Goal: Evaluate the importance and reasons of non-infectious complications of non-tunneled central venous catheterization in our hemodialysis unit. Patients and methods: The study, a prospective type, was conducted in ...Goal: Evaluate the importance and reasons of non-infectious complications of non-tunneled central venous catheterization in our hemodialysis unit. Patients and methods: The study, a prospective type, was conducted in the department of nephrology and hemodialysis of Yalgado Ouedraogo University Hospital Center (YO-UHC) in Ouagadougou, Burkina Faso, from 15 February to 30 June 2015. Patients in whom a new central venous catheter (CVC) was inserted during the study period were included. Catheterization-related complications were noted. Results: During the study period, 156 CVCs (9 per week) were placed in femoral (56.4%), internal jugular (40.4%) or subclavian vein (3.2%). There were 114 patients (59.7% of men and 40.3% of women), average age 41.8 ± 17.1 years, low socio-economic level in 64% of cases. At least a non-infectious complication was observed in 67 cases representing 42.9%. They were: puncture failure (40%), arterial puncture (12.2%), puncture of the thoracic duct (1.3%), pneumothorax (1.3%), bleeding related to the catheter insertion (5.8%), hematoma (1.3%), opposite direction (0.6%), dysfunction of the CVC (10.3%), femoralthrombophlebitis (3.2%). Conclusion: Non-infectious complications of non-tunneled central venous catheterization in our hemodialysis unit were frequent and sometimes severe. Their common denominator was the absence of ultrasound guidance. Our study reaffirms the need for equipping with Doppler ultrasound in our hemodialysis units, even in developing countries, for better security of the patient during central venous catheterization.展开更多
Hemodialysis is the main method of clinical renal replacement therapy, and its effectiveness and safety have been widely confirmed. High-flux hemodialysis, as a constantly updating new mode in the field of blood purif...Hemodialysis is the main method of clinical renal replacement therapy, and its effectiveness and safety have been widely confirmed. High-flux hemodialysis, as a constantly updating new mode in the field of blood purification, has effectively improved the efficiency of hemodialysis and reduced the incidence of hemodialysis complications. High-flux hemodialysis has been widely used in clinical practice, and mainly plays its role through adsorption, convection and dispersion. High-flux hemodialysis has some advantages not possessed by conventional hemodialysis, including protecting injured renal function, reducing the incidence of cardiovascular complications in hemodialysis patients, improving the patients' nutritional status, reducing the occurrence of renal osteopathy and delaying the occurrence time of dialysis-associated amyloidosis. However, high-flux hemodialysis also has some limitations, such as the elimination of drugs and nutrients, and the backfiltration caused by increased pressure on the dialysis membrane and dialysate side. In this review, the related progress of high-flux hemodialysis in clinical application, mechanism, complications and treatment are discussed in order to provide a reference for its more rational clinical use.展开更多
BACKGROUND Diabetic kidney disease(DKD)is a prevalent complication of diabetes that often requires hemodialysis for treatment.In the field of nursing,there is a growing recognition of the importance of humanistic care...BACKGROUND Diabetic kidney disease(DKD)is a prevalent complication of diabetes that often requires hemodialysis for treatment.In the field of nursing,there is a growing recognition of the importance of humanistic care,which focuses on the holistic needs of patients,including their emotional,psychological,and social well-being.However,the application of humanistic nursing in the context of hemodialysis for DKD patients remains relatively unexplored.AIM To explore the experience of humanistic nursing in hemodialysis nursing for DKD patients.METHODS Ninety-six DKD patients treated with hemodialysis from March 2020 to June 2022 were included in the study and divided into the control cluster(48 cases)and the study cluster(48 cases)according to different nursing methods;the control cluster was given routine nursing and the study cluster was given