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Xu F, Shu P, Li C, Huo S, Wen Z. The Effectiveness of Electronic Cannulation Atlas in Patients with Arteriovenous Fistula. Int J Gen Med 2024; 17:3119-3127. [PMID: 39049836 PMCID: PMC11268560 DOI: 10.2147/ijgm.s469520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 07/11/2024] [Indexed: 07/27/2024] Open
Abstract
Objective This study aimed to assess the effectiveness of an electronic cannulation atlas in preventing and treating complications of arteriovenous fistula. Methods The observation group, consisting of 92 dialysis patients from July to December 2021, was managed with an electronic cannulation atlas. After 6 months, the incidence of complications such as stenosis, hematoma, thrombus, aneurysm, and cannulation failure was compared between the groups. Nurse satisfaction with the electronic cannulation atlas system was also assessed through a questionnaire. Results The observation group had lower incidence rates of arteriovenous fistula stenosis, thrombus, aneurysm, and failure rate of cannulation compared to the control group, with statistically significant differences (p<0.05). The incidence rates of hematoa were similar in both groups, showing no significant difference (p>0.05). After 3 months of management, the incidence of arteriovenous fistula complications in the observation group was significantly lower than in the control group (p<0.05). Additionally, utilizing the electronic cannulation atlas system was found to increase nurses' job satisfaction. Conclusion The use of electronic cannulation atlas for the treatment of patients' arteriovenous fistula could effectively reduce the incidence of complications of patients' arteriovenous fistula, reduce the failure rate of cannulation, reduce the workload of nurses, and improve the job satisfaction of nurses.
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Affiliation(s)
- Fang Xu
- Nephrology Department, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
| | - Peng Shu
- Nephrology Department, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
| | - Chenchen Li
- Nephrology Department, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
| | - Shanshan Huo
- Nephrology Department, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
| | - Zhuping Wen
- Nephrology Department, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
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Tito F, Davidson-Peck D, Roettger AD, Borghetti F, Corbo M, Tozzi M. Hemodialysis patients and complications management costs in Italy: Plastic cannulae a potentially cost-effective strategy. J Vasc Access 2024; 25:599-606. [PMID: 36250425 PMCID: PMC10938477 DOI: 10.1177/11297298221129898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/08/2022] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The treatment of end-stage chronic renal failure involves substantial costs for health care, which could be higher considering hemodialysis access complications management costs. Complications could be addressed by cannulation technique, but also by the needle. In particular, the use of a metal needle for cannulation is responsible for several complications that compromise dialysis delivery and require interventions. This analysis aims to evaluate, from a hospital perspective, the direct costs related to complications that may occur in hemodialysis patients in Italy. METHODS To identify the main complications to consider in our analysis and related patient pathway for their management, we conducted an international literature search on PubMed and validated the data for Italy with an Italian Key Opinion Leader (KOL). A micro-costing analysis was developed to precisely assess the economic costs of healthcare interventions to manage complications due to vascular access cannulation. RESULTS The major complications identified, and the average cost/per episode for their management are the following ones: Local infection € 1455 (min € 745 and max € 2160); Sepsis, that requires hospitalization in ward € 4401 (min € 3693 and max € 4623); Sepsis (ICU) € 17,190; Hematoma € 304 (min € 252 and max € 728); Aneurysm € 3632 (min € 3139 and max € 4014); Pseudoaneurysm € 3695 (min € 3615 and max € 4014); Stenosis € 2229 (min € 1874 and max € 4857); Thrombosis € 2151 (min € 1941 and max € 3395). CONCLUSIONS In making decisions, hospital administration, and payer should take into consideration, not just the price of devices, but the entire patient's pathway. The use of plastic cannulae in hemodialysis patients shows improved outcomes compared to traditional metal needles. Furthermore, combining it with accurate and efficient cannulation techniques reduces complication rates, improves patients' quality of life, and reduces healthcare resource consumption.
