stage renal disease using hemodialysis, allowing her to regain consciousness. Throughout the 1950s and 1960s, dialysis treatment expanded but demand still far exceeded capacity, with challenges in finding long-term treatment for chronic kidney disease patients.
Sindrome de reabsorcion post reseccion transuretral de prostataSandra Careaga Cortes
El documento describe el tratamiento quirúrgico de la hiperplasia benigna de próstata mediante resección transuretral. Este procedimiento utiliza irrigación con líquidos para mejorar la visión, pero estos líquidos pueden ser absorbidos y causar alteraciones hemodinámicas. Se recomienda monitorear la absorción de líquidos y no sobrepasar los 60 minutos de duración para reducir riesgos.
This document discusses different types of vascular access for hemodialysis including arteriovenous fistulae (AVF), polytetrafluoroethylene grafts, and temporary and tunnelled dialysis catheters. It provides details on AVF maturation criteria, cannulation techniques, and care. Complications of fistulae and grafts like clotting, infection, and steal syndrome are outlined. The use of temporary catheters, characteristics of tunnelled catheters, and management of catheter malfunction are summarized.
This document summarizes the history and developments in vascular access for hemodialysis. It discusses key milestones like the first hemodialysis in 1924, the Quinton-Scribner shunt in 1960, and the Brescia-Cimino fistula in 1966. It then compares arteriovenous fistulas, grafts, and catheters and their primary failure rates, infection risks, and longevity. The document outlines criteria for successful fistulas and grafts and factors that can lead to stenosis. It also discusses strategies to prevent stenosis and reduce catheter use, such as earlier patient referral and education on permanent access options.
Dialysis is used to treat kidney failure and manage its complications. There are different modalities including peritoneal dialysis, hemodialysis, and continuous renal replacement therapy. Hemodialysis uses a dialyzer, tubing, and machine to remove waste and fluid by diffusion and ultrafiltration as blood and dialysate flow countercurrently. Vascular access includes catheters, arteriovenous grafts, and arteriovenous fistulas. Complications can include infections, thrombosis, and fluid overload.
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.
This document discusses the buttonhole cannulation technique for vascular access in hemodialysis patients. It provides a history of the technique, beginning in the 1970s in Poland. Early experiences in the US showed benefits like reduced pain, infiltration, and hematoma rates compared to rope-ladder cannulation. The technique involves creating fibrous tracts at constant needle insertion sites using repeated cannulation with sharp then blunt needles. Correct technique includes proper site selection, needle angle/depth, disinfection, and complete scab removal to prevent infection. Larger US studies are still needed to better evaluate risks and benefits.
This document discusses adopting radial artery access over femoral artery access for cardiac catheterization procedures. It provides advantages of radial access including reduced vascular complications, earlier ambulation for patients, and cost savings from not needing closure devices. Guidelines for assessing hemostasis after radial access and monitoring the access site are outlined. Adopting radial access could allow for same day discharges after coronary interventions. Policy changes would need to be made to reflect the practice change to radial artery access.
This document provides information on pediatric intravenous cannulation. It defines pediatric IV cannulation as inserting a cannula into a child's vein to administer medications, fluids, blood or nutrition. The document outlines indications for IV cannulation in children and discusses sites to avoid. It also describes the proper procedure for pediatric IV insertion including preparing the child, identifying appropriate veins, inserting the cannula, securing it, and documenting the process. Potential complications of improper cannulation are explained as well as a scale for assessing infusion phlebitis.
This document discusses Natural Orifice Transluminal Endoscopic Surgery (NOTES), a new surgical technique. NOTES involves performing surgery using an endoscope inserted through natural openings like the mouth, vagina, or anus without external incisions. The document provides a brief history of NOTES, describes some procedures that have been performed, and discusses potential advantages as well as challenges to further development and acceptance of the technique.
Learn the essential skill of intravenous cannulation. Check out the latest in our series about surviving the early days of your medical internship.
We know from experience how difficult the first days can be, and we're here to share the benefit of our own experiences.
NOTES (Natural Orifice Transluminal Endoscopic Surgery)- By Dr. Onkardronkarsingh
Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an experimental surgical technique that performs abdominal operations through natural orifices like the mouth, urethra, anus or vagina without external incisions. NOTES aims to reduce surgical trauma and pain for patients by avoiding incisions. It also shortens recovery time and eliminates risks of complications from external incisions like infections and hernias. While still in development, NOTES shows promise as a less invasive future of surgery.
