The number of patients with chronic kidney disease re-quiring renal replacement therapy has increased world-wide. The most common replacement therapy is hemo-dialysis （HD）. Vascular access （VA） has a key role for ...The number of patients with chronic kidney disease re-quiring renal replacement therapy has increased world-wide. The most common replacement therapy is hemo-dialysis （HD）. Vascular access （VA） has a key role for successful treatment. Despite the advances that have taken place in the feld of the HD procedure, few things have changed with regards to VA in recent years. Ar-teriovenous fstula （AVF）, polytetrafuoroethylene graft and the cuffed double lumen silicone catheter are the most common used for VA. In the long term, a number of complications may present and more than one VA is needed during the HD life. The most common com-plications for all of VA types are thrombosis, bleeding and infection, the most common cause of morbidity in these patients. It has been estimated that VA dysfunc-tion is responsible for 20% of all hospitalizations. The annual cost of placing and looking after dialysis VA in the United States exceeds 1 billion dollars per year. A good functional access is also vital in order to deliver adequate HD therapy. It seems that the native AVF that Brescia and Cimino described in 1966 still remains the frst choice for VA. The native forearm AVFs have the longest survival and require the fewest interventions. For this reason, the forearm AVF is the frst choice, fol-lowed by the upper-arm AVF, the arteriovenous graft and the cuffed central venous catheter is the final choice. In conclusion, VA remains the most importantissue for patients on HD and despite the technical im-provements, a number of problems and complications have to be resolved.展开更多
Establishing a long-term vascular access in patients exhibiting vascular access exhaustion is challenging. In this study, we reported a case of a direct catheterization in the superior vena cava of a hemodialysis pati...Establishing a long-term vascular access in patients exhibiting vascular access exhaustion is challenging. In this study, we reported a case of a direct catheterization in the superior vena cava of a hemodialysis patient with vascular access exhaustion and original dysfunctional catheter inserted via the left internal jugular vein. The direct catheterization was performed with cuffed tunnel catheter （CUFF） and guided by digital subtraction angiography （DSA） and multidetector computedtomography venography （MDCTV）. The DSA and MDCTV results revealed an occlusion in the right innominate vein and thromboses in the left innominate, right internal jugular, subclavian, and femoral veins. The distal end of the superior vena cava was localized clearly by the original CUFF under DSA. Directed at the distal end of the superior vena cava, a 0.5-cm secondary puncture was introduced below the lateral head of the sternocleidomastoid muscle via the right neck area. This study is one of the few reports regarding direct catheterization of CUFF via the superior vena cava of a patient with vascular access exhaustion and CUFF dysfunction on the left internal jugular vein. We believe that our study can provide a new alternative for inserting central venous catheter for such patient.展开更多
目的:探讨在维持性血液透析患者中采用实时超声引导留置永久性双腔导管的价值,并对其成功率、并发症进行临床分析.方法:2012年1月至2012年10月对我院共63例(男39例,女24例)维持性血液透析患者留置永久性双腔导管.在Logiq 5彩色多普勒超...目的:探讨在维持性血液透析患者中采用实时超声引导留置永久性双腔导管的价值,并对其成功率、并发症进行临床分析.方法:2012年1月至2012年10月对我院共63例(男39例,女24例)维持性血液透析患者留置永久性双腔导管.在Logiq 5彩色多普勒超声仪实时引导下,均经颈内静脉采用Seldinger技术加撕脱型扩张导管置管法植入永久性血液透析导管.分析记录穿刺次数、手术成功率、手术时间以及术后并发症的发生率.并将患者分为一般患者及高危患者两组进行对比,曾经有过颈内静脉临时置管或曾经有过置管困难情况或配合差、肥胖、衰弱、骨骼畸形及凝血功能异常者为高危患者.结果:全部患者采用实时超声引导经颈内静脉留置永久性导管成功率100％,其中高危患者20例(31.7％);有60例患者一次性置管成功(95.2％);穿刺次数1～3(1.23±0.21)次;3例患者出现术中即刻并发症(4.7％);在使用过程中导管感染3例(4.7％).手术时间高危组患者长于一般患者组[(30.6±0.11) min vs (19.1±0.09) min,P＜0.05];两组在穿刺次数,置管成功率、术中并发症方面的差异无统计学意义(P＞0.05);但高危组(4/20,20％)在长期使用导管过程更易因导管血栓形成而导致流量不佳.结论:采用超声引导下颈内静脉留置永久性双腔导管是一种安全、有效的血管通路技术,成功率高;不论在高危患者还是一般患者中都具有操作简单、并发症少的特点,值得在临床广泛推广.展开更多