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Affiliation(s)
- Federica Tito
- Value Access & Policy, Medtronic Italy S.p.A, Milano, Lombardy, Italy
| | - Donna Davidson-Peck
- Clinical/Medical, Renal Care Solutions, Medtronic Global, Minneapolis, MN, USA
| | - Amy Denise Roettger
- Clinical/Medical, Renal Care Solutions, Medtronic Global, Minneapolis, MN, USA
| | | | - Mara Corbo
- Value Access & Policy, Medtronic Italy S.p.A, Milano, Lombardy, Italy
| | - Matteo Tozzi
- Insubria University of Varese, Varese, Lombardy, Italy
- ASST Sette Laghi, Varese, Lombardy, Italy
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Djajakusumah TM, Hapsari P, Nugraha P, Muhammad A, Lukman K. Characteristics of Vascular Access Cannulation Complications in End Stage Kidney Disease Patients in West Java from 2018 to 2022: A Retrospective Observational Study. Int J Nephrol Renovasc Dis 2024; 17:47-58. [PMID: 38370010 PMCID: PMC10870994 DOI: 10.2147/ijnrd.s440467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/01/2024] [Indexed: 02/20/2024] Open
Abstract
Background End-stage kidney disease (ESKD) is associated with a tremendous financial burden. Data in Indonesia shows an increasing number of patients with ESKD taking hemodialysis as a routine procedure every year. Establishment and maintenance of vascular access are important in the management of ESKD. Vascular complications that often arise due to hemodialysis are common and one of the main reasons for hospitalization. Cannulation complications ranged from minor hematomas to acute bleeding from pseudoaneurysms that required emergency surgical procedures. This study aims to assess the different clinicopathological characteristics of ESKD patients with vascular access cannulation complications and the surgical management related to the complications. Materials and Methods This research is a retrospective observational study. The research subjects in this study were ESKD patients in the vascular and endovascular surgery division of the tertiary hospital in West Java, Indonesia. There were 121 study subjects. Clinicopathological characteristics of vascular cannulation complications and surgical management are extracted from the medical record. Results Three major vascular complications were ruptured pseudoaneurysms 64/121 (52.9%), impending rupture pseudoaneurysms 28/121 (23.1%), and pseudoaneurysms 21/121 (17.4%). Common surgical procedures were ligation of the draining vein 47/121 (38.8%), arterial primary repair 28/121 (23.1%), and arterial patch repair 18/121 (14.9%). There was a significant relationship between symptoms of bleeding in ruptured pseudoaneurysms and bulging masses in pseudoaneurysms (p = 0.001). There was a significant relationship between the diameter of the vascular mass, vascular defect size, and hematoma and the type of surgical procedure taken (p < 0.010). Conclusion Ruptured, impending rupture, and pseudoaneurysms are major complications of vascular access in ESKD patients, and there was a significant relationship between the carried-out surgical procedure and the size of the vascular mass, defect, and hematoma.
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Affiliation(s)
- Teguh Marfen Djajakusumah
- Department of Surgery, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Putie Hapsari
- Department of Surgery, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Prapanca Nugraha
- Department of Surgery, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Arrayyan Muhammad
- Department of Surgery, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Kiki Lukman
- Department of Surgery, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
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Grosu I, Stirbu O, Schiller A, Gadalean F, Bob F. Point-of-Care Arterio-Venous Fistula Ultrasound in the Outpatient Hemodialysis Unit-A Survey on the Nurses' Perspective. NURSING REPORTS 2024; 14:353-361. [PMID: 38391072 PMCID: PMC10885040 DOI: 10.3390/nursrep14010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
The preservation of complication-free arterio-venous fistulas (AVF) for long-term hemodialysis (HD) use is associated with better overall patient outcomes, which is why this is a current goal in any HD center. Point-of-care ultrasound (POCUS) for in-center AVF assessment has proven its benefits in the identification of vascular access (VA) complications and as an additional tool to avoid blind cannulation. The current study aims to assess the change in the HD nurses' perceptions regarding AVF POCUS use in the HD center. The nursing staff anonymously answered a Likert scale questionnaire with five questions related to various aspects of AVF POCUS utility shortly after the technique had been implemented and at a 5-year follow-up. The results showed an overall positive attitude toward this method, both at implementation and at follow-up, with no statistically significant score changes for four out of the five items assessed. However, we found a statistically significant reduction in the nurses' cannulation confidence scores at the 5-year follow-up (p < 0.01). Overall, AVF POCUS implementation is regarded as a useful tool, with major benefits both for the patient and for the medical team. The current study results aim to support the introduction of AVF POCUS assessment as a standard practice from the nursing staff's viewpoint. This study was not registered.