This document discusses the issues with current intravenous cannulation procedures and introduces a new cannulation device called the U-Cannula. It notes that current cannulation techniques often require multiple puncture attempts, which increases trauma, risk of infection, and healthcare costs. The U-Cannula aims to address this by using an introducer strap to smoothly guide the cannula into place in one attempt. Clinical studies found the U-Cannula successful in 94% of first attempts compared to average attempts of 2.48 for standard cannulas. While the concept has support from doctors, major manufacturers have been reluctant due to concerns it could reduce skills or increase costs. The document argues the U-Cannula could help reduce infection
1) An endodontic emergency is an unexpected event requiring immediate treatment to relieve pain and swelling.
2) Common types of endodontic emergencies include irreversible pulpitis, pulp necrosis with or without swelling, and complications during or after root canal treatment.
3) Proper diagnosis and treatment planning is important to determine the cause and provide appropriate pain relief through elimination of inflammation or drainage of infection.
This document discusses post dural puncture headache (PDPH), including its presentation, diagnosis, differential diagnosis, incidence related to various procedures, and treatment options. The primary treatment discussed is an epidural blood patch, with details provided on how to perform the procedure and its high success rates in providing relief from PDPH.
The document discusses various aspects of the medical laboratory workflow process and phlebotomy procedure. It covers topics like patient registration, requisition forms, specimen collection, coding and billing, laboratory information systems, and the venipuncture procedure. The venipuncture procedure is described in detail in multiple steps, including greeting the patient, verifying patient identification, selecting a vein site, preparing the site, inserting the needle, drawing blood into tubes, removing the needle, and finishing up. Patient identification is stressed as the most critical part of phlebotomy. Risks of phlebotomy to patients and health workers are also reviewed.
If you’re looking to enhance your beauty routine or explore new ways to achieve your desired aesthetic results, then you’ve come to the right place. We’ll cover everything you need to know about aesthetic cannulas, from what they are to how to choose the right one for your procedure.
Nasogastric Tube (NGT) insertion and removalLouie Ray
An NG tube is usually inserted to decompress the stomach after surgery to prevent vomiting. It is typically left in place for 48-72 hours after surgery. The tube can also be used to assess and treat upper GI bleeding, collect gastric contents, perform lavage, and administer medications. Inserting an NG tube involves measuring tube length, lubricating the tube, inserting it into the nose while having the patient swallow, and ensuring proper placement in the stomach through aspiration or auscultation. Potential complications include esophagitis, gastric ulcers, electrolyte imbalances, and damage to nasal or gastric tissues.
The document summarizes modern techniques for tonsillectomy, including indications, history, and innovative methods. It discusses intracapsular tonsillectomy using instruments like a microdebrider or coblation, which may reduce postoperative pain compared to traditional subcapsular removal. Studies on harmonic scalpel, laser, and coblation tonsillectomy aim to lower blood loss, pain, and recovery time versus electrocautery. However, long-term outcomes like tonsil regrowth require further evaluation.
Endodontic mishaps include procedural errors that can occur during root canal treatment such as ledge formation, canal perforation, separated instruments, and overfilling/underfilling of canals. It is important for practitioners to understand how to recognize, prevent, and treat these mishaps. Common causes include inadequate access, excessive force, or improper instrument use. Perforations require immediate sealing with materials like MTA to achieve the best prognosis. Separated instruments may be bypassed or retrieved, while ledges can sometimes be circumvented with smaller files. Overall, minimizing errors requires adherence to principles like conservative access, copious irrigation, and careful instrumentation.
The document provides guidelines for urinary catheterization including preparing the patient, performing the procedure aseptically, inserting the catheter into the bladder, securing it, and documenting the process. It describes indications for catheterization as well as contraindications. Potential complications are outlined and care of indwelling catheters is discussed.