humanized nursing.The variances of negative emotion mark,blood glucose,renal function,the incidence of complications,life mark and nursing satisfaction before and after nur-sing were contrasted between the two clusters.RESULTS No significant difference in negative emotion markers between the two clusters were observed before nursing(P>0.05),and the negative emotion markers of the two clusters decreased after nursing.The Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale markers were lower in the study cluster than the control cluster.The healing rate of patients in the study cluster was significantly higher than the control cluster(97.92%vs 85.42%,P<0.05).Blood glucose parameters were not significantly different between the groups prior to nursing(P>0.05).However,after nursing,blood urea nitrogen and serum creatinine(SCr)levels in the study cluster were lower than those in the control cluster(P<0.05).The incidence rate of complications was significantly lower in the study group compared to the control cluster(6.25%vs 20.83%,P<0.05).There was no significant difference in the life markers between the two clusters before nursing.While the life markers increased after nursing for both groups,the 36-item health scale markers in the study cluster were higher than those within the control cluster(P<0.05).Finally,the nursing satisfaction rate was 93.75% in the study cluster,compared to 75% in the control cluster(P<0.05).CONCLUSION In hemodialysis for DKD patients,the implementation of humanistic nursing achieved ideal results,effectively reducing patients’psychological negative emotion markers so that they can actively cooperate with the diagnosis and nursing,facilitate the control of blood glucose and the maintenance of residual renal function,reduce the occurrence of complications,and finally enhance the life quality and nursing satisfaction of patients.It is worthy of being widely popularized and applied.展开更多
Infective endocarditis (IE) is a frequent complication in chronic hemodialysis patients (CHD). The repeated placement and manipulation of central venous catheters, underlying valvulopathies, and immunosuppression are ...Infective endocarditis (IE) is a frequent complication in chronic hemodialysis patients (CHD). The repeated placement and manipulation of central venous catheters, underlying valvulopathies, and immunosuppression are the main predisposing factors for these patients to develop IE. We aimed to highlight the clinical and microbiological specificities of IE in CHD patients, detail the therapeutic management in these patients and identify the risk factors for in-hospital mortality. We included 28 CHD patients in whom the diagnosis of IE was established according to modified Duke criteria. The mean age was 47 ± 17 years. Among them, 57% were hypertensive and 39% were diabetic. The average duration of hemodialysis was 3.5 ± 7 years. The vascular access was a tunnelled jugular catheter, arteriovenous fistula, and temporary catheter in 54%, 28%, and 18% of patients, respectively. Half of the patients presented with heart failure at admission. Methicillin-sensitive Staphylococcus is the most commonly implicated pathogen. Transthoracic echocardiography revealed vegetation in all patients. In 60% of cases, the lesion is located on the mitral valve, and in 35% it is on the tricuspid valve. Patients initially received empirical antibiotic therapy, which was adjusted according to bacteriological results. Valve surgery was indicated in 12 patients, with aortic valve replacement being the most performed procedure followed by tricuspid annuloplasty. The in-hospital mortality rate was 32%. Factors associated with mortality were severe mitral insufficiency (p = 0.036), heart failure (p = 0.043), and the presence of Methicillin-resistant Staphylococcus in blood cultures (p = 0.047). IE is a complication with high morbidity and mortality. Its increasing incidence, specificities in chronic CHD patients, and the complexity of its management require a rigorous preventive strategy. A multidisciplinary collaboration between nephrologists, infectious disease specialists, cardiologists, and surgeons is crucial to optimize therapeutic management.展开更多
