Análisis de la punción de prótesis intravasculares recubiertas tras el rescate de la fístula arteriovenosa después de 12 meses de experiencia / Analysis of puncture of coated intravascular prostheses after salvage of arteriovenous fistula, after 12 months of experience

Objetivos: Evaluar la eficacia a medio plazo de una nueva prótesis intravascular (VIABAHN(R)), y su seguridad, analizando la incidencia de eventos adversos asociados a su punción. Pacientes y Método: Se estudiaron 20 pacientes, a los que se les implantó VIABAHN(R), por pseudoaneurismas con trombosis, úlceras en las zonas de punción, fracaso de angioplastia o reestenosis en menos de 6 meses. Se estudió: Parámetros de la FAV, permeabilidad primaria y secundaria (6 y 12 meses), presencia de complicaciones y control del deterioro de la prótesis mediante flebografía a los 3 y 6 meses. Para la punción se esperó un periodo de 4 semanas. Resultados: Se analizó un periodo de 15±9.4 meses. La media de los parámetros funcionales de la FAV durante la hemodiálisis fue: Fs: 362.5±43.3 ml/min, PA: -209.5±35.6 mmHg, PV: 215.8±34.5 mmHg, Kt 55±5.4 l y Recirculación 12.7±3.7%. A los 6 meses el 66% (IC 95% 54-77) de los pacientes tenía permeabilidad primaria y el 77% (IC 95% 67-87) tenía permeabilidad secundaria. A los 12 meses el 38% (IC 95% 24-52) permeabilidad primaria y el 76% (IC 95% 66-87) permeabilidad secundaria. No se observaron eventos adversos relacionados con la punción, ni se objetivó radiológicamente deterioro en las prótesis. Hubo un episodio de infección que requirió la retirada de la prótesis. Conclusiones: La prótesis vascular recubierta VIABAHN(R) es eficaz y segura en el rescate de las FAVs nativas estenosadas y/o trombosadas, ya que proporciona excelentes parámetros de diálisis y alta permeabilidad primaria y secundaria, sin que su punción repetida se asocie a complicaciones (AU)

Aim: To evaluate the medium-term efficacy of a new intravascular prosthesis (VIABAHN(R)), and its safety, by analyzing the incidence of adverse events associated with its puncture. Patients and method: Twenty patients, with VIABAHN(R) implanted, were studied for pseudoaneurysms with thrombosis, ulcers in the puncture sites, failure of angioplasty or restenosis in less than 6 months. Parameters of AVF, primary and secondary patency (6 and 12 months), presence of complications and control of prosthesis deterioration by phlebography at 3 and 6 months were studied. For the puncture, a period of 4 weeks was expected. Results: A period of 15 ± 9.4 months was analyzed. The mean of the functional parameters of the AVF during hemodialysis was: blood flow rate: 362.5 ± 43.3 ml / min, Arterial Pressure: -209.5 ± 35.6 mmHg, Venous Pressure: 215.8 ± 34.5 mmHg, Kt 55 ± 5.4 l and recirculation 12.7 ± 3.7%. At 6 months, 66% (95% CI: 54-77) of the patients had primary permeability and 77% (95% CI 67-87) had secondary permeability. At 12 months 38% (IC 95% 24-52) primary permeability and 76% (IC 95% 66-87) secondary permeability. No adverse events related to the puncture, nor radiologically objectified deterioration in prostheses were observed. There was an episode of infection requiring removal of the prosthesis. Conclusión: The VIABAHN(R) coated vascular prosthesis is effective and safe in the rescue of stented and / or thrombosed native AVFs, as it provides excellent dialysis parameters and high primary and secondary permeability, without repeated puncture associated with complications (AU)

Actuaciones ante sucesos adversos: Cuidados enfermeros en la rotura del catéter venoso central / Procedure adverse events: Nursing care in central venous catheter fracture