ENDOSCOPIC TREATMENT OF PILONIDAL SINUS IN EGYPTIAN PATIENTSindexPub
Background: Treatment for pilonidal disease using minimally invasive methods is a reliable and successful alternative to conventional surgery, with quicker recovery, better cosmetic outcomes, and better pain management. The primary goals of this study are to assess the early outcomes of endoscopic pilonidal sinus treatment and to demonstrate the surgical approach and its adaptations. Materials and Methods: Our study was conducted on 30 patients with pilonidal sinus disease as a prospective cohort study for endoscopic treatment of the pilonidal sinus, from October 2021 to October 2022, in our surgical department at Theodor Bilharz Research Institute (TBRI). Surgical outcomes of sinus healing, pain, and discharge were reviewed in the outpatient clinic, and patient satisfaction levels were assessed through a standardized phone interview. Results: There were 24 males and 6 females, with a median age of 21.87±1.85 years (ranging from 16 to 57 years). The mean operative time was 44.17 (35-55) ±1.26 min. During the follow-up period of 24 weeks, wound closure was seen after a median of 4 weeks. Wounds were closed in 72% of patients after one month and 93% of patients after two months. 2 patients had to be re-operated due to failure: one had persistence of discharge, and the other had recurrence after 3 months. The satisfaction rate was 93.3%. Conclusions: Endoscopic pilonidal sinus treatment is a minimally invasive and cosmetically favorable procedure. To find out if it reduces recovery time and the long-term recurrence rate, a larger sample size and a longer follow-up are needed.
- Balloon sinuplasty is a minimally invasive technique for treating sinusitis using balloon catheters to dilate sinus ostia rather than conventional endoscopic sinus surgery.
- Studies show balloon sinuplasty improves symptoms in selected patients with chronic sinusitis and is safe, with minimal adverse effects. However, longer term data is still needed to define its optimal role and indications.
- While initial data is promising for symptom relief and preservation of sinus anatomy compared to traditional FESS, balloon sinuplasty may not eliminate the need for conventional sinus surgery in all patients.
The document provides information about local anesthesia techniques for pediatric patients. It discusses the history of technology changes from 1975 to 2011, including transitions from paper to electronic charts and film-based to digital x-rays. It then focuses on anesthesia drug choices and volumes used for different ages. The remainder of the document provides step-by-step instructions for performing local anesthesia injections for different procedures using the STA single tooth anesthesia system, including intra-ligamentary, AMSA, and P-ASA injections.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
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Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
30. Buttonhole Evaluation Questionnaires similar to the Gold Coast (Paula McLeister’s) presentation at RSA 2006 were given to 13 buttonhole clients and also the staff who had been present pre and post buttonhole experience. This has enabled Bendigo to compare results with the Gold Coast buttonhole experience.
No doubt many of you who work in haemodialysis can relate to this cartoon. It was situations like this that lead us to explore butthole cannulation Buttonholing is not a new technique Used for homehaemo clients Used extensively in Europe for some decades Not generally been used in-centre Limited literature found on lit search Bendigo commenced in-centre buttonholing in Nov 2004 and have buttonholed 19 clients todate We use dull fistula needles after the establishment phase with the buttonhole
Rope ladder cannulation appears to be the most commonly taught method however area puncture appears to be the most common practice, especially when a difficult fistula is faced and probably more so when less experienced staff are cannulating. Tendency to follow the previous cannulation in around the same area
If buttonholing is being contemplated then the reasons why need to be examined as they will influence where the holes should be created and on what angle Support may need to be sought from the Physician or surgeon and this needs to be ongoing support
The initial clients selected had cannulation difficulties frequently required transfer to Parent Hospital to facilitate dialysis treatment Inconvenient for clients Frustrating for staff - regional & metro After establishment of buttonholing there were no cannulation issues requiring transfer to Parent Hospital
Observe and palpate fistula and plan out the areas for buttonholes and include plans for a 2 nd set of holes at a later date If the establisher not available for a cannulation episode then other staff can cannulate but must avoid the planned sites
The entire buttonhole creation is hinged on the exact same site, angle and depth – hence the need for one cannulator in the break in or establishment phase Our experience has been that establishing probably takes between 6 to 12 cannulations but is very much dependant on the fistula and client
Establishing is really no different to an ordinary cannulation except for the repeat site/angle/depth each time
Scab removing can be time consuming for some fistulas. We find soaking with alcohol chlohex for 5 minutes or more does generally help soften and aid lifting of scab
Again no different to any other cannulation
Insertion is quicker but removing scabs can take a little time Bleeding time for some problem clients has been reduced I guess because it is a clean cannulation without trauma We have buttonholed approx 20 clients in 2 years and in that time 2 clients have had fistula infections. One clients hygiene is such that infections had occurred pre buttonholing and the other client works out in dirt and dust and therefore is a candidate for infection regardless of cannulation method
