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Is heparin and antibiotic use necessary or not necessary during av fistula creation?

Year 2022, Volume: 13 Issue: 1, 42 - 46, 26.03.2022
https://doi.org/10.18663/tjcl.1025705

Abstract

Aim: The necessity of heparin and antibiotics for prevention from infection and early thrombosis in vascular access attempts for hemodialysis is still under discussion. In this article, we investigate this requirement by comparing two different notions retrospectively.
Material and Methods: In this paper, we investigated all Arteriovenous (AV) fistula operations for hemodialysis between 2015-2019. While 242 of 456 patients did not have any premedication, the other 214 patients received 80-100 mg / kg heparin and 1 gr cefazolin iv before the procedure, and they completed antibiotic treatment for 1 week after discharge. We compared the differences of these two different methods in terms of infection and thrombosis.
Results: Compared the premedication group using heparin and antibiotics with the control group, fistula locations are similar in terms of localization. There was no difference between the groups in terms of comorbid diseases and demographical data. The hematoma rates detected high at premedication group despite of not statistically significant (2%, 0.9%, p = 0.45). There is no significant difference in terms of early patency rates and fistula reaching dialysis in 3 months. No fistula infection was observed in both groups.
Conclusion: As premedication, heparin and antibiotics does not contribute to the prevention of infection nor early thrombosis in vascular access interventions. AV fistül creation can be performed safely without any antibiotics and heparin.

References

  • 1. Zhang QL, Rothenbacher D. Prevalence of chronic kidney disease in population-based studies: systematic review. BMC Public Health. 2008;8:117.
  • 2. Xi W, Harwood L, Diamant MJ, Brown JB, Gallo K, Sontrop JM, et al. Patient attitudes towards the arteriovenous fistula: a qualitative study on vascular access decision making. Nephrol Dial Transplant. 2011;26(10):3302-8.
  • 3. Schmidli J, Widmer MK, Basile C, de Donato G, Gallieni M, Gibbons CP, et al. Editor's Choice - Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(6):757-818.
  • 4. Schinstock CA, Albright RC, Williams AW, Dillon JJ, Bergstralh EJ, Jenson BM, et al. Outcomes of arteriovenous fistula creation after the Fistula First Initiative. Clin J Am Soc Nephrol. 2011;6(8):1996-2002.
  • 5. Bhomi KK, Shrestha S, Bhattachan CL. Role of systemic anticoagulation in patients undergoing vascular access surgery. Nepal Med Coll J. 2008;10(4):222-4.
  • 6. Wang BR, Rowe VL, Ham SW, Han S, Patel K, Weaver FA, et al. A prospective clinical evaluation of the effects of intraoperative systemic anticoagulation in patients undergoing arteriovenous fistula surgery. Am Surg. 2010;76(10):1112-4.
  • 7. Ravari H KG, Sarookhani A, Khashayar P. EFFECT OF HEPARIN ON THE PATENCY OF ARTERIOVENOUS FISTULA. Acta Med Iran. 1;46(5):379-382.
  • 8. Farber A, Imrey PB, Huber TS, Kaufman JM, Kraiss LW, Larive B, et al. Multiple preoperative and intraoperative factors predict early fistula thrombosis in the Hemodialysis Fistula Maturation Study. J Vasc Surg. 2016;63(1):163-70 e6.
  • 9. Stewart AH, Eyers PS, Earnshaw JJ. Prevention of infection in peripheral arterial reconstruction: a systematic review and meta-analysis. J Vasc Surg. 2007;46(1):148-55.
  • 10. Guideline for prevention of surgical site infection. Bull Am Coll Surg. 2000;85(7):23-9.
  • 11. Bergamini TM, Polk HC, Jr. The importance of tissue antibiotic activity in the prevention of operative wound infection. J Antimicrob Chemother. 1989;23(3):301-13.
  • 12. Trerotola SO. KDOQI Clinical Practice Guideline for Vascular Access 2019 Update: Kinder, Gentler, and More Important Than Ever. J Vasc Interv Radiol. 2020;31(7):1156-7.
  • 13. Konner K. History of vascular access for haemodialysis. Nephrol Dial Transplant. 2005;20(12):2629-35.
  • 14. Tümer NB, Tekeli Kunt, A. , Günertem, O. E. , Babaroğlu, S. , Budak, A. B. , Karahasanoğlu, O. , Günaydın, S. , Özışık, K. Treatment for venous aneurysm: A salvage technique of AVF with an early cannulation prosthetic graft. Turkish Journal of Clinics and Laboratory. 2019 10(1): 74-78.
  • 15. Ocak G, Rookmaaker MB, Algra A, de Borst GJ, Doevendans PA, Kappelle LJ, et al. Chronic kidney disease and bleeding risk in patients at high cardiovascular risk: a cohort study. J Thromb Haemost. 2018;16(1):65-73.
  • 16. Gray K, Korn A, Zane J, Alipour H, Kaji A, Bowens N, et al. Preoperative Antibiotics for Dialysis Access Surgery: Are They Necessary? Ann Vasc Surg. 2018;49:277-80.

