Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.010
Filtrar
1.
Rev Bras Enferm ; 72(3): 774-779, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269145

RESUMO

OBJECTIVE: To evaluate the compliance of the care process involving insertion of central vascular catheter (CVC) in hemodialysis. METHOD: Cross-sectional quantitative approach developed at the hemodialysis service of a reference hospital in Sergipe, Brazil. Sample consisting of 1,342 actions evaluated, corresponding to 122 forms for monitoring and control of CVC insertion. Data collection was held from July to December 2016. RESULTS: The adherence rate to the use of the insertion form was 54.9%. The procedure evaluated achieved 93% overall compliance. Of the 11 specific actions observed, seven (64%) presented 100% compliance. The density of the overall incidence of primary bloodstream infections reduced from 10.6 to 3.1 infections per 1,000 patients/day. CONCLUSION: Although the observed actions reached specific desired conformities, the use of the checklist was lower than expected. Strategies for monitoring, coaching and educational and organizational actions can contribute to safe care.


Assuntos
Cateteres Venosos Centrais/efeitos adversos , Fidelidade a Diretrizes/normas , Controle de Infecções/normas , Adulto , Brasil , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Cateteres Venosos Centrais/estatística & dados numéricos , Estudos Transversais , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Controle de Infecções/estatística & dados numéricos , Masculino , Garantia da Qualidade dos Cuidados de Saúde/métodos , Diálise Renal/instrumentação , Diálise Renal/métodos
3.
Khirurgiia (Mosk) ; (6): 111-116, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317950

RESUMO

We present a case report of atypical hand ischemia probably caused by a combination of venous insufficiency and steal syndrome in patient with arteriovenous fistula for hemodialysis. Unclear clinical symptoms may be due to severe trophic disorders (delayed treatment) or combination of two complications (steal syndrome and venous insufficiency). At the same time, we did not get any diagnostic data confirming organic injury of the upper limb veins or central veins. AVF closure did not result positive changes. Angiography made it possible to assess veins patency, to detect additional patent AVF and to close it. It was previously assumed that this previously created AVF was completely occluded. Therefore, positive changes were observed: rapid healing of trophic ulcers, complete disappearance of pain and gradual restoration of function.


Assuntos
Fístula Arteriovenosa/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Embolização Terapêutica/métodos , Mãos/irrigação sanguínea , Isquemia/cirurgia , Insuficiência Venosa/cirurgia , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/diagnóstico por imagem , Procedimentos Endovasculares/métodos , Mãos/cirurgia , Humanos , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Diálise Renal/instrumentação , Veias/diagnóstico por imagem , Insuficiência Venosa/etiologia
4.
Rev Med Chil ; 147(4): 458-464, 2019 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-31344207

RESUMO

BACKGROUND: Placing central venous lines under ultrasonographic guidance reduces the complications of the procedure. AIM: To compare prevalences of complications of central venous line placements with or without ultrasonographic guidance. MATERIAL AND METHODS: Descriptive study that contemplated the comparison of two groups of patients subjected to a central venous line placement at a nephrology service for renal replacement therapy. In one group of 100 patients, the line was placed without ultrasonographic guidance between 2008 and 2012. Between 2015 and 2017 the line was placed in 138 patients using ultrasonographic guidance. The prevalences of complications with both types of procedures were recorded. RESULTS: The frequency of complications of procedures with and without ultrasonographic guidance was 0.7 and 18% respectively (prevalence ratio 0.04, 95% confidence interval 0-0.3). Ninety five percent of recorded complications were arterial puncture, followed by hematomas in 10% and pneumothorax in 5%. The higher prevalence of complications was observed in emergency line placement without ultrasonographic guidance. There was a direct association between the number of line placement attempts in a single procedure and the prevalence of complications. CONCLUSIONS: Ultrasonographic guidance is associated with a reduction in the prevalence of central venous line complications.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Diálise Renal/efeitos adversos , Adulto , Idoso , Cateterismo Venoso Central/instrumentação , Cateterismo Venoso Central/métodos , Chile/epidemiologia , Estudos Transversais , Feminino , Hematoma/epidemiologia , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Prevalência , Diálise Renal/instrumentação , Diálise Renal/métodos , Distribuição por Sexo , Ultrassonografia de Intervenção/métodos
5.
J Vasc Access ; 20(5): 567-569, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31190613