The complications of hemodialysis accompanied the hemodialysis and threaten the patients’life.Besides the loss of nutrient substance,such as amino acid and vitamin,we found new clues that the adsorbed proteins on com...The complications of hemodialysis accompanied the hemodialysis and threaten the patients’life.Besides the loss of nutrient substance,such as amino acid and vitamin,we found new clues that the adsorbed proteins on common-used polysulfone-based dialysis membrane might be the reason according to the qualitative proteomic study by ionic liquid assisted sample preparation method.Our results indicated that the adsorbed proteins on the membrane were related with complement activation,blood coagulation,and leukocyte-related biological process.The quantitative proteome further demonstrated some significant changes of signal proteins in the post-dialysis plasma after the hemodialysis,such as beta-2-microglobulin and platelet factor-4,which would further verify these new clues.展开更多
Femoral venous catheterization is the most used technic in emergency he-modialysis. Some uncommon mechanical complications can occur during a catheterization. We report the case of an accidental migration of a guide w...Femoral venous catheterization is the most used technic in emergency he-modialysis. Some uncommon mechanical complications can occur during a catheterization. We report the case of an accidental migration of a guide wire during the placement of a hemodialysis femoral catheter. The case of a patient admitted in the nephrology department at Aristide Le Dantec University Hospital for malignant hypertension was investigated. Emergency hemodialysis was indicated. Surgical extraction of the metal guide has been performed and the outcome was favorable.展开更多
近年来,中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)已被公认为一种新型预测生物标志物,由于其创伤小、经济、简便、敏感性和特异性高等优点,在心血管疾病、肾脏疾病、自身免疫性疾病等预后指标中广泛应用。血液透析...近年来,中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)已被公认为一种新型预测生物标志物,由于其创伤小、经济、简便、敏感性和特异性高等优点,在心血管疾病、肾脏疾病、自身免疫性疾病等预后指标中广泛应用。血液透析(haemodialysis,HD)作为危重症或晚期肾病患者延长寿命的治疗手段,不可避免会导致很多并发症,因此及时识别和治疗HD相关并发症至关重要。有研究发现在HD相关并发症中NLR似乎具有一定的识别和预测能力,故本综述通过总结当前HD患者相关并发症中NLR研究进展,为临床医生评估HD患者相关并发症的发生和预后提供依据。展开更多
目的观察自制血透导管保护套在老年血透患者中的应用效果,为老年血透患者的护理提供方法。方法选取2022年1月—2022年12月于上海中医药大学附属曙光医院肾病科收治的老年血透导管置管患者70例,按照随机数字表法分为试验组(n=35)和对照组...目的观察自制血透导管保护套在老年血透患者中的应用效果,为老年血透患者的护理提供方法。方法选取2022年1月—2022年12月于上海中医药大学附属曙光医院肾病科收治的老年血透导管置管患者70例,按照随机数字表法分为试验组(n=35)和对照组(n=35)。试验组患者使用自制血透导管保护套进行导管保护及固定,对照组患者使用纱布、橡皮胶、纱带进行导管保护及固定。观察并比较2组导管延长管移位率、导管污染率、皮肤并发症发生率、穿刺部位出血率、患者舒适度[采用视觉模拟评分法(VAS)评估]、护理操作时间。结果试验组导管延长管移位率低于对照组(0 vs 85.71%,P<0.05);试验组导管污染率低于对照组(5.71%vs 42.86%,P<0.05);试验组皮肤并发症发生率低于对照组(0 vs 51.43%,P<0.05);试验组穿刺部位出血率低于对照组(2.86%vs 25.71%,P<0.05);试验组患者舒适度评分低于对照组[(3.97±1.22)分vs(8.64±0.92)分,P<0.05];试验组护理操作时间短于对照组[(10.25±3.39)min vs(33.46±10.67)min,P<0.05]。结论血透导管保护套有助于降低老年血透患者导管延长管移位率、导管污染率、皮肤并发症发生率、穿刺部位出血率,提高患者的舒适度,缩短护理操作时间,可为老年血透患者护理的一种选择方法。展开更多
文摘Goal: Evaluate the importance and reasons of non-infectious complications of non-tunneled central venous catheterization in our hemodialysis unit. Patients and methods: The study, a prospective type, was conducted in the department of nephrology and hemodialysis of Yalgado Ouedraogo University Hospital Center (YO-UHC) in Ouagadougou, Burkina Faso, from 15 February to 30 June 2015. Patients in whom a new central venous catheter (CVC) was inserted during the study period were included. Catheterization-related complications were noted. Results: During the study period, 156 CVCs (9 per week) were placed in femoral (56.4%), internal jugular (40.4%) or subclavian vein (3.2%). There were 114 patients (59.7% of men and 40.3% of women), average age 41.8 ± 17.1 years, low socio-economic level in 64% of cases. At least a non-infectious complication was observed in 67 cases representing 42.9%. They were: puncture failure (40%), arterial puncture (12.2%), puncture of the thoracic duct (1.3%), pneumothorax (1.3%), bleeding related to the catheter insertion (5.8%), hematoma (1.3%), opposite direction (0.6%), dysfunction of the CVC (10.3%), femoralthrombophlebitis (3.2%). Conclusion: Non-infectious complications of non-tunneled central venous catheterization in our hemodialysis unit were frequent and sometimes severe. Their common denominator was the absence of ultrasound guidance. Our study reaffirms the need for equipping with Doppler ultrasound in our hemodialysis units, even in developing countries, for better security of the patient during central venous catheterization.