AV fistül oluşturulması sırasında heparin ve antibiyotik kullanımı gerekli mi değil mi?

Year 2022, Volume: 13 Issue: 1, 42 - 46, 26.03.2022
https://doi.org/10.18663/tjcl.1025705

Abstract

Amaç: Hemodiyaliz amaçlı Arteriovenöz (AV) fistül oluşturulmasında enfeksiyon ve erken trombozdan korunmak için heparin ve antibiyotiklerin preoperatif kulanım gerekliliği halen tartışılmaktadır. Bu yazıda, iki farklı nosyon retrospektif olarak karşılaştırıp bu gerekliliği tartışmaktayız.
Gereç ve Yöntemler:2015-2020 yılları arasında hemodiyaliz amaçlı tüm AV fistül ameliyatlarını inceledik. 456 hastanın 242'sine herhangi bir premedikasyon uygulanmazken, diğer 214 hastaya işlem öncesi 80-100 mg/kg heparin ve 1 gr sefazolin iv verildi ve taburcu olduktan sonra antibiyotik tedavisi 1 haftaya tamamlandı. Bu iki farklı yöntemin enfeksiyon ve erken dönem açıklık oranlarını karşılaştırdık.
Bulgular: Ön kol AV fistül oluşturulan hastalar heparin ve antibiyotik kullanan premedikasyon grubu ile kontrol grubu olarak gruplandırıldı. Gruplar arasında komorbit hastalıklar ve demografik veriler açısından fark yoktu. İstatistiksel olarak anlamlı olmasa da premedikasyon grubunda hematom oranları yüksek saptandı (%2, %0,9, p=0,45). Postoperatif ilk kontrolde erken açık kalma oranları ve 3 ayda diyalize ulaşan fistül oranları açısından anlamlı bir fark yoktu. Her iki grupta da fistül enfeksiyonu gözlenmedi.
Sonuç: Premedikasyon olarak heparin ve antibiyotikler damar yolu girişimlerinde enfeksiyonun önlenmesine veya erken trombozu önlenmesine katkı sağlamamaktadır. AV fistül oluşturma herhangi bir antibiyotik ve heparin olmadan güvenle yapılabilir.

References

  • 1. Zhang QL, Rothenbacher D. Prevalence of chronic kidney disease in population-based studies: systematic review. BMC Public Health. 2008;8:117.
  • 2. Xi W, Harwood L, Diamant MJ, Brown JB, Gallo K, Sontrop JM, et al. Patient attitudes towards the arteriovenous fistula: a qualitative study on vascular access decision making. Nephrol Dial Transplant. 2011;26(10):3302-8.
  • 3. Schmidli J, Widmer MK, Basile C, de Donato G, Gallieni M, Gibbons CP, et al. Editor's Choice - Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(6):757-818.
  • 4. Schinstock CA, Albright RC, Williams AW, Dillon JJ, Bergstralh EJ, Jenson BM, et al. Outcomes of arteriovenous fistula creation after the Fistula First Initiative. Clin J Am Soc Nephrol. 2011;6(8):1996-2002.
  • 5. Bhomi KK, Shrestha S, Bhattachan CL. Role of systemic anticoagulation in patients undergoing vascular access surgery. Nepal Med Coll J. 2008;10(4):222-4.
  • 6. Wang BR, Rowe VL, Ham SW, Han S, Patel K, Weaver FA, et al. A prospective clinical evaluation of the effects of intraoperative systemic anticoagulation in patients undergoing arteriovenous fistula surgery. Am Surg. 2010;76(10):1112-4.
  • 7. Ravari H KG, Sarookhani A, Khashayar P. EFFECT OF HEPARIN ON THE PATENCY OF ARTERIOVENOUS FISTULA. Acta Med Iran. 1;46(5):379-382.
  • 8. Farber A, Imrey PB, Huber TS, Kaufman JM, Kraiss LW, Larive B, et al. Multiple preoperative and intraoperative factors predict early fistula thrombosis in the Hemodialysis Fistula Maturation Study. J Vasc Surg. 2016;63(1):163-70 e6.
  • 9. Stewart AH, Eyers PS, Earnshaw JJ. Prevention of infection in peripheral arterial reconstruction: a systematic review and meta-analysis. J Vasc Surg. 2007;46(1):148-55.
  • 10. Guideline for prevention of surgical site infection. Bull Am Coll Surg. 2000;85(7):23-9.
  • 11. Bergamini TM, Polk HC, Jr. The importance of tissue antibiotic activity in the prevention of operative wound infection. J Antimicrob Chemother. 1989;23(3):301-13.
  • 12. Trerotola SO. KDOQI Clinical Practice Guideline for Vascular Access 2019 Update: Kinder, Gentler, and More Important Than Ever. J Vasc Interv Radiol. 2020;31(7):1156-7.
  • 13. Konner K. History of vascular access for haemodialysis. Nephrol Dial Transplant. 2005;20(12):2629-35.
  • 14. Tümer NB, Tekeli Kunt, A. , Günertem, O. E. , Babaroğlu, S. , Budak, A. B. , Karahasanoğlu, O. , Günaydın, S. , Özışık, K. Treatment for venous aneurysm: A salvage technique of AVF with an early cannulation prosthetic graft. Turkish Journal of Clinics and Laboratory. 2019 10(1): 74-78.
  • 15. Ocak G, Rookmaaker MB, Algra A, de Borst GJ, Doevendans PA, Kappelle LJ, et al. Chronic kidney disease and bleeding risk in patients at high cardiovascular risk: a cohort study. J Thromb Haemost. 2018;16(1):65-73.
  • 16. Gray K, Korn A, Zane J, Alipour H, Kaji A, Bowens N, et al. Preoperative Antibiotics for Dialysis Access Surgery: Are They Necessary? Ann Vasc Surg. 2018;49:277-80.
There are 16 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Orıgınal Artıcle
Authors

