TY  - JOUR
T1  - Acil Hemodiyaliz Uygulanan Hastalarda Vasküler Erişim  Tercihleri: Tek Merkez Deneyimi /   Vascular Access Preferences in Patients Undergoing Emergency  Hemodialysis: A Single Center Experience
TT  - Vascular Access Preferences in Patients Undergoing Emergency  Hemodialysis: A Single Center Experience
AU  - Altındal, Filiz
AU  - Kayabaşı, Hasan
AU  - Şit, Dede
AU  - Ersoy Yeşil, Ezgi
AU  - Yılmaz, Funda
AU  - Kızılay, Yağmur
AU  - Karakoç, Ayten
PY  - 2021
DA  - May
DO  - 10.47565/ndthdt.2021.32
JF  - Nefroloji Hemşireliği Dergisi
JO  - NefroHemDergi
PB  - Türk Nefroloji, Diyaliz ve Transplantasyon Hemşireleri Derneği
WT  - DergiPark
SN  - 2147-7728
SP  - 54
EP  - 59
VL  - 16
IS  - 2
LA  - tr
AB  - Amaç: Hemodiyaliz (HD) üremik hastalarda yaşam kurtarıcı bir tedavi modelidir. Türkiye dahil birçok ülkede hastalar hemodiyalize başlangıçta santral venöz kateter tercih edilir. Etkin veyeterli bir HD için uygun bir vasküler erişim yöntemihemodiyaliz hastalarının tedavisinde en önemli bileşenlerindenbiridir. Bu çalışmada tek bir merkezin HD için vasküler erişimdeneyimi incelenmiştir.Gereç ve Yöntem: Araştırmanın yeri olarak seçilen merkezdeOcak 2016-Haziran 2018 tarihleri arasında çeşitli endikasyonlarla hemodiyalize alınan hastalar retrospektif olarak tarandı.Hastaların demografik özellikleri, HD’ye alınma endikasyonları,vasküler erişim yöntemi ve vasküler erişim yöntemini uygulayanklinisyenin uzmanlık alanı kaydedildi.Bulgular: 30 aylık sürede toplam 429 (kadın/erkek:178/251)olguya HD tedavisi uygulandı. Hastaların yaş ortalaması66,8±32,3 idi. Olguların %27,04’ünün akut böbrek hasarı vezehirlenmeler nedeniyle, %72,96’sının kronik böbrek hastalığıve ilişkili komplikasyonlar nedeniyle HD’e alındıkları saptandı.Hastaların %3,96’sında arteriyovenöz fistül (AVF),%96,04’ünde kateter ile HD işlemi gerçekleştiği görüldü. Geçicivasküler erişim tercihleri %66,9 femoral kateter, %25,6 jugulerkateter ve %3,49 subklaviyen kateter oranlarında idi. Jugulerkateter tercihinin çalışmanın ilk aylarına göre tedricen artışgösterdiği ve çoğunlukla (n:67 olgu %60,90) nefroloji uzmanıtarafından tercih edildiği görüldü.Sonuç: Bu çalışmada elde edilen sonuçların; literatürde önerilenvasküler erişim yöntemlerinden farklı olduğu saptanmıştır.Tercih edilen yöntemlerin kararının verilmesinde nefrolojiuzmanının önemli rol oynadığı görüldü. Hemodiyaliz hastalarında yaşamsal önem taşıyan vasküler erişim yolunun doğruseçilmesi için gerekli farkındalığın sağlanması en önemliönlemlerden olacaktır.
KW  - Arteriyovenöz fistül
KW  - Hemodiyaliz
KW  - Vasküler erişim
KW  - Kateterizasyon
N2  - Objective: Hemodialysis (HD) is a life-saving treatment modality in uremic patients. In many countries, including Turkey, a central venous catheter is preferred at the beginning of hemodialysis. A suitable vascular access method for an effective and adequate HD is one of the most important components in the treatment of hemodialysis patients. In this study, a single center's experience of vascular access for HD has been examined. Materials and Methods: Patients who underwent hemodialysis for various indications between January 2016 and June 2018 in the center chosen as the location of the study were retrospectively scanned. Demographic characteristics of the patients, indications for HD admission, vascular access method, and the specialty of the clinician who applied the vascular access method have been recorded. Results: HD treatment was applied to a total of 429 (female/male:178/251) cases over a 30-month period. The mean age of the patients was 66.8±32.3. It was determined that 27.04% of the cases were taken to HD due to acute kidney injury and poisoning, 72.96% of them due to chronic kidney disease and related complications. Arteriovenous fistula (AVF) in 3.96% of the patients and it was observed HD procedure was performed with a catheter in 96.04% of them. Temporary vascular access preferences were 66.9% femoral catheter, 25.6% jugular catheter, and 3.49% subclavian catheter. It was observed that the jugular catheter preference increased gradually compared to the first months of the study and was mostly preferred by the nephrology specialist (n:67 cases 60.90%). Conclusion: The results obtained in this study were found to be different from the vascular access methods recommended in the literature. It was seen that the nephrology specialist played an important role in the decision of the preferred methods. Providing the necessary awareness for the correct selection of the vital vascular access route in hemodialysis patients will be one of the most important measures.