文摘Hemodialysis is the main method of clinical renal replacement therapy, and its effectiveness and safety have been widely confirmed. High-flux hemodialysis, as a constantly updating new mode in the field of blood purification, has effectively improved the efficiency of hemodialysis and reduced the incidence of hemodialysis complications. High-flux hemodialysis has been widely used in clinical practice, and mainly plays its role through adsorption, convection and dispersion. High-flux hemodialysis has some advantages not possessed by conventional hemodialysis, including protecting injured renal function, reducing the incidence of cardiovascular complications in hemodialysis patients, improving the patients' nutritional status, reducing the occurrence of renal osteopathy and delaying the occurrence time of dialysis-associated amyloidosis. However, high-flux hemodialysis also has some limitations, such as the elimination of drugs and nutrients, and the backfiltration caused by increased pressure on the dialysis membrane and dialysate side. In this review, the related progress of high-flux hemodialysis in clinical application, mechanism, complications and treatment are discussed in order to provide a reference for its more rational clinical use.
基金Supported by 2021 Wuxi Nursing Association Nursing Scientific Research Project Fund,No.Q202106.
文摘BACKGROUND Diabetic kidney disease(DKD)is a prevalent complication of diabetes that often requires hemodialysis for treatment.In the field of nursing,there is a growing recognition of the importance of humanistic care,which focuses on the holistic needs of patients,including their emotional,psychological,and social well-being.However,the application of humanistic nursing in the context of hemodialysis for DKD patients remains relatively unexplored.AIM To explore the experience of humanistic nursing in hemodialysis nursing for DKD patients.METHODS Ninety-six DKD patients treated with hemodialysis from March 2020 to June 2022 were included in the study and divided into the control cluster(48 cases)and the study cluster(48 cases)according to different nursing methods;the control cluster was given routine nursing and the study cluster was given humanized nursing.The variances of negative emotion mark,blood glucose,renal function,the incidence of complications,life mark and nursing satisfaction before and after nur-sing were contrasted between the two clusters.RESULTS No significant difference in negative emotion markers between the two clusters were observed before nursing(P>0.05),and the negative emotion markers of the two clusters decreased after nursing.The Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale markers were lower in the study cluster than the control cluster.The healing rate of patients in the study cluster was significantly higher than the control cluster(97.92%vs 85.42%,P<0.05).Blood glucose parameters were not significantly different between the groups prior to nursing(P>0.05).However,after nursing,blood urea nitrogen and serum creatinine(SCr)levels in the study cluster were lower than those in the control cluster(P<0.05).The incidence rate of complications was significantly lower in the study group compared to the control cluster(6.25%vs 20.83%,P<0.05).There was no significant difference in the life markers between the two clusters before nursing.While the life markers increased after nursing for both groups,the 36-item health scale markers in the study cluster were higher than those within the control cluster(P<0.05).Finally,the nursing satisfaction rate was 93.75% in the study cluster,compared to 75% in the control cluster(P<0.05).CONCLUSION In hemodialysis for DKD patients,the implementation of humanistic nursing achieved ideal results,effectively reducing patients’psychological negative emotion markers so that they can actively cooperate with the diagnosis and nursing,facilitate the control of blood glucose and the maintenance of residual renal function,reduce the occurrence of complications,and finally enhance the life quality and nursing satisfaction of patients.It is worthy of being widely popularized and applied.
