Vascular Nursing and Vascular Surgery.

BACKGROUND: Patients requiring vascular surgery have turned in older subjects with several comorbidities with frailty problems and increased vulnerability. Treating this kind of patients has become an important challenge both for vascular surgeons and for dedicated nurses, as these patients are more susceptible to postoperative complications and during discharge. The aim of this review is to analyze the role of vascular nurse in vascular surgery activities. METHODS: For this study, Medline, ScienceDirect, and Scopus databases were searched. The following keywords were used: nursing and vascular surgery, nursing and vascular disease, nursing and vascular procedure, and care and vascular patient. RESULTS: From the search strategy, the following areas were identified as relevant and analyzed in detail: vascular disease related to vascular surgery, the definition of vascular nursing, the role of vascular nursing in implementing clinical pathways in vascular surgery procedures, nursing postoperative care in vascular surgery, frailty assessment in vascular patient, nursing in phlebology and wound care, and the management of vascular access. CONCLUSIONS: Vascular nursing is a discipline that is able to provide comprehensive and optimal care, better postoperative outcomes, and coordinated, standardized, and cost-effective clinical pathways for patients managed in the area of vascular surgery.

Managing vascular compromise of hand and digit replantation following traumatic amputation.

Hands are anatomically complex and have great social, physical and emotional importance. Hand or digit replantation following traumatic partial or complete amputation is a complex injury for nursing staff to understand and manage. The absence of clear guidance, combined with a lack of consensus in the literature gives rise to ambiguity and insufficient understanding of appropriate and effective management. This article aims to outline nursing care of the patient in the first few days following hand or digit reattachment, particularly focusing on the recognition and management of arterial and venous compromise. Complications must be recognised and acted on quickly to give the best chance of survival so it is essential for nurses to have an accurate understanding of the signs, symptoms and management options of vascular compromise. Leech therapy, also discussed, has long been used as a nonsurgical option in the management of venous congestion and is a simple and minimally invasive method of managing congestion.

Monitorización del acceso vascular: parámetros convencionales frente a flujo intraacceso / Vascular access monitoring: conventional parameters versus intra-access flow

Mantener la permeabilidad de los accesos vasculares es un objetivo capital en el paciente en hemodiálisis. Los parámetros clásicos de monitorización del acceso vascular son en general tardíos para la detección de estenosis. El cálculo del flujo intraacceso es un método de segunda generación que permite conocer el flujo sanguíneo máximo del acceso así como detectar estenosis ante una disminución del mismo. El objetivo de este estudio es valorar la eficacia de la medición y vigilancia del flujo intraacceso frente a los parámetros clínicos de primera generación. Mensualmente se realiza monitorización del acceso vascular registrando variables del examen físico y del examen dinámico. La determinación de flujo intraacceso se realiza trimestralmente en FAV y mensualmente en PPTFE. Se indica realización de fistulografía si el flujo intraacceso es menor de 500ml/min o disminución en un 20% confirmado en dos tomas consecutivas, si hay variaciones en la exploración física y disminución ≥ 25% de Kt, flujo sanguíneo o aumento de presiones venosas o recirculación. Se realizan 61 fistulografías. Se hallan diferencias significativas por método de valoración (p<0,001) así como diferencias significativas en falsos positivos (fistulografía blanca o estenosis < 50%) (p=0,024). La monitorización del flujo intraacceso es un método altamente sensible de detección de disfunción del acceso vascular. La combinación de parámetros clínicos, clásicos y el flujo intraacceso en un programa de monitorización del acceso vascular permite detectar más del 80% de los casos confirmados por fistulografía (AU)

It is a major goal in hemodialysis patient to maintain permeable vascular access. Classic parameters for monitoring the vascular access are generally slow to detect stenosis. Intra-access flow calculation is a second-generation method that allows knowing the maximum access blood flow and to detect stenosis when there is a decreased flow. The aim of this study is to assess the efficacy of the measurement and monitoring of intra-access flow compared to first-generation clinical parameters. Vascular access monitoring is done monthly, recording the physical and dynamic examination variables. The determination of intra-access flow is performed quarterly in AVF and monthly in PTFE. Fistulography is recommended if the intra-access flow is less than 500 ml / min or a decrease by 20% confirmed on two consecutive measurements, or if there are variations in the physical examination and Kt decreased by over 25%, blood flow or increased venous pressure or recirculation. 61 fistulographies were performed. Significant differences by valuation method (p <0.001) and in false positives (stenosis <50%) (p = 0.024) was found. Intra-access flow monitoring is a highly sensitive method for detection of vascular access dysfunction. The combination of clinical, classical parameters and intra-access flow in a monitoring program for vascular access, can detect more than 80% of confirmed cases by fistulography (AU)

Predictors of pressure ulcer development in patients with vascular disease.