CR  - 1. Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Abreo K, Allon M, Asif A, Astor BC, Glickman MH, Graham J, Moist LM,
Rajan DK, Roberts C, Vachharajani TJ, Valentini RP; National Kidney Foundation. KDOQI Clinical Practice Guideline for
Vascular Access: 2019 Update. Am J Kidney Dis. 2020 Apr;75(4 Suppl 2):S1-S164.
CR  - 2. Allon M. Vascular Access for Hemodialysis Patients: New Data Should Guide Decision Making. Clin J Am Soc Nephrol. 2019
Jun 7;14(6):954-61.
CR  - 3. Hayashi R, Huang E, Nissenson AR. Vascular Access for hemodialysis. Nat Clin Pract Nephrol. 2006;2(9):504-13.
CR  - 4. Woo K, Lok CE. New insights into dialysis vascular access: What is the optimal vascular access type and timing of access
creation in CKD and dialysis patients? Clin J Am Soc Nephrol. 2016 ;11(8):1487-94.
CR  - 5. Sequeira A, Naljayan M, Vachharajani TJ. Vascular access guidelines: summary, rationale, and controversies. Tech Vasc Interv
Radiol. 2017;20(1):2-8.
CR  - 6. Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease: A position statement from
Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2005; 67: 2089-100.
CR  - 7. Süleymanlar G, Utaş C, Arınsoy T, et al. A population based survey of chronic renal disease in Turkey - The CREDIT study.
Nephrol Dial Transplant 2011; 26: 1862-71.
CR  - 8. Süleymanlar G, Ateş K, Seyahi N. Türkiye’de Nefroloji, Diyaliz ve Transplantasyon – Registry 2019. Türk Nefroloji Derneği
Yayınları, Ankara, 2020. ISBN 978-605–62465–0–0.
CR  - 9. Tordoir J, Canaud B, Haage P, et al: European best practice guidelines on haemodialysis (EBPG) on Vascular Access. Nephrol
Dial Transplant 2007; 22 [Suppl 2]:ii88-117.
CR  - 10. Ravani P, Gillespie BW, Quinn RR, et al. Temporal risk profile for infectious and noninfectious complications of hemodialysis
access. J Am Soc Nephrol. 2013; 24(10):1668-77.
CR  - 11. Aydın Z, Öztürk S. Gürsu M. Uzun S, Karadağ S, Tayfur F. Çoban T. Kazancıoğlu R. hemodiyaliz hastalarında damar giriş
yolu olarak kateter kullanımı: Tek merkez deneyimi. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi 2010;19(1):46-51.
CR  - 12. Al-Balas A, Lee T, Young CJ, Kepes JA, Barker-Finkel J, Allon M. The clinical and economic effect of vascular access selection
in patients initiating hemodialysis with a catheter. J Am Soc Nephrol. 2017;28(12):3679-87.
CR  - 13. Rayner HC, Besarab A, Brown WW, Disney A, Saito A, Pisoni RL:Vascular access results from the Dialysis Outcomes and
Practice Patterns Study (DOPPS): Performance against Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice
guidelines. Am J Kidney Dis 2004; 44: 22–6.
CR  - 14. Miguel SS, Chow J. Vascular dialysis Access flow measurement: early intervention through early detection. J Ren Care
2009;35(4):185-91.
CR  - 15. Kelly YP, Mendu ML. Vascular access for renal replacement therapy in acute kidney injury: Are nontunneled catheters the right
choice? Semin Dial. 2019;32(5):406-10.
CR  - 16. Coryell L, Lott JP, Stavropoulos SW, et al. The case for primary placement of tunneled hemodialysis catheters in acute kidney
injury. J Vasc Interv Radiol. 2009;20(12):1578-81.
CR  - 17. Ozmen S, Kadiroglu AK, Ozmen CA, Danis R, Sit D, Akin D, Yilmaz ME. Does the direction of arterial needle in AV fistula
cannulation affect dialysis adequacy? Clin Nephrol. 2008;70(3):229-32.
CR  - 18. Harwood L, Wilson B, Goodman M. Cannulation outcomes of the arteriovenous fistula for hemodialysis: A Scoping review.
Nephrol Nurs J. 2017;44(5):411-25.
CR  - 19. Wilson B, Harwood L. Outcomes for successful cannulation of the arteriovenous fistula: perspectives from patients on
hemodialysis. Nephrol Nurs J. 2017;44(5):381-8.
CR  - 20. Allon M, Brouwer-Maier DJ, Abreo K, et al. Recommended clinical trial end points for dialysis catheters. Clin J Am Soc
Nephrol. 2018;13(3):495-500.
CR  - 21. Almasri J, Alsawas M, Mainou M, et al. Outcomes of vascular access for hemodialysis: A systematic review and meta-analysis.
J Vasc Surg. 2016;64(1):236-43.
CR  - 22. Ravani P, Quinn R, Oliver M, et al. Examining the association between hemodialysis access type and mortality: The role of
access complications. Clin J Am Soc Nephrol. 2017;12(6):955-64.
CR  - 23. Murea M, Geary RL, Davis RP, Moossavi S. Vascular access for hemodialysis: A perpetual challenge. Semin Dial.
2019;32(6):527-34.
UR  - https://doi.org/10.47565/ndthdt.2021.32
L1  - https://dergipark.org.tr/tr/download/article-file/1488397
ER  -