文摘Infective endocarditis (IE) is a frequent complication in chronic hemodialysis patients (CHD). The repeated placement and manipulation of central venous catheters, underlying valvulopathies, and immunosuppression are the main predisposing factors for these patients to develop IE. We aimed to highlight the clinical and microbiological specificities of IE in CHD patients, detail the therapeutic management in these patients and identify the risk factors for in-hospital mortality. We included 28 CHD patients in whom the diagnosis of IE was established according to modified Duke criteria. The mean age was 47 ± 17 years. Among them, 57% were hypertensive and 39% were diabetic. The average duration of hemodialysis was 3.5 ± 7 years. The vascular access was a tunnelled jugular catheter, arteriovenous fistula, and temporary catheter in 54%, 28%, and 18% of patients, respectively. Half of the patients presented with heart failure at admission. Methicillin-sensitive Staphylococcus is the most commonly implicated pathogen. Transthoracic echocardiography revealed vegetation in all patients. In 60% of cases, the lesion is located on the mitral valve, and in 35% it is on the tricuspid valve. Patients initially received empirical antibiotic therapy, which was adjusted according to bacteriological results. Valve surgery was indicated in 12 patients, with aortic valve replacement being the most performed procedure followed by tricuspid annuloplasty. The in-hospital mortality rate was 32%. Factors associated with mortality were severe mitral insufficiency (p = 0.036), heart failure (p = 0.043), and the presence of Methicillin-resistant Staphylococcus in blood cultures (p = 0.047). IE is a complication with high morbidity and mortality. Its increasing incidence, specificities in chronic CHD patients, and the complexity of its management require a rigorous preventive strategy. A multidisciplinary collaboration between nephrologists, infectious disease specialists, cardiologists, and surgeons is crucial to optimize therapeutic management.
基金supported by the National Key Research and Development Program of China (2017YFA0505003,2016YFA0501401)the National Natural Science Foundation of China (21375126, 21405154)
文摘The complications of hemodialysis accompanied the hemodialysis and threaten the patients’life.Besides the loss of nutrient substance,such as amino acid and vitamin,we found new clues that the adsorbed proteins on common-used polysulfone-based dialysis membrane might be the reason according to the qualitative proteomic study by ionic liquid assisted sample preparation method.Our results indicated that the adsorbed proteins on the membrane were related with complement activation,blood coagulation,and leukocyte-related biological process.The quantitative proteome further demonstrated some significant changes of signal proteins in the post-dialysis plasma after the hemodialysis,such as beta-2-microglobulin and platelet factor-4,which would further verify these new clues.
文摘Femoral venous catheterization is the most used technic in emergency he-modialysis. Some uncommon mechanical complications can occur during a catheterization. We report the case of an accidental migration of a guide wire during the placement of a hemodialysis femoral catheter. The case of a patient admitted in the nephrology department at Aristide Le Dantec University Hospital for malignant hypertension was investigated. Emergency hemodialysis was indicated. Surgical extraction of the metal guide has been performed and the outcome was favorable.
文摘近年来,中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)已被公认为一种新型预测生物标志物,由于其创伤小、经济、简便、敏感性和特异性高等优点,在心血管疾病、肾脏疾病、自身免疫性疾病等预后指标中广泛应用。血液透析(haemodialysis,HD)作为危重症或晚期肾病患者延长寿命的治疗手段,不可避免会导致很多并发症,因此及时识别和治疗HD相关并发症至关重要。有研究发现在HD相关并发症中NLR似乎具有一定的识别和预测能力,故本综述通过总结当前HD患者相关并发症中NLR研究进展,为临床医生评估HD患者相关并发症的发生和预后提供依据。
文摘目的观察自制血透导管保护套在老年血透患者中的应用效果,为老年血透患者的护理提供方法。方法选取2022年1月—2022年12月于上海中医药大学附属曙光医院肾病科收治的老年血透导管置管患者70例,按照随机数字表法分为试验组(n=35)和对照组(n=35)。试验组患者使用自制血透导管保护套进行导管保护及固定,对照组患者使用纱布、橡皮胶、纱带进行导管保护及固定。观察并比较2组导管延长管移位率、导管污染率、皮肤并发症发生率、穿刺部位出血率、患者舒适度[采用视觉模拟评分法(VAS)评估]、护理操作时间。结果试验组导管延长管移位率低于对照组(0 vs 85.71%,P<0.05);试验组导管污染率低于对照组(5.71%vs 42.86%,P<0.05);试验组皮肤并发症发生率低于对照组(0 vs 51.43%,P<0.05);试验组穿刺部位出血率低于对照组(2.86%vs 25.71%,P<0.05);试验组患者舒适度评分低于对照组[(3.97±1.22)分vs(8.64±0.92)分,P<0.05];试验组护理操作时间短于对照组[(10.25±3.39)min vs(33.46±10.67)min,P<0.05]。结论血透导管保护套有助于降低老年血透患者导管延长管移位率、导管污染率、皮肤并发症发生率、穿刺部位出血率,提高患者的舒适度,缩短护理操作时间,可为老年血透患者护理的一种选择方法。