1,721,344 research outputs found
Central vein catheterization of dialysis patients with real time ultrasound guidance
No full textInternal jugular vein cannulation has become a routinary and clinically important aspect of medical care in critically ill patients. The landmark-guided technique usually affords rapid and easy vascular access, but it is not always successful and may be complicated by arterial puncture, hematoma, pneumothorax. A prospective, descriptive study is reported on the use and success of ultrasound-assisted central vein catheterization in dialysis patients who had an indication for internal jugular vein catheterization. Data were collected prospectively on number of punctures, needle passes, and success rates. Over a 6-year period, there were 220 attempts at internal jugular catheterization in 205 patients and ultrasound guidance was used in 210 of the 220 (95%) attempts. Incidences of successful puncture and cannulation using ultrasound were 100% (210 out of 210) and 99.5% (209 out of 210), respectively, compared with 80% (8 out of 10) and 80% (8 out of 10) in the landmark group. With the availability of the ultrasound device complication rates also improved markedly, suggesting that the ultrasound technique is an easily learned technique that rapidly produces an improvement over the external landmark method. First attempt success improved from 20% to 85%, carotid punctures decreased from 33% to 2.9% (6 out of 210). The patient population also included 32 patients with several high risk conditions, such as no visual or palpable landmarks, severe coagulopathies due to hepatic failure or ex-cess of anticoagulation treatment. In these patients, cannulation was successful in 100% (32 out of 32) using ultrasound guidance. In 9 patients (9/195, 4.6%), preliminary ultrasound evaluation of the neck vessels failed to identify a right internal jugular vein suitable for cannulation, because of thrombosis or a small diameter of the vein. In all cases, the left internal jugular vein could be cannulated without difficulties. Our results confirm that ultrasound-guided cannulation of the internal jugular vein offers several advantages over the external landmarks technique: higher success rate in both vein puncture and catheter placement, lower complications, lower patient discomfort during the procedure because of a low number of needle passes. Ultrasound-assisted cannulation of the internal jugular vein may become the standard approach to dialysis catheter placement in the future
Iron in the treatment of anemia in dialysis patients: an important support to erythropoietin
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Transparent film for intravascular catheter exit-site dressings
No full textTransparent polyurethane film is recommended for catheter site insertion dressing by the American guidelines for the prevention of infections associated with intravascular catheters. It has been proven to offer the advantages of excellent adhesion, firm support of the catheter, good tolerability, ease of application and fewer replacements per catheter lifetime. The last two features save nursing time and result in healthcare cost savings
La gestione dell’iperfosfatemia
No full textSerum phosphate levels, along with serum calcium and parathyroid hormone (PTH), are the most commonly used
markers for the diagnosis, monitoring and treatment of chronic kidney disease (CKD)-mineral and bone disorder
(MBD) abnormalities in patients affected by kidney failure. Hyperphosphatemia appears late in the course of CKD,
but the consequences of phosphate retention, such as increased levels of FGF23 and hyperparathyroidism, can
be appreciated much earlier. Clinical practice guidelines suggest aiming at phosphate levels that currently are reached
by no more than 50% of patients, despite major efforts of nephrologists, nurses and dieticians in addressing
the issue of dietary and pharmacological compliance. Thus, there are margins of improvement of phosphate management
in CKD patients, which could be accomplished by dietary and/or pharmacological approaches aimed
at improving patient compliance. Severe hyperphosphatemia is always associated with phosphate overload, but
it should be kept in mind that even mild hyperphosphatemia can be linked to a positive phosphate balance and
its deleterious consequences. In fact, hyperphosphatemia is associated with mortality and morbidity (including
hyperparathyroidism, left ventricular hypertrophy, and vascular calcifications). Management of hyperphosphatemia
should take into account the main rings of the therapeutic chain of phosphate control: defense of residual
renal function, adequate dialysis, diet, and phosphate binders. Along with the traditional approaches to phosphate
control, in this article new aspects of phosphate control are summarized, such as cooking tips, education
regarding the presence of phosphate-based additives/preservatives in foods and even drugs, and the potential
advantages of last-generation phosphate binders
Angiotensin II, distal nephron acidification, acid retention, and possibly increased ammonia levels?
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