Betty was our driving force to commence buttonholing She was seriously considering ceasing treatment purely because of the pain, anxiety and frustration experienced with her cannulation for her haemodialysis treatment
Fay has a short fistula which is quite soft onesititis was becoming obvious She had had some infection issues as a result of picking at her fistula when infection was present there was even more limited cannulatable areas
Fay now has very successful buttonholes She has had one episode of infection but as mentioned this was occuring pre buttoholing as well
To evaluate the effectiveness of our buttonhole program we developed questionnaires similar to the Gold Coast presentation at RSA 2006. 13 clients and 9 staff undertook the questionnaires
Firstly we asked about the good and bad things associated with the method It was reassuring to see that there was unanimous agreement that there was nothing bad about buttonholing from the patients perspective
Clients were questioned regarding pain during buttonholing & 11 of the 13 experienced less pain with the new buttonhole method
TIME - 9 Clients noted reduced time from sitting in their chair to begining their treatment and the all important time count down on the dialysis machine
11 clients stated that they experienced less anxiety with the buttonhole method of cannulation Prior to buttonholing some clients had experienced on average 2 dialysis sessions per week with cannulation troubles so anxiety had become a BIG problem
9 of the 13 clients had experienced frequent "blows" of their accesses during cannulation prior to commencing buttonholing. Following buttonholing commencement there have been NO blows for any of these clients. 7 clients commented they had reduced post bleeding times with the buttonhole method
These are some comments pulled from the questionnaires The top comment says it all for our first client as she is still dialysing. Comments like 'I am pleased I haven't got big lumps up my arm' make you realise that body image is a concern for some clients
Infection rates contry to some beliefs in the renal world we have not seen any increased fistula infections associated with our in centre buttonholing We have experienced one infection but this client had had previous fistula infections prior to buttonhole commencement We had 2 fistula infections in the non buttonhole clients over the same two year period. A Lit search could find no documented evidence of increased infection rates associated with buttonholing
Twardowski probably the most published person with regard to buttonholing todate sums up the advantages of buttonholing succinctly in this quote
9 of our staff who were present pre and post buttonholing were given questionnaires Again all the comments were positive less pain less anxiety less time to cannulate were all noted
This slide again shows staff comments like * increased confidence with difficult fistulas * decreased time troubleshooting * decreased time looking for suitable cannulation sites As a result of our buttonholing program all staff members in Bendigo regardless of experience can now cannulate every client in the unit
2 difficulties were noted by staff 1. scab removal............. remains an ongoing issue as it is individual client dependant * some scabs lift easier than others * We soak to moisten with Chlorhex soaked gauze * Scrape with the gauze or lift with a blunt drawing up needle 2. Need for careful positioning of the fistula arm to align the fistula and buttonhole tracks correctly
This client had a very deep fistula and quite fleshy arm. With a very poor cardiac & medical history the surgeons were extremely reluctant to take her back to theatre for superficialisation of the fistula. After some limited success with cannulations and an ongoing reliance on her permcath we decided to try buttonholing. We used the site rite machine in the initial stages to give a guide for needle attempts and after many agonizing sessions managed to create some buttonholes
With the thought to trying to get this client home we commenced buttonholes and self cannulation with this client
Another success with what was a short and difficult access
Left short forearm fistula about 5mm available area initially This pic shows how mushy to buttonholes can become when attempting scab removal
2 sets of sites are good if there is room for these then alternating sites is possible Education for both nurses and medical staff is very important for the acceptance of buttonholing Need to be aware that when using the dull needle the cannulation sensation for the cannulator can be different may need to push harder and there can be the trampoline effect May need to slightly rotate the needle on insertion to cut through the vessel
we acknowledge that buttonholong is not necessarily possible/suitable for all haemodialysis areas but it would be advantagous if all staff had an understanding of the principles of cannulation & management for a buttonhole and when they are not able or confident to buttonhole then to be aware to cannulate away from the buttonhole areas.
in conclusion our experience in Bendigo has shown that buttonholing ......... * has positive outcomes * is not difficult * has shown no increased fistula infection rates * has decreased stress levels for client and staff * and promotes greater client self care, autonomy & confidence
finally Anything which can potentially promote the logevity of the fistula is surely worth doing.
Betty is now a very happy lady
These are our eferences and we would like to acknowledge the clients and staff who have embraced the buttonhole program and made this presentation possible. Thanks also to the clients for allowing us to use their photos and tell their stories