En la unidad de cuidados intensivos (UCI) existen muchos factores que pueden propiciar la aparición de sucesos adversos, estando relcionados con la administracion de farmacos es un alto porcentaje, estando relcionados con la administracion de farmacos es un alto porcentaje relacionados con la administración de fármacos. La tomografía axial computarizada es una prueba diagnóstica habitual en el paciente crítico. Para mejorar la visualización de tejidos blandos se utiliza contraste. El contraste es una medicación y la enfermera es la responsable de su correcta administración. El manejo del paciente crítico es complejo. El equipo de UCI y radiología, comparten la responsabilidad de la asistencia y seguridad del paciente durante el traslado y realización de las pruebas con contraste. La Organización Mundial de la Salud recomienda, en sus estrategias para la seguridad del paciente, analizar los errores y aprender de los mismos. Por ello, decidimos investigar las causas del suceso adverso, ocurrido con categoría de gravedad E a un paciente que ingresó en la UCI por un shock séptico de origen abdominal. Se realizó tomografía axial computarizada abdominal con contraste el cual se inyectó por un catéter venoso central. El contraste no apareció en la imagen. ¿Qué ocurrió? El análisis causal permitió entender los factores desencadenantes del evento. Se elaboró un plan de cuidados y un algoritmo para que no volviera a suceder, cuyos objetivos fueron: la mejora de conocimientos, habilidades y la promoción de actitudes favorables hacia la seguridad del paciente, actuando en todos los niveles de prevención primaria, secundaria y terciaria

In a intensive care unit (ICU) there are many factors that can lead to the occurrence of adverse events. A high percentage of these events are associated with the administration of drugs. Diagnostic tests, such as computed tomography, is common in critically ill patients and technique can be performed with injection of contrast agent to enhance the visualization of soft tissue. The contrast is a medication and the nurse is responsible for its proper administration. The management of the critically ill patient is complex. ICU team and radiology shares responsibility for the care and safety of the patient safety during the transfer and performing tests with contrast. The World Health Organisation patient safety strategies, recommends analysing errors and learning from them. Therefore, it was decided to investigate the causes of the category E severity adverse events that occurred in a patient who was admitted to the ICU for septic shock of abdominal origin. An abdominal computed tomography was performed with contrast which was injected through a central venous catheter. The contrast did not appear in the image. What happened? Causal analysis helped to understand what triggered the event. A care plan and an algorithm were drafted to prevent it from happening again, with the following objectives: improving knowledge, skills and promoting positive attitudes towards patient safety, working at primary, secondary and tertiary care levels

How data can help reduce vascular access events.

Thrombosis is the leading cause of access dysfunction and is expensive to treat. In 2011, only 10 AV access capable patients in our center were placed on a bridge catheter because of our ability to assess health and proactively use angioplasty to keep it open. Surveillance also helped us follow the progression of new fistula maturation and helped us decide on early intervention to prevent total, access failure. The Sparrow Center documented successful results with the selection of a new surveillance system that dramatically improved the quality of patient care and financial viability of the center. For dialysis center staffs looking for ways to operate more efficiently and at the same time reduce the incidence of vascular access complications caused by thrombosis, a data-driven surveillance device along with clinical monitoring protocols seems to provide a cost effective approach to addressing this critical area of patient care.

Improving arteriovenous fistula cannulation skills.

Cannulation of arteriovenous fistulae is technically more challenging than cannulation of arteriovenous grafts. With the advent of the National Vascular Improvement Initiative, Fistula First, the United States has seen an increase in the number of arteriovenous fistulae. The problem we now face is how to refocus and reeducate nurses to the intricacies of arteriovenous fistula cannulation. Through evidenced-based practice and current best-demonstrated practices, this article will provide the tools needed to improve arteriovenous fistulae cannulation skills.

Detecting hemodialysis vascular access stenosis: a tracking tool.

A tool for tracking indicators of hemodialysis vascular access stenosis is described to facilitate documentation of early signs of stenosis. Prompt notification of the nephrologist, and referral to an interventional radiologist for percutaneous transluminal angioplasty may prevent more costly interventions or hospitalizations, and even loss of the permanent access. Inadequate dialysis and its complications may be avoided by nursing observation and documentation of indicators known to be predisposing factors to hemodialysis vascular access stenosis.

Caring for patients undergoing treatment for vascular occlusion.

In the treatment of arterial and graft occlusion, St George's Hospital has moved the emphasis away from long infusions of streptokinase to short, high-dose, pulsed administration of recombinant human tissue-type plasminogen activator (rt-PA). This has led to a change in nursing management.