Acil Hemodiyaliz Uygulanan Hastalarda Vasküler Erişim Tercihleri: Tek Merkez Deneyimi / Vascular Access Preferences in Patients Undergoing Emergency Hemodialysis: A Single Center Experience

Yıl 2021, Cilt: 16 Sayı: 2, 54 - 59, 31.05.2021

Filiz Altındal , Hasan Kayabaşı Dede Şit , Ezgi Ersoy Yeşil Funda Yılmaz Yağmur Kızılay Ayten Karakoç

https://doi.org/10.47565/ndthdt.2021.32

Öz

Amaç: Hemodiyaliz (HD) üremik hastalarda yaşam kurtarıcı bir tedavi modelidir. Türkiye dahil birçok ülkede hastalar hemodiyalize başlangıçta santral venöz kateter tercih edilir. Etkin ve

yeterli bir HD için uygun bir vasküler erişim yöntemi hemodiyaliz hastalarının tedavisinde en önemli bileşenlerinden biridir. Bu çalışmada tek bir merkezin HD için vasküler erişim
deneyimi incelenmiştir.
Gereç ve Yöntem: Araştırmanın yeri olarak seçilen merkezde Ocak 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 uygulayan klinisyenin uzmanlık alanı kaydedildi.
Bulgular: 30 aylık sürede toplam 429 (kadın/erkek:178/251) olguya HD tedavisi uygulandı. Hastaların yaş ortalaması 66,8±32,3 idi. Olguların %27,04’ünün akut böbrek hasarı ve
zehirlenmeler nedeniyle, %72,96’sının kronik böbrek hastalığı ve ilişkili komplikasyonlar nedeniyle HD’e alındıkları saptandı.Hastaların %3,96’sında arteriyovenöz fistül (AVF),
%96,04’ünde kateter ile HD işlemi gerçekleştiği görüldü. Geçici vasküler erişim tercihleri %66,9 femoral kateter, %25,6 juguler kateter ve %3,49 subklaviyen kateter oranlarında idi. Juguler
kateter tercihinin çalışmanın ilk aylarına göre tedricen artış gösterdiği ve çoğunlukla (n:67 olgu %60,90) nefroloji uzmanı tarafından tercih edildiği görüldü.
Sonuç: Bu çalışmada elde edilen sonuçların; literatürde önerilen vasküler erişim yöntemlerinden farklı olduğu saptanmıştır. Tercih edilen yöntemlerin kararının verilmesinde nefroloji
uzmanının önemli rol oynadığı görüldü. Hemodiyaliz hastalarında yaşamsal önem taşıyan vasküler erişim yolunun doğru seçilmesi için gerekli farkındalığın sağlanması en önemli
önlemlerden olacaktır.

Anahtar Kelimeler

Arteriyovenöz fistül, Hemodiyaliz, Vasküler erişim, Kateterizasyon

Destekleyen Kurum

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Proje Numarası

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Teşekkür

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Vascular Access Preferences in Patients Undergoing Emergency Hemodialysis: A Single Center Experience

Öz

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.

Anahtar Kelimeler

Hemodialysis, vascular access, catheterization, arteriovenous fistula

Proje Numarası

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Kaynakça

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