RESUMO

INTRODUCTION: Vascular access for hemodialysis is a key factor in every patient dependent on this treatment. Maintaining a central venous catheter can be a good choice when all the other options have been exhausted, but unwanted and rare complications may arise from longer catheter dwell time. CASE REPORT: We describe a case of a 65-year-old woman undergoing hemodialysis treatment since 1986 after a bilateral nephrectomy due to complicated nephrolithiasis. Her last access, two Tesio® tunneled cuffed catheters implanted via the right internal jugular vein functioned correctly for 14 years without complications, and so, was not replaced in the meantime. She was referred to our hospital due to a rupture in a catheter lumen, which was corrected conservatively by creating a more proximal tunnel and excising the affected area. A few weeks later, a new rupture in the same lumen was identified, so the catheter was replaced with angiographic control. The catheter was frail, so upon its removal, the tip fractured and remained in the right ventricle, being swiftly removed by an endovascular snare without complications. DISCUSSION: This case reports two rare complications associated with catheter handling and identifies a possible technique for conservative resolution of a lumen rupture.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Falha de Equipamento , Veias Jugulares , Nefrectomia , Nefrolitíase/cirurgia , Diálise Renal/efeitos adversos , Diálise Renal/instrumentação , Idoso , Remoção de Dispositivo/métodos , Procedimentos Endovasculares , Desenho de Equipamento , Feminino , Humanos , Veias Jugulares/diagnóstico por imagem , Flebografia , Fatores de Tempo , Resultado do Tratamento
7.
Int Heart J ; 60(3): 521-526, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31105145

RESUMO

Prior research has revealed poorer clinical outcomes after drug-eluting stent (DES) implantation for hemodialysis patients. This study aims to investigate the long-term clinical and angiographic outcomes after new-generation DES implantation for hemodialysis patients.We retrospectively enrolled 91 consecutive patients (118 lesions) who underwent successful new-generation DES (everolimus-, zotarolimus-, and biolimus-eluting stents) implantation for the first time. We measured the serum calcium and phosphorus levels in the blood samples obtained just before hemodialysis. The follow-up period of clinical events was, at least, 1.5 years. In this study, major adverse cardiac and cerebrovascular events (MACCE) and clinically driven target lesion revascularization were reported in 36 (39.6%) and 11 (12.1%) patients, respectively. The prevalence of peripheral artery disease was significantly higher in the MACCE group (41.7% versus 14.5%, P = 0.006). The serum calcium level was significantly higher in the MACCE group (9.34 ± 0.92 mg/dL versus 8.77 ± 0.88 mg/dL; P = 0.004). The multivariate Cox proportional hazards model revealed that the serum calcium level (hazard ratio, 1.86; 95% confidence interval [CI]: 1.26-2.77; P = 0.002), suboptimal (over 55 mg2/dL2) calcium-phosphorus product (hazard ratio, 3.27; 95% CI: 1.41-7.61; P = 0.006) and the coexistence of peripheral artery disease (hazard ratio, 3.15; 95% CI: 1.49-6.65; P = 0.003) were independent predictors of MACCE.For hemodialysis patients, MACCE remains a frequent occurrence after new-generation DES implantation and is associated with calcium-phosphate metabolism and peripheral artery disease.


Assuntos
Angiografia/métodos , Cálcio/sangue , Stents Farmacológicos/efeitos adversos , Doença Arterial Periférica/epidemiologia , Fósforo/sangue , Diálise Renal/instrumentação , Idoso , Everolimo/administração & dosagem , Feminino , Seguimentos , Humanos , Imunossupressores/administração & dosagem , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etiologia , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/etiologia , Prevalência , Estudos Retrospectivos , Sirolimo/administração & dosagem , Sirolimo/análogos & derivados
8.
Contrib Nephrol ; 198: 94-102, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30991407

RESUMO

BACKGROUND: With the advancement of technology, a dialysis membrane has been developed to achieve the efficient removal of beta-2 microglobulin (ß2MG), which could not be removed with previous hemodialysis (HD) membranes. Recently, there has been an increase in the population of elderly chronic kidney disease (CKD) patients with chronic inflammation and malnutrition. The optimal extracorporeal circulation treatment for elderly CKD patients is not certain. SUMMARY: We have reported the clinical advantages, such as improvements in nutritional, inflammatory, and hemodynamic conditions, of the adsorptive HD membrane for elderly HD patients. We have also reported that the use of ß2MG adsorption columns improved the symptoms of dialysis-related amyloidosis and the number of bone cysts, which could not be improved by the high-flux hemodialyzer. Both the adsorptive HD membrane and ß2MG adsorption columns remove uremic toxins and inflammatory cytokines via adsorption without aggravating the nutritional condition of these patients. Key Messages: We should reconsider the mechanisms of adsorption, in addition to diffusion and convection, in the extracorporeal circulation treatment of elderly HD patients.


