Dataset Information

Direct arterial puncture for hemodialysis, a neglected but simple and valuable vascular access.

ABSTRACT:

Introduction

The purpose of this study is to present the prevalence and effects of direct arterial puncture (DAP) for hemodialysis patients, and to introduce optimal option for the vascular access (VA) in certain hemodialysis patients with poor condition of vascular or cardiac function in a compelling situation.

Methods

This was a cross-sectional study. Demographic characteristics and laboratory data were extracted from the health care system. Relevant DAP information was collected by a questionnaire. Case-control matching was performed to compare the hemodialysis adequacy between DAP and other VAs.

Results

A total of 526 patients were selected for analysis by convenience sampling, of which 38 patients relied https://www.baidu.com/link?url=eaDh8Hn-yZGJyDB0_h4zBenKd7qY1yX-KNxO-qU49gktQOGTJJg3slTjIbG095st4hRfprQIHRjfhfeGOZyH73y8tvSUCwMmvWbUhyix2ZK on DAP for hemodialysis. The main reasons using DAP for hemodialysis included the cost of arteriovenous access creation or maintenance in 19(50%) patients and the poor condition of vascular or cardiac function in 14 (39.5%) patients. Some complications of DAP occurred, such as aneurysm or pseudoaneurysm in 16(42.1%) patients, infiltration in 12 (31.6%) patients. Differences in hemodialysis adequacy were not statistically significant between DAP and other types of VA.

Conclusion

In conclusion, DAP can meet the need of prescription hemodialysis, yet it has several limitations. Although the patients in our study were long-term dependent on DAP for hemodialysis with various reasons, we do not recommend DAP as a long-term vascular access if better options are available. However, DAP should not be overlooked to be a supplemental VA for hemodialysis with adequate blood flow and availability for individuals with poor condition of vascular or cardiac function in a compelling situation.

SUBMITTER: Sun CY

PROVIDER: S-EPMC9219229 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Publications

Direct arterial puncture for hemodialysis, a neglected but simple and valuable vascular access.

Sun Chun-Yan CY Zhong Mi M Song Li L Chen Ying-Gui YG Quan Zi-Lin ZL Zhao Li-Yan LY Cui Dong-Mei DM Fu Xia X

BMC nephrology 20220623 1

<h4>Introduction</h4>The purpose of this study is to present the prevalence and effects of direct arterial puncture (DAP) for hemodialysis patients, and to introduce optimal option for the vascular access (VA) in certain hemodialysis patients with poor condition of vascular or cardiac function in a compelling situation.<h4>Methods</h4>This was a cross-sectional study. Demographic characteristics and laboratory data were extracted from the health care system. Relevant DAP information was collecte ...[more]

PMID: 35739470

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Project description:ObjectivesVascular access thrombosis (VAT) is a common complication in patients with end-stage renal disease (ESRD), significantly impacting hemodialysis efficacy and patient survival. Currently, temporary dialysis access is typically established via deep vein catheterization (VC), however, this method is highly invasive and associated with risks of infection and other complications. This study aims to explore the feasibility of using direct anastomosis indwelling needle puncture (DAINP) for temporary dialysis access.MethodsBetween March 2023 and March 2024, patients VAT were recruited at Sir Run Run Shaw Hospital of Zhejiang University School of Medicine to undergo DAINP. Clinical data, including age, gender, dry and wet body weight, and blood biochemical parameters, were collected. Patient VA types, locations, and insertion vessels were documented. Detailed assessments and records of VAT were performed for all patients, including the distance of thrombus from the anastomosis, residual blood flow at the VA anastomosis, and corresponding selection of the DAINP insertion site. Ultrasound was utilized to measure and record the puncture depth. Concurrently, clinical data of patients undergoing venous catheterization (VC) for temporary dialysis access were collected. The operative time for both groups, defined as the interval from ultrasound assessment initiation to completion of the procedure, was recorded and compared.ResultsA total of 74 patients successfully underwent DAINP, with a 100% puncture success rate. Among them, 20 patients had residual blood flow at the VA stump, and the distance between the anastomosis and arterial flow was ≥ 1 cm. Patients with VA located at the elbow demonstrated the greatest puncture depth. Moreover, the operative time for the DAINP group was significantly shorter compared to the 17 patients who underwent VC for VAT during the same period. However, patients with VA located in the groin required a longer operative time for DAINP.ConclusionsThis study demonstrates that DAINP provides a rapid and safe method for establishing temporary hemodialysis access in VAT patients, effectively reducing the invasiveness and risks associated with traditional VC.

Project description:ObjectiveWhile the benefit of mechanical thrombectomy (MT) for patients with anterior circulation acute ischemic stroke with large-vessel occlusion (AIS-LVO) has been clearly established, difficult vascular access may make the intervention impossible or unduly prolonged. In this study, the authors evaluated safety as well as radiographic and functional outcomes in stroke patients treated with MT via direct carotid puncture (DCP) for prohibitive vascular access.MethodsThe authors retrospectively studied patients from their prospective AIS-LVO database who underwent attempted MT between 2015 and 2018. Patients with prohibitive vascular access were divided into two groups: 1) aborted MT (abMT) after failed transfemoral access and 2) attempted MT via DCP. Functional outcome was assessed using the modified Rankin Scale at 3 months. Associations with outcome were analyzed using ordinal logistic regression.ResultsOf 352 consecutive patients with anterior circulation AIS-LVO who underwent attempted MT, 37 patients (10.5%) were deemed to have prohibitive vascular access (mean age [± SD] 82 ± 11 years, mean National Institutes of Health Stroke Scale [NIHSS] score 17 ± 5, with females accounting for 75% of the patients). There were 20 patients in the DCP group and 17 in the abMT group. The two groups were well matched for the known predictors of clinical outcome: age, sex, and admission NIHSS score. Direct carotid access was successfully obtained in 19 of 20 patients. Successful reperfusion (thrombolysis in cerebral infarction score 2b or 3) was achieved in 16 (84%) of 19 patients in the DCP group. Carotid access complications included an inability to catheterize the carotid artery in 1 patient, neck hematomas in 4 patients, non-flow-limiting common carotid artery (CCA) dissections in 2 patients, and a delayed, fatal carotid blowout in 1 patient. The neck hematomas and non-flow-limiting CCA dissections did not require any subsequent interventions and remained clinically silent. Compared with the abMT group, patients in the DCP group had smaller infarct volumes (11 vs 48 ml, p = 0.04), a greater reduction in NIHSS score (-4 vs +2.9, p = 0.03), and better functional outcome (shift analysis for 3-month modified Rankin Scale score: adjusted OR 5.2, 95% CI 1.02-24.5; p = 0.048).ConclusionsDCP for emergency MT in patients with anterior circulation AIS-LVO and prohibitive vascular access is safe and effective and is associated with higher recanalization rates, smaller infarct volumes, and improved functional outcome compared with patients with abMT after failed transfemoral access. DCP should be considered in this patient population.

Dataset Information

Direct arterial puncture for hemodialysis, a neglected but simple and valuable vascular access.

Introduction

Methods

Results

Conclusion

Publications

Direct arterial puncture for hemodialysis, a neglected but simple and valuable vascular access.

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