文摘The number of patients with chronic kidney disease re-quiring renal replacement therapy has increased world-wide. The most common replacement therapy is hemo-dialysis （HD）. Vascular access （VA） has a key role for successful treatment. Despite the advances that have taken place in the feld of the HD procedure, few things have changed with regards to VA in recent years. Ar-teriovenous fstula （AVF）, polytetrafuoroethylene graft and the cuffed double lumen silicone catheter are the most common used for VA. In the long term, a number of complications may present and more than one VA is needed during the HD life. The most common com-plications for all of VA types are thrombosis, bleeding and infection, the most common cause of morbidity in these patients. It has been estimated that VA dysfunc-tion is responsible for 20% of all hospitalizations. The annual cost of placing and looking after dialysis VA in the United States exceeds 1 billion dollars per year. A good functional access is also vital in order to deliver adequate HD therapy. It seems that the native AVF that Brescia and Cimino described in 1966 still remains the frst choice for VA. The native forearm AVFs have the longest survival and require the fewest interventions. For this reason, the forearm AVF is the frst choice, fol-lowed by the upper-arm AVF, the arteriovenous graft and the cuffed central venous catheter is the final choice. In conclusion, VA remains the most importantissue for patients on HD and despite the technical im-provements, a number of problems and complications have to be resolved.
文摘Establishing a long-term vascular access in patients exhibiting vascular access exhaustion is challenging. In this study, we reported a case of a direct catheterization in the superior vena cava of a hemodialysis patient with vascular access exhaustion and original dysfunctional catheter inserted via the left internal jugular vein. The direct catheterization was performed with cuffed tunnel catheter （CUFF） and guided by digital subtraction angiography （DSA） and multidetector computedtomography venography （MDCTV）. The DSA and MDCTV results revealed an occlusion in the right innominate vein and thromboses in the left innominate, right internal jugular, subclavian, and femoral veins. The distal end of the superior vena cava was localized clearly by the original CUFF under DSA. Directed at the distal end of the superior vena cava, a 0.5-cm secondary puncture was introduced below the lateral head of the sternocleidomastoid muscle via the right neck area. This study is one of the few reports regarding direct catheterization of CUFF via the superior vena cava of a patient with vascular access exhaustion and CUFF dysfunction on the left internal jugular vein. We believe that our study can provide a new alternative for inserting central venous catheter for such patient.
文摘目的:探讨在维持性血液透析患者中采用实时超声引导留置永久性双腔导管的价值,并对其成功率、并发症进行临床分析.方法:2012年1月至2012年10月对我院共63例(男39例,女24例)维持性血液透析患者留置永久性双腔导管.在Logiq 5彩色多普勒超声仪实时引导下,均经颈内静脉采用Seldinger技术加撕脱型扩张导管置管法植入永久性血液透析导管.分析记录穿刺次数、手术成功率、手术时间以及术后并发症的发生率.并将患者分为一般患者及高危患者两组进行对比,曾经有过颈内静脉临时置管或曾经有过置管困难情况或配合差、肥胖、衰弱、骨骼畸形及凝血功能异常者为高危患者.结果:全部患者采用实时超声引导经颈内静脉留置永久性导管成功率100％,其中高危患者20例(31.7％);有60例患者一次性置管成功(95.2％);穿刺次数1～3(1.23±0.21)次;3例患者出现术中即刻并发症(4.7％);在使用过程中导管感染3例(4.7％).手术时间高危组患者长于一般患者组[(30.6±0.11) min vs (19.1±0.09) min,P＜0.05];两组在穿刺次数,置管成功率、术中并发症方面的差异无统计学意义(P＞0.05);但高危组(4/20,20％)在长期使用导管过程更易因导管血栓形成而导致流量不佳.结论:采用超声引导下颈内静脉留置永久性双腔导管是一种安全、有效的血管通路技术,成功率高;不论在高危患者还是一般患者中都具有操作简单、并发症少的特点,值得在临床广泛推广.