Assuntos
Membranas Artificiais , Diálise Renal/instrumentação , Microglobulina beta-2/isolamento & purificação , Adsorção , Idoso , Idoso de 80 Anos ou mais , Amiloidose/etiologia , Amiloidose/prevenção & controle , Cistos Ósseos/etiologia , Cistos Ósseos/prevenção & controle , Humanos , Masculino , Diálise Renal/efeitos adversos , Diálise Renal/métodos , Diálise Renal/tendências , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia
9.
Cardiovasc Intervent Radiol ; 42(5): 770-774, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30824945

RESUMO

BACKGROUND: Renal patients with a tunnelled haemodialysis line are at risk of fibrin 'sheath' formation which can lead to occlusion. Dysfunctional lines are best treated by catheter exchange with a new subcutaneous tunnel; however, there is a risk of scarring, venous stenosis, potential loss of valuable access as well as the risk of infection. METHOD: We report a retrospective review of our experience using tunnelled line intraluminal plasty (TuLIP) in 11 patients over 16 months with fibrin sheath formation on pre-existing tunnelled haemodialysis catheters. RESULT: All patients responded well to treatment with median line patency post TuLIP reaching 112 days. CONCLUSION: TuLIP may have a role in extending catheter lifespan and delaying more invasive intervention.


Assuntos
Angioplastia com Balão/métodos , Cateteres de Demora/efeitos adversos , Fibrina/efeitos adversos , Diálise Renal/efeitos adversos , Diálise Renal/instrumentação , Terapia de Salvação/métodos , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/instrumentação , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Fibrina/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
10.
Braz J Cardiovasc Surg ; 34(2): 222-225, 2019 Mar-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30916133

RESUMO

The partial anomalous pulmonary vein drainage is a rare congenital defect. The pulmonary vein drains in to a systemic vein instead of draining in to the left atrium. In this rare birth defect, the right sided pulmonary vein involvement is more prevalent than the left sided pulmonary veins. We present a case where the anomalous left superior pulmonary vein was diagnosed when a renal dialysis catheter (size = 12F x 16cm) was mal-positioned in to the Anomalous left superior pulmonary vein, demonstrating confusing blood results. We describe how a systematic multidisciplinary approach and use of advanced imaging techniques can recognise and deal with this rare clinical dilemma.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Cateteres de Demora , Veias Pulmonares/anormalidades , Veias Pulmonares/diagnóstico por imagem , Síndrome de Cimitarra/diagnóstico por imagem , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Diálise Renal/instrumentação , Tomografia Computadorizada por Raios X
11.
Transplant Proc ; 51(5): 1571-1574, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30833028