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Affiliation(s)
- Iulia Grosu
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Division of Nephrology, Department of Internal Medicine II, County Emergency Hospital Timisoara, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania
- B Braun Avitum Dialysis Centers, 300417 Timișoara, Romania
| | - Oana Stirbu
- B Braun Avitum Dialysis Centers, 300417 Timișoara, Romania
- Department of Nephrology and Dialysis, Arad County Hospital, 310158 Arad, Romania
| | - Adalbert Schiller
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Division of Nephrology, Department of Internal Medicine II, County Emergency Hospital Timisoara, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Florica Gadalean
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Division of Nephrology, Department of Internal Medicine II, County Emergency Hospital Timisoara, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania
- B Braun Avitum Dialysis Centers, 300417 Timișoara, Romania
| | - Flaviu Bob
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Division of Nephrology, Department of Internal Medicine II, County Emergency Hospital Timisoara, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania
- B Braun Avitum Dialysis Centers, 300417 Timișoara, Romania
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5
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Forneris G, Savio D, Cecere P, Boghi A, Roccatello D. Successful 8-year use of Venous Window Needle Guide for deep arteriovenous fistula cannulation. J Vasc Access 2024; 25:348-350. [PMID: 36131379 DOI: 10.1177/11297298221125961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We describe the case of a patient who had been on hemodialysis for 8 years using a native arteriovenous fistula cannulated through the Venous Window Needle Guide™ device (VWING). The overall outcome was excellent and complication-free with intact state of the underlying vessel and a high degree of patient satisfaction. The patient was able to carry out self-cannulation without any difficulty almost from the very beginning. The current unavailability of VWING is a missed opportunity in the field of vascular access.
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Affiliation(s)
- Giacomo Forneris
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-net, ERN-Reconnect and RITA-ERN Member) including the Nephrology and Dialysis Unit, Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), Department of Clinical and Biological Sciences, San Giovanni Bosco Hub Hospital, University of Turin, Turin, Italy
| | - Daniele Savio
- Radiology Department, Interventional Radiology Unit, G. Bosco Hospital, Turin, Piedmont, Italy
| | - Pasqualina Cecere
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-net, ERN-Reconnect and RITA-ERN Member) including the Nephrology and Dialysis Unit, Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), Department of Clinical and Biological Sciences, San Giovanni Bosco Hub Hospital, University of Turin, Turin, Italy
| | - Andrea Boghi
- Radiology Department, Interventional Radiology Unit, G. Bosco Hospital, Turin, Piedmont, Italy
| | - Dario Roccatello
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-net, ERN-Reconnect and RITA-ERN Member) including the Nephrology and Dialysis Unit, Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), Department of Clinical and Biological Sciences, San Giovanni Bosco Hub Hospital, University of Turin, Turin, Italy
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6
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Staaf K, Fernström A, Uhlin F. Preconditions that facilitate cannulation in arteriovenous fistula: A mixed-methods study. J Ren Care 2023; 49:264-277. [PMID: 36394202 DOI: 10.1111/jorc.12448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Nurses have a great responsibility in the daily care of arteriovenous fistulae, which entails the potential to affect patency. However, good cannulation technique involves more than placing a needle in the vessel and relies on different skills to facilitate needling. OBJECTIVES To describe the preconditions for cannulation in arteriovenous fistulas. DESIGN Descriptive statistics and qualitative content analysis were used in a mixed-methods design. PARTICIPANTS Haemodialysis units in Sweden. MEASUREMENTS Local guidelines regarding arteriovenous fistula cannulation were analysed in parallel with responses to a questionnaire that contained open-ended and closed-ended questions on cannulation technique. RESULTS Preconditions that facilitate cannulation fall into five stages, each with relevant factors in relation to the cannulation, as follows: planning cannulation-maturation and planning the cannulation, patient record, education and experience, and patient information; precannulation-physical examination, hygiene routines, arm position, tourniquet, choosing the cannulation site, and preventing pain; during cannulation-how to needle, type of needle, angle during cannulation, fixation, and adjusting; evaluating cannulation-blood flow rate and arterial and venous pressure; and postcannulation-needle withdrawal and haemostasis. The majority of dialysis units identified implementation of most of these preconditions, but the units handle several practical aspects differently. CONCLUSIONS Tracing the chain of cannulation led to identification of necessary preconditions for facilitating good cannulation technique. The findings also show the need for a better understanding of how different preconditions affect arteriovenous fistula and patency.