BACKGROUND: Although pressure ulcer (PU) risk factors are well known in the general population, little research is available in hospitalized surgical patients admitted with vascular diseases. METHODS: Using a retrospective medical records review, characteristics of hospitalized surgical patients with vascular diseases were assessed. Variables were based on literature review of PUs and availability of medical records and administrative data. Trained registered nurses collected data. Analyses included descriptive and comparative statistics, and multivariable modeling was used to determine predictors of PU. RESULTS: In 849 adult admissions, 18.9% had a PU; 11.8% were hospital-acquired PU (HAPU). Patients were more likely to be elderly, male (n = 575; 67.7%), and Caucasian (n = 704; 83.3%). Common diagnoses were aneurysms/embolisms (43.2%) and atherosclerosis (31.2%). Patients with HAPU were more likely to be discharged to a skilled nursing or other facility compared with home (P < .001). In univariate analyses, 12 patient characteristics were associated with HAPU presence: Female gender, non-married status, current smoker, non-Caucasian race, non-intensive care unit (ICU) stay, primary diagnosis of atherosclerosis, higher analgesic use, higher right ankle brachial index (ABI), lower Braden score, higher blood urea nitrogen (BUN) higher serum creatinine and higher total protein levels. In multivariate analyses, nine factors predicted HAPU: Lower right ABI and Braden score, an ICU stay, low and high hematocrit values, female gender, non-White race, atherosclerosis history, and higher BUN and body mass index (BMI). The concordance index for the nine-item model was 0.854. CONCLUSION: The rate of HAPU in hospitalized surgical patients with vascular diseases was greater than expected. Assessment of important HAPU factors and implementation of interventions are needed to decrease risk and improve clinical outcomes.

Acute chest syndrome of sickle cell disease.

As patients with sickle cell anemia (SCA) are living longer, health care practitioners increasingly manage the chronic effects of the disease. Although significant strides in management of children with SCA over the past decade resulted in decreased mortality, less research exists to guide the care of the adult with complications from the disease. This case study reviews the care of a young woman with SCA admitted to the hospital for vaso-occlusive crisis with subsequent acute chest syndrome and acute respiratory distress syndrome. The pathophysiology and management of SCA, vaso-occlusive crisis, and pulmonary and neurologic complications of the disease are discussed.

Recirculación de la sangre durante la sesión de hemodiálisis en el catéter tunelizado PalindromeTM / Blood recirculation during the haemodialysis session in the tunnelled catheter PalindromeTM

Uno de los problemas más frecuentes que encontramos al utilizar los catéteres venosos tunelizados como acceso vascular para hemodiálisis, es un déficit de flujo sanguíneo, teniendo que invertir las líneas del circuito para poder continuar la sesión. Los investigadores, conscientes de que así puede aumentar la recirculación y derivar en una menor calidad de la técnica, han diseñado un nuevo modelo de catéter, para evitar en lo posible la recirculación de la sangre. Actualmente, este tipo de catéter es el que se implanta a nuestros pacientes; debido a esto y a la escasez de estudios publicados en estos nuevos catéteres sobre este tema, realizamos un estudio para calcular el porcentaje de recirculación que tienen dichos catéteres, tanto con las líneas del circuito en posición normal como en posición invertida. Calculamos este porcentaje analizando la determinación sérica de la urea, en 4 muestras de sangre, extraídas semanalmente, con las líneas del circuito de hemodiálisis en ambas posiciones y aplicamos la fórmula de recirculación: R = (BUN A2−BUN A1/BUN A2−BUN V) x 100. Tras los resultados obtenidos podemos concluir, que el porcentaje de recirculación de la sangre en dichos catéteres es prácticamente el mismo, tanto con las líneas del circuito en una posición como en otra, habiéndose obtenido unas cifras más que aceptables para poder conseguir hemodiálisis de buena calidad, según los parámetros que aconsejan las guías de la sociedad española de nefrología de accesos vasculares (AU)