RESUMO

In the face of access failure for renal replacement therapy or severe complications despite or due to dialysis, high-urgency renal transplant (HU-RT) allocation is possible. Vascular access failure patients have multiple comorbidities and a higher risk of cardiovascular and thrombotic events. Thus, it is presumed that graft and patient survivals might be worse for these patients. The aim of this paper was to analyze the characteristics and outcomes of HU-RT patients due to access failure for renal replacement therapy when comparing them to a population of deceased-donor renal transplant (DDRT) patients. We analyzed data from our Renal Transplantation Unit from January 2006 to April 2017. In this period, 374 patients had a renal transplant. Of these, 11 patients received a high-urgency deceased-donor renal transplant (HU-DDRT). Compared with patients who had a DDRT, HU-DDRT patients were predominantly female (54.5% vs 43.5%, P = .007) and younger (41.6 ± 7.9 vs 49.4 ± 11.8, P = .031). HU-DDRT patients were not significantly more sensitized than DDRT (14.1 ± 27.4 vs 13.5 ± 24.1, P = .935), and had a comparable number of HLA mismatches (3.4 ± 1.4 vs 3.6 ± 1.2, P = .343). Despite the higher incidence in hypertensive (90.9 vs 73.5%, P = .196) and diabetic patients (27.3% vs 15.7%, P = .305) in the HU-DDRT group, this difference was not statistically significant. The percentage of retransplantation was similar in both groups (9.1% vs 7.2%, P = .808). Donor sex, age, and baseline serum creatinine were similar between the groups. There was an increased proportion of expanded criteria donors in HU-DDRT (54.5% vs 25.1%, P = .028). There were no differences in cold or warm ischemia time nor in serum creatinine at discharge or during the first 2 years of follow-up. In both groups, a similar proportion of patients experienced acute rejection episodes. Comparable to DDRT patients, HU-DDRT patients had a high proportion of graft survival at the 1-year follow-up (90.9% vs 93.1%, P = .777). At a 2-year follow-up, graft survival was lower in the HU-DDRT group (81.8% vs 91.5%, P = .267). Mean follow-up for both groups was comparable (78.5 ± 46.7 vs 68.4 ± 40.8 months, P = .424). Overall, graft loss occurred in approximately 36.4% of HU-DDRT patients and 20.9% of DDRT patients (P = .219). Both groups had an overall mortality rate of around 9%. The differences were not statistically significant due to the limited number of patients. More comorbidities and reportedly worse cardiovascular prognosis of access failure (AF) patients and use of expanded criteria donors did not negatively reflect in worse short-term outcomes in our cohort, which highlights the importance of HU-RT in prolonging the survival of AF patients.


Assuntos
Transplante de Rim/métodos , Diálise Renal/instrumentação , Insuficiência Renal/epidemiologia , Insuficiência Renal/etiologia , Dispositivos de Acesso Vascular/efeitos adversos , Adulto , Comorbidade , Falha de Equipamento , Feminino , Humanos , Incidência , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Insuficiência Renal/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Doadores de Tecidos , Resultado do Tratamento
14.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(1): 75-78, 2019 Jan 30.
Artigo em Chinês | MEDLINE | ID: mdl-30770699

RESUMO

OBJECTIVE: To analyze the causes leading to hemodialysis machine & accessories faults and to give preventive measures. METHODS: The causes of 34 hemodialysis machine & accessories faults during hemodialysis process were studied through retrospective analysis from January 2017 to June 2018 in our hemodialysis center. RESULTS: The main factors were hemodialysis machine failure, water & electricity failure, dialytic pipeline failure, unstandardized using. The members in hemodialysis center benefited a lot from the faults, The engineers strengthened the preventive repair & quality control of hemodialysis machine, the monitoring of water & electricity. The nursing staff strengthened the quality control of the pipeline and the study of the principle & standard use of hemodialysis machine. CONCLUSIONS: The study on hemodialysis machine & accessories faults improved the professional level of nurses & engineers, helped them to solve and prevent faults more precisely and improved the quality of hemodialysis.


Assuntos
Diálise Renal , Controle de Qualidade , Diálise Renal/instrumentação , Estudos Retrospectivos
15.
Kidney Int ; 95(1): 38-49, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30606427

RESUMO

Choosing the optimal hemodialysis vascular access for the elderly patient is best achieved by a patient-centered coordinated multidisciplinary team approach that aligns the patient's end-stage kidney disease Life-Plan, i.e., the individual treatment approach (supportive care, time-limited or long-term kidney replacement therapy, or combination thereof) and selection of dialysis modality (peritoneal dialysis versus hemodialysis) with the most suitable dialysis access. Finding the right balance between the patient's preferences, the likelihood of access function and survival, and potential complications in the context of available resources and limited patient survival can be extremely challenging. The framework for choosing the most appropriate vascular access for the elderly presented in this review considers the individual end-stage kidney disease Life-Plan, the patient life expectancy, the likelihood of access function and survival, the timing of dialysis relative to access placement, prior access history, and patient preference. This complex decision-making process should be dynamic in order to accommodate patients' changing needs and life and health circumstances. Effective and timely communication between the patient, their caregivers, and treating team is key to delivering truly patient-centered care. Delivering this care also requires overcoming the limitations of the currently available evidence that is predominantly based on observational data with its inherent risks of bias. While challenging, future randomized controlled studies exploring the risks, benefits, costs, and timing of placement of available access types in the elderly are required to help us "get it right" for our patients.


