Purse-string suture to prevent bleeding after tunneled dialysis catheter insertion.

PURPOSE: To determine whether placing a purse-string suture at the tunnel exit site at the time of tunneled dialysis catheter (TDC) insertion will decrease postprocedural bleeding. MATERIALS AND METHODS: In a retrospective single-center, single-operator study, 51 patients in the control group had TDCs inserted without purse-string sutures at the tunnel exit site and 50 patients in the experimental group had TDCs inserted with purse-string sutures at the tunnel exit site. The patients' charts were evaluated for postprocedural progress notes describing bleeding, plasma hemoglobin levels before and after catheter insertion, and transfusion of packed red blood cells in the first 5 days after catheter insertion. RESULTS: Thirteen patients in the control group (25.4%) and three patients in the experimental group (6%) had postprocedural chart notes describing bleeding. The difference between the two groups was highly significant (P = .0124). Six percent of patients in the control group and none of the patients in the experimental group required prolonged compression or compression dressing placement after catheter insertion. There was a significant mean hemoglobin decrease of 0.3 g/dL after catheter insertion in the control group and an insignificant mean hemoglobin decrease of 0.1 g/dL in the experimental group. The difference in hemoglobin decrease between the two groups was not significant. The difference in the number of patients requiring transfusion in the 5 days after catheter insertion (eight of 51 vs nine of 50) was not significant. CONCLUSIONS: Venous bleeding after TDC insertion is a complication that merits attention. Routine purse-string suture placement at the tunnel exit site is a minor change in standard technique that can nearly eliminate this problem, as reflected in postprocedural chart notes.

Adherence to highly active antiretroviral treatment in HIV-infected Rwandan women.

BACKGROUND: Scale-up of highly active antiretroviral treatment therapy (HAART) programs in Rwanda has been highly successful but data on adherence is limited. We examined HAART adherence in a large cohort of HIV+ Rwandan women. METHODS: The Rwanda Women's Interassociation Study Assessment (RWISA) was a prospective cohort study that assessed effectiveness and toxicity of ART. We analyzed patient data 12±3 months after HAART initiation to determine adherence rates in HIV+ women who had initiated HAART. RESULTS: Of the 710 HIV+ women at baseline, 490 (87.2%) initiated HAART. Of these, 6 (1.2%) died within 12 months, 15 others (3.0%) discontinued the study and 80 others (19.0%) remained in RWISA but did not have a post-HAART initiation visit that fell within the 12±3 month time points leaving 389 subjects for analysis. Of these 389, 15 women stopped their medications without being advised to do so by their doctors. Of the remaining 374 persons who reported current HAART use 354 completed the adherence assessment. All women, 354/354, reported 100% adherence to HAART at the post-HAART visit. The high self-reported level of adherence is supported by changes in laboratory measures that are influenced by HAART. The median (interquartile range) CD4 cell count measured within 6 months prior to HAART initiation was 185 (128, 253) compared to 264 (182, 380) cells/mm(3) at the post-HAART visit. Similarly, the median (interquartile range) MCV within 6 months prior to HAART initiation was 88 (83, 93) fL compared to 104 (98, 110) fL at the 12±3 month visit. CONCLUSION: Self-reported adherence to antiretroviral treatment 12±3 months after initiating therapy was 100% in this cohort of HIV-infected Rwandan women. Future studies should explore country-specific factors that may be contributing to high levels of adherence to HAART in this population.