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Affiliation(s)
- Karin Staaf
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Nephrology, Linköping University Hospital, Linköping, Sweden
| | - Anders Fernström
- Department of Nephrology, Linköping University Hospital, Linköping, Sweden
| | - Fredrik Uhlin
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Nephrology, Linköping University Hospital, Linköping, Sweden
- Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia
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7
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Sousa CN, Teles P, Ribeiro OMPL, Sousa R, Lira MN, Delgado E, Oliveira D, Campos L, Fernandes F, Moura SCM, Delgado MF, Sá TG, Teixeira SMP, Souza LH, Ribeiro RCHM, Oliveira GFN, Mendonça AEO, Ozen N. How to choose the appropriate cannulation technique for vascular access in hemodialysis patients. Ther Apher Dial 2023; 27:394-401. [PMID: 36717974 DOI: 10.1111/1744-9987.13973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 02/01/2023]
Abstract
The cannulation technique is important for the survival of the arteriovenous access. Choosing the appropriate technique is a complex decision. Such choice must be customized to patients, considering their characteristics, the type of arteriovenous access and the experience of the hemodialysis team. We describe seven items that can help nurses to identify the appropriate cannulation technique: type of arteriovenous access; drainage vein; hygienic self-care profile; experience of the nursing staff in the cannulation technique and nurse-to-patient ratio; hemodialysis treatment method; patient's condition; and patient's decision. Such items can help nurses in decision-making on the "ideal" cannulation technique for each patient.
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Affiliation(s)
- Clemente Neves Sousa
- S Francisco Dialysis Unit, Porto, Portugal.,CINTESIS-Center for Health Technology and Services Research Faculty of Medicine, Porto University, Porto, Portugal.,Nursing School of Porto, Porto, Portugal
| | - Paulo Teles
- School of Economics and LIAAD-INESC Porto LA, Porto University, Porto, Portugal
| | - Olga Maria Pimenta Lopes Ribeiro
- CINTESIS-Center for Health Technology and Services Research Faculty of Medicine, Porto University, Porto, Portugal.,Nursing School of Porto, Porto, Portugal
| | - Rui Sousa
- CINTESIS-Center for Health Technology and Services Research Faculty of Medicine, Porto University, Porto, Portugal
| | | | | | | | | | | | - Sandra Cristina Mendo Moura
- CINTESIS-Center for Health Technology and Services Research Faculty of Medicine, Porto University, Porto, Portugal.,Mogadouro Dialysis Unit-TECSAM; Unidade de Local Saúde Nordeste, Bragança, Portugal
| | - Millena Freire Delgado
- CINTESIS-Center for Health Technology and Services Research Faculty of Medicine, Porto University, Porto, Portugal
| | | | | | - Lara Helk Souza
- Medical School of São José do Rio Preto (FAMERP), São Paulo, Brazil
| | | | | | | | - Nurten Ozen
- Florence Nightingale Hospital School of Nursing, Demiroglu Bilim University, Istanbul, Turkey
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8
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Haroon SWP, Lau TWL, Tan GL, Liu EHC, Hui SH, Lim SL, Santos D, Hodgson R, Taylor L, Tan JN, Davenport A. Risk assessment of failure during transitioning from in-centre to home haemodialysis. BMC Nephrol 2022; 23:406. [PMID: 36539703 PMCID: PMC9768953 DOI: 10.1186/s12882-022-03039-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Introducing a de-novo home haemodialysis (HHD) program often raises safety concerns as errors could potentially lead to serious adverse events. Despite the complexity of performing haemodialysis at home without the supervision of healthcare staff, HHD has a good safety record. We aim to pre-emptively identify and reduce the risks to our new HHD program by risk assessment and using failure mode and effects analysis (FMEA) to identify potential defects in the design and planning of HHD. METHODS We performed a general risk assessment of failure during transitioning from in-centre to HHD with a failure mode and effects analysis focused on the highest areas of failure. We collaborated with key team members from a well-established HHD program and one HHD patient. Risk assessment was conducted separately and then through video conference meetings for joint deliberation. We listed all key processes, sub-processes, step and then identified failure mode by scoring based on risk priority numbers. Solutions were then designed to eliminate and mitigate risk. RESULTS Transitioning to HHD was found to have the highest risk of failure with 3 main processes and 34 steps. We identified a total of 59 areas with potential failures. The median and mean risk priority number (RPN) scores from failure mode effect analysis were 5 and 38, with the highest RPN related to vascular access at 256. As many failure modes with high RPN scores were related to vascular access, we focussed on FMEA by identifying the risk mitigation strategies and possible solutions in all 9 areas in access-related medical emergencies in a bundled- approach. We discussed, the risk reduction areas of setting up HHD and how to address incidents that occurred and those not preventable. CONCLUSIONS We developed a safety framework for a de-novo HHD program by performing FMEA in high-risk areas. The involvement of two teams with different clinical experience for HHD allowed us to successfully pre-emptively identify risks and develop solutions.