Ferit Kasimzade 0000-0003-3646-3181

Gokay Denız 0000-0002-0110-5045

Bahadır Aytekin

Publication Date March 26, 2022
Published in Issue Year 2022 Volume: 13 Issue: 1

Cite

APA Kasimzade, F., Denız, G., & Aytekin, B. (2022). AV fistül oluşturulması sırasında heparin ve antibiyotik kullanımı gerekli mi değil mi?. Turkish Journal of Clinics and Laboratory, 13(1), 42-46. https://doi.org/10.18663/tjcl.1025705
AMA Kasimzade F, Denız G, Aytekin B. AV fistül oluşturulması sırasında heparin ve antibiyotik kullanımı gerekli mi değil mi?. TJCL. March 2022;13(1):42-46. doi:10.18663/tjcl.1025705
Chicago Kasimzade, Ferit, Gokay Denız, and Bahadır Aytekin. “AV fistül oluşturulması sırasında Heparin Ve Antibiyotik kullanımı Gerekli Mi değil Mi?”. Turkish Journal of Clinics and Laboratory 13, no. 1 (March 2022): 42-46. https://doi.org/10.18663/tjcl.1025705.
EndNote Kasimzade F, Denız G, Aytekin B (March 1, 2022) AV fistül oluşturulması sırasında heparin ve antibiyotik kullanımı gerekli mi değil mi?. Turkish Journal of Clinics and Laboratory 13 1 42–46.
IEEE F. Kasimzade, G. Denız, and B. Aytekin, “AV fistül oluşturulması sırasında heparin ve antibiyotik kullanımı gerekli mi değil mi?”, TJCL, vol. 13, no. 1, pp. 42–46, 2022, doi: 10.18663/tjcl.1025705.
ISNAD Kasimzade, Ferit et al. “AV fistül oluşturulması sırasında Heparin Ve Antibiyotik kullanımı Gerekli Mi değil Mi?”. Turkish Journal of Clinics and Laboratory 13/1 (March 2022), 42-46. https://doi.org/10.18663/tjcl.1025705.
JAMA Kasimzade F, Denız G, Aytekin B. AV fistül oluşturulması sırasında heparin ve antibiyotik kullanımı gerekli mi değil mi?. TJCL. 2022;13:42–46.
MLA Kasimzade, Ferit et al. “AV fistül oluşturulması sırasında Heparin Ve Antibiyotik kullanımı Gerekli Mi değil Mi?”. Turkish Journal of Clinics and Laboratory, vol. 13, no. 1, 2022, pp. 42-46, doi:10.18663/tjcl.1025705.
Vancouver Kasimzade F, Denız G, Aytekin B. AV fistül oluşturulması sırasında heparin ve antibiyotik kullanımı gerekli mi değil mi?. TJCL. 2022;13(1):42-6.


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