Assuntos
Tomada de Decisão Clínica , Falência Renal Crônica/terapia , Preferência do Paciente , Assistência Centrada no Paciente/métodos , Diálise Renal/métodos , Fatores Etários , Idoso , Humanos , Falência Renal Crônica/mortalidade , Expectativa de Vida , Diálise Renal/instrumentação , Fatores de Tempo , Dispositivos de Acesso Vascular
16.
Isr Med Assoc J ; 21(1): 5-9, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30685897

RESUMO

BACKGROUND: Dialysate purity contributes to the inflammatory response that afflicts hemodialysis patients. OBJECTIVES: To compare the clinical and laboratory effects of using ultrapure water produced by a water treatment system including two reverse osmosis (RO) units in series, with a system that also includes an ultrapure filter (UPF). METHODS: We performed a retrospective study in 193 hemodialysis patients during two periods: period A (no UPF, 6 months) and period B (same patients, with addition of UPF, 18 months), and a historical cohort of patients treated in the same dialysis unit 2 years earlier, which served as a control group. RESULTS: Mean C-reactive protein, serum albumin and systolic blood pressure worsened in period B compared to period A and in the controls. CONCLUSIONS: A double RO system to produce ultrapure water is not inferior to the use of ultrapure filters.


Assuntos
Soluções para Diálise/química , Diálise Renal/instrumentação , Ultrafiltração/instrumentação , Purificação da Água/instrumentação , Idoso , Pressão Sanguínea/fisiologia , Proteína C-Reativa/análise , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Osmose , Diálise Renal/métodos , Estudos Retrospectivos , Albumina Sérica/análise , Purificação da Água/métodos
17.
Biomed Mater ; 14(2): 025007, 2019 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-30620939

RESUMO

Clinically available alternatives of vascular access for long-term haemodialysis-currently limited to native arteriovenous fistulae and synthetic grafts-suffer from several drawbacks and are associated to high failure rates. Bioprosthetic grafts and tissue-engineered blood vessels are costly alternatives without clearly demonstrated increased performance. In situ tissue engineering could be the ideal approach to provide a vascular access that profits from the advantages of vascular grafts in the short-term (e.g. early cannulation) and of fistulae in the long-term (e.g. high success rates driven by biointegration). Hence, in this study a three-layered silk fibroin/polyurethane vascular graft was developed by electrospinning to be applied as long-term haemodialysis vascular access pursuing a 'hybrid' in situ engineering approach (i.e. based on a semi-degradable scaffold). This Silkothane® graft was characterized concerning morphology, mechanics, physical properties, blood contact and vascular cell adhesion/viability. The full three-layered graft structure, influenced by the polyurethane presence, ensured mechanical properties that are a determinant factor for the success of a vascular access (e.g. vein-graft compliance matching). The Silkothane® graft demonstrated early cannulation potential in line with self-sealing commercial synthetic arteriovenous grafts, and a degradability driven by enzymatic activity. Moreover, the fibroin-only layers and extracellular matrix-like morphology, presented by the graft, revealed to be crucial in providing a non-haemolytic character, long clotting time, and favourable adhesion of human umbilical vein endothelial cells with increasing viability after 3 and 7 d. Accordingly, the proposed approach may represent a step forward towards an in situ engineered hybrid vascular access with potentialities for vein-graft anastomosis stability, early cannulation, and biointegration.


Assuntos
Prótese Vascular , Fibroínas/química , Poliuretanos/química , Diálise Renal/instrumentação , Engenharia Tecidual/métodos , Dispositivos de Acesso Vascular , Animais , Materiais Biocompatíveis/química , Testes de Coagulação Sanguínea , Bombyx , Adesão Celular , Sobrevivência Celular , Eletroquímica , Hemólise , Células Endoteliais da Veia Umbilical Humana , Humanos , Inflamação , Permeabilidade , Diálise Renal/métodos , Estresse Mecânico , Suturas , Resistência à Tração
19.
Medicine (Baltimore) ; 98(3): e14192, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30653173