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Affiliation(s)
- Sabrina-Wong-Peixin Haroon
- grid.412106.00000 0004 0621 9599Division of Nephrology, National University Hospital Singapore, Level 10, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228 Republic of Singapore
| | - Titus-Wai-Leong Lau
- grid.412106.00000 0004 0621 9599Division of Nephrology, National University Hospital Singapore, Level 10, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228 Republic of Singapore
| | - Gan Liang Tan
- grid.508163.90000 0004 7665 4668Department of General Medicine, Sengkang General Hospital, Singapore, Singapore
| | - Eugene-Hern Choon Liu
- grid.4280.e0000 0001 2180 6431Department of Anaesthesia, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Soh Heng Hui
- grid.412106.00000 0004 0621 9599Renal Centre, National University Hospital, Singapore, Singapore
| | - Siao Luan Lim
- grid.412106.00000 0004 0621 9599Renal Centre, National University Hospital, Singapore, Singapore
| | - Diana Santos
- grid.412106.00000 0004 0621 9599Medical Affairs-Clinical Governance, National University Hospital Singapore, Singapore, Singapore
| | - Robyn Hodgson
- grid.83440.3b0000000121901201Department of Renal Medicine, University College London, Royal Free Hospital, London, United Kingdom
| | - Lindsay Taylor
- grid.83440.3b0000000121901201Department of Renal Medicine, University College London, Royal Free Hospital, London, United Kingdom
| | - Jia Neng Tan
- grid.412106.00000 0004 0621 9599Division of Nephrology, National University Hospital Singapore, Level 10, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228 Republic of Singapore
| | - FH HHD
- grid.83440.3b0000000121901201Department of Renal Medicine, University College London, Royal Free Hospital, London, United Kingdom
| | - Andrew Davenport
- grid.83440.3b0000000121901201Department of Renal Medicine, University College London, Royal Free Hospital, London, United Kingdom
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Wang Z, Hong Y, Wei Z, Chen J, Li L, Zhu Y. Managing thrombosis of arteriovenous fistula accompanied by aneurysm and single outflow of elbow perforating vein: a case report. BMC Nephrol 2022; 23:271. [PMID: 35907795 PMCID: PMC9338526 DOI: 10.1186/s12882-022-02897-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background We report a case of a patient who suffered thrombosis of a radial artery-cephalic vein fistula accompanied by aneurysm and a single outflow path of the elbow perforating vein. We performed open surgery combined with Fogarty balloon catheter embolectomy, anastomotic reconstruction and forearm median vein transposition. Case presentation The patient presented with an arteriovenous fistula (AVF) after haemodialysis 5 years ago. In the process of dialysis, the fistula vein was punctured, resulting in aneurysm, high pressure and difficult haemostasis after needle extraction. AVF occlusion was observed on April 12, 2022. We performed a combined open surgery. First, a Fogarty balloon catheter was used to remove the thrombus, and the anastomosis was then reconstructed to restore AVF fistula patency. Finally, forearm median vein transposition was used to establish dual outflow. Postoperative haemodialysis was possible. There are various methods for removing the thrombus in AVF. Here, we report a case in which we performed open surgery combined with Fogarty balloon catheter embolectomy, anastomotic reconstruction and forearm median vein transposition to ensure fistula patency. Conclusion We removed a complete reverse ‘Z’-shaped thrombus of the elbow perforating vein in a haemodialysis fistula. This report provides an effective strategy to manage a high-pressure fistula with single outflow of the elbow perforating vein.
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Affiliation(s)
- Ziqiang Wang
- Department of Nephrology, The First Affiliated Hospital of Hainan Medical University, Hainan province, Haikou, 570102, China
| | - Yifen Hong
- Department of Nephrology, The People`S Hospital of Wanning, Hainan province, Wanning, 571500, China
| | - Zefeng Wei
- Department of Nephrology, The First Affiliated Hospital of Hainan Medical University, Hainan province, Haikou, 570102, China
| | - Juan Chen
- Department of Nephrology, The First Affiliated Hospital of Hainan Medical University, Hainan province, Haikou, 570102, China
| | - Li Li
- Department of Nephrology, The First Affiliated Hospital of Hainan Medical University, Hainan province, Haikou, 570102, China
| | - Yongjun Zhu
- Department of Nephrology, The First Affiliated Hospital of Hainan Medical University, Hainan province, Haikou, 570102, China.
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