One of the most frequent problems we find when using tunnelled venous catheters as vascular access for haemodialysis is a shortfall in blood flow, making it necessary to invert the circuit lines in order to continue the session. Aware that this can increase recirculation and lead to a decreased quality of the technique, researchers have designed a new catheter model to avoid blood recirculation as much as possible. This is the type of catheter currently used with our patients; because of this and the scarcity of studies published on these new catheters with regard to this matter, we carried out a study to calculate the percentage recirculation of these catheters, both with circuit lines in normal position and in inverted position. We calculated this percentage by analysing the determination of urea in serum, in 4 blood samples drawn weekly, with the haemodialysis circuit lines in both positions, and we applied the recirculation formula: R = (BUN A2−BUNA1/BUN A2−BUN V)x100 Based on the results obtained we can conclude that the percentage of blood recirculation in these catheters is practically the same with the circuit lines in each position, and the figures obtained were more than acceptable to achieve a good quality of haemodialysis, according to the parameters recommended by the spanish nefrology society vascular access guidelines (AU)

Compassion satisfaction, burnout, and secondary traumatic stress in heart and vascular nurses.

Objectives for this project were to determine the prevalence of compassion satisfaction (CS), burnout, and secondary traumatic stress (STS) in heart and vascular nurses to confirm whether differences exist between intensive care and intermediate care nurses. The Professional Quality of Life Scale Compassion Satisfaction and Compassion Fatigue: Version 5 developed by Stamm (2009) was used. Results showed that nurses who work in the heart and vascular intermediate care unit had average to high scores of CS, low to average levels of burnout, and low to average levels of STS. Nurses who work in the heart and vascular intensive care unit had average to high levels of CS, low to average levels of burnout, and low to average levels of STS. These findings suggest that leadership should be aware of the prevalence of STS and burnout in heart and vascular nurses. Raising awareness of STS and burnout in intensive care and intermediate care nurses can help in targeting more specific strategies that may prevent the onset of developing these symptoms.

The effect of a self-management intervention to reduce vascular risk factors in patients with manifestations of vascular diseases.

BACKGROUND: Self-management can improve health behaviors and influence reduction of vascular risk. We developed a 1-year self-management intervention and investigated its effect on vascular risk factors and quality of life in patients with different vascular diseases. DESIGN AND METHODS: This observational cohort study involved 223 patients (self-management group, n=125; usual care group n=98) with at least two modifiable vascular risk factors. RESULTS: Patients in the self-management group achieved treatment goals for LDL-cholesterol (difference 13%; 95%CI 1-26) and HDL-cholesterol (difference 9% 95%CI 0-19) significantly more often than did patients in the usual care group. Mean systolic blood pressure decreased significantly by 5mm Hg (95%CI -9 to 0) in the self-management group and mean BMI increased significantly by 0.4 kg/m(2) (95%CI -0.8 to -0.1) in the usual care group. No significant differences were seen in waist circumference, smoking, or triglycerides. General health (RAND36) improved more in the self-management group (by 8 points 95%CI 3-12) than in the usual care group. CONCLUSION: After 1 year, the self-management intervention was more effective than usual care on several important vascular risk factors in patients with vascular diseases. PRACTICE IMPLICATIONS: This self-management intervention used in a hospital population may be applicable in different care settings.

Ressonância magnética cardiovascular e tomografia computadorizada cardiovascular nas doenças não-coronárias / Role of cardiovascular magnetic resonance and computed tomography in noncoronary diseases

A tomografia computadorizada e, principalmente, a ressonância magnética cardiovascular têm se mostrado de utilidade cada vez maior para a avaliação de doenças cardiovasculares não-isquêmicas. A alta resolução tanto espacial como temporal desses métodos possibilita a aquisição de imagens com grande detalhamento anatômico, permitindo a avaliação da relação espacial entre estruturas adjacentes de forma não-invasiva. A tomografia tem particular importância para a análise vascular e é o melhor método para detecção de calcificações. No entanto, tem a desvantagem de utilizar contraste iodado e radiação ionizante, de não apresentar alta resolução de contraste entre as estruturas, e de adquirir imagens predominantemente estáticas. A ressonância magnética, por sua vez, é um método que não utiliza radiação ionizante e, por meio de diversas sequências de pulsos e técnicas de aquisição de imagens, é capaz de fornecer, além do detalhamento anatômico...