RESUMO

RATIONALE: Double-lumen hemodialysis catheters are commonly used as temporary hemodialysis routes. Complications include infection, thrombosis, cardiac arrhythmia, entrapped guide wire, and malposition. We report a rare complication of delayed hemodialysis catheter malposition that caused retroperitoneal hemorrhage and hypovolemic shock during hemodialysis. PATIENT CONCERNS: A 72-year-old female patient who was receiving hemodialysis was referred to our emergency department because of general discomfort and decreased blood pressure (BP) after her regular hemodialysis. She had undergone surgery for a left forearm arteriovenous pseudoaneurysm and received a temporary hemodialysis catheter insertion via the left femoral vein 2 weeks before. The initial blood examination revealed a mildly decreased baseline hemoglobin level (7.2 g/dL) and hyperkalemia (5.9 mmol/L). Her BP recovered after fluid resuscitation. She was administered hemodialysis again, following which her BP reduced and a change in consciousness developed. DIAGNOSIS: Chest and abdominal computed tomographies were performed to exclude acute vascular problems and showed a hemodialysis catheter tip protruding from the left iliac vein and hematoma in the left retroperitoneal space and pelvic cavity. INTERVENTIONS: Intubation, fluid resuscitation, vasopressor administration, and blood transfusion were performed. She was admitted to the intensive care unit. The left femoral hemodialysis catheter was removed. OUTCOMES: Follow-up computed tomography revealed resolution of the retroperitoneal space hematoma. She was transferred to the ordinary ward 18 days later with a stable hemodynamic status. Unfortunately, she developed hospital-acquired pneumonia and arteriovenous shunt infection, and died from respiratory failure and sepsis on the 34th day in our hospital. LESSONS: Femoral double-lumen catheter malposition is rare and potentially fatal. Emergency physicians should be aware of situations wherein a patient's BP declines markedly soon after a hemodialysis initiation.


Assuntos
Hemorragia/etiologia , Diálise Renal/efeitos adversos , Choque/etiologia , Dispositivos de Acesso Vascular/efeitos adversos , Idoso , Transfusão de Sangue/métodos , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Falha de Equipamento , Feminino , Veia Femoral/lesões , Hidratação/métodos , Hemorragia/terapia , Humanos , Veia Ilíaca/lesões , Intubação Intratraqueal/métodos , Diálise Renal/instrumentação , Choque/terapia , Tomografia Computadorizada por Raios X
20.
Int J Artif Organs ; 42(4): 175-181, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30638104

RESUMO

PURPOSE:: Microaggregates have often been observed during hemodialysis and are clearly associated with complications of hemodialysis therapy. In this study, we aimed to clarify the effects of two polysulfone membranes, with different abilities to activate blood cells, on the formation of these microaggregates; we also investigated their molecular mechanisms. METHODS:: Human whole blood was circulated through a mini-module dialyzer using the membranes in vitro; platelet-neutrophil complexes in blood were determined by flow cytometry. Isolated human neutrophils were incubated with the membranes in plasma, in the presence or absence of platelets, followed by flow cytometric analysis of intracellular reactive oxygen species and cell-surface activated CD11b on neutrophils. RESULTS:: CX-U, a conventional polysulfone membrane with remarkable cell activation, induced the formation of platelet-neutrophil complexes; however, NV-U, a new hydrophilic polysulfone membrane with slight or no cell activation, did not cause complex formation. Moreover, CX-U-induced reactive oxygen species production and the increase in activated CD11b expression on neutrophils were enhanced by platelets. On the other hand, NV-U hardly affected neutrophil activation, regardless of whether platelets were present or not. The enhancement of CX-U-induced neutrophil activations by platelets was greatly inhibited by anti-CD62P antibody. CONCLUSION:: The ability of polysulfone membranes to activate blood cells is closely related to platelet-neutrophil interaction. Therefore, a biocompatible membrane, like NV-U, can be expected to prevent microaggregate formation during hemodialysis and avoid subsequent cell activation.


Assuntos
Membranas Artificiais , Ativação de Neutrófilo/efeitos dos fármacos , Ativação Plaquetária/efeitos dos fármacos , Polímeros/farmacologia , Diálise Renal , Sulfonas/farmacologia , Materiais Biocompatíveis/farmacologia , Plaquetas/efeitos dos fármacos , Plaquetas/fisiologia , Antígeno CD11b/análise , Comunicação Celular , Citometria de Fluxo/métodos , Humanos , Neutrófilos/efeitos dos fármacos , Neutrófilos/fisiologia , Selectina-P , Espécies Reativas de Oxigênio/análise , Diálise Renal/efeitos adversos , Diálise Renal/instrumentação , Diálise Renal/métodos , Propriedades de Superfície/efeitos dos fármacos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA