Abstract: The VenaTrac is a new device designed to be used during exchange and primary placement of chronic tunneled hemodialysis catheters over a wire. It occludes both lumens of the catheter for the purpose of reducing the risk of air embolism and blood loss. A retrospective review of 171 chronic hemodialysis dialysis catheters placed using the VenaTrac device was made. Hundred twenty four procedures were catheter exchanges over a wire and 47 were primary placement without peel-away sheath. 145 catheters (85%) were inserted from right internal jugular vein approach and 26 (15%) from left internal jugular vein. In one case primary placement over the wire failed and conversion to a peel-away sheath was needed. No insertion complications using the VenaTrac were encountered. Specifically, no air embolism was seen. During the study period 5 cases of air emboli were documented during catheter exchanges without the use of VenaTrac. VenaTrac over-the-wire insertion device demonstrated safe and reliable use with no incidence of air embolism.
Introduction:
Insertion of tunneled hemodialysis catheters is a common procedure performed in the interventional suite or the operating room. Insertion can be done either with a peel apart introducer sheath or over the wire. Because of frequent incidence of air embolism during insertion using regular peel-away sheath, valved peel-away sheaths were developed which have shown to greatly reduce air embolism (Kolbeck, et al., 2005).
Over the wire insertion technique has advantages of reducing air embolism and excessive blood loss. During the insertion procedure the introducer sheath serves as an open conduit between the superior vena cava and the atmospheric air. Because of the negative pressu...
... middle of paper ...
...MG. 'Comparison of Recirculation Percentage of the Palindrome Catheter and Standard Hemodialysis Catheters in a Swine Model.', J Vasc Interv Radiol Vol. 16, No. 9, 1237-40, 2005.
Vesely, TM. 'Air Embolism During Insertion of Central Venous Catheters.', J Vasc Interv Radiol Vol. 12, No. 11, 1291-5, 2001.
Vesely, TM, AG Fazzaro, and D Gherardini. 'Preliminary Evaluation of a Valved Introducer Sheath for the Insertion of Tunneled Hemodialysis Catheters.', Semin Dial Vol. 17, No. 1, 65-8.
Worthington-Kirsch, RL. 'Modified Monorail Technique for Insertion of Tunneled Hemodialysis Catheters.', J Vasc Interv Radiol Vol. 15, No. 3, 303-4, 2004.
Wysoki, MG, A Covey, J Pollak, M Rosenblatt, J Aruny, and N Denbow. 'Evaluation of Various Maneuvers for Prevention of Air Embolism During Central Venous Catheter Placement.', J Vasc Interv Radiol Vol. 12, No. 6, 764-6, 2001.
Transcatheter aortic valve replacement or TAVR is the latest technology used principally for the treatment of aortic stenosis, a condition in which one of the major valves of the heart, the aortic valve, becomes tight and stiff, usually as a result of aging (3). Since many patients who need aortic valve replacement for aortic stenosis are too sick to undergo major valve replacement surgery, they are unable to get the treatment they need. With the transcatheter aortic valve, this issue is bypassed because this valve can be implanted in the heart by accessing the patient’s heart through an artery in the groin. The valve can be inserted through a wire that can be pushed to the heart, and the old valve is simply pushed to the side when the new valve is implanted. This technology has been in use in the US with Edwards’ Sapiens valve since 2011 and has saved the lives of many patients with aortic stenosis (4).
Hemodialysis is the process of blood that is transported outside the body to a dialysis machine where it is cleaned of waste products and returned to the circulatory system. It is a lifetime requirement. As a result, of the repeated and life-long needle puncture of the involved blood vessels, thick scar tissue eventually develops which makes the procedure difficult and painful. To avoid this complication, a surgical procedure known as an arteriovenous fistula is performed. It produces a large vein that can be entered safely and easily with large needles for the three times a week procedure. New techniques are intended to improve the efficiency of dialysis and thereby increases life expectancy, as 20% of people with end-stage renal disease die annually. Peritoneal Dialysis. Peritoneum is the lining of the abdominal cavity. The tissue has the properties of a semi-permeable membrane, allowing the process of diffusion to take place in abdominal cavity. An incision is made through the anterior abdominal muscle wall; through this opening, a tube (catheter) is inserted into the abdominal space. Sterile dialysate (a solution to clear waste products) is introduced and allowed to remain in the cavity four to six hours or overnight. During this time, through the process of diffusion, impurities pass through the peritoneum into the dialysate. The dialysate and its collected impurities are then eliminated from the body. Kidney transplantation when possible, is the best alternative for end stage renal disease. Often, the body rejects the kidney and when this occurs the recipient must undergo a medication regimen to suppress the immune system. Relatives are recommended to donate their liver so that the body has a smaller chance to reject the kidney. I comparison with dialysis kidney transplantation has advantages that positively affect the person’s medical and vocational rehabilitation potential. The person with the
Then after threading a catheter through the needle, the anesthesiologist will withdraw the needle and leave the catheter i...
26-Noble S, Asgar A, Cartier R, Virmani R, Bonan R. Anatomopathological analysis after CoreValve ReValving system implantation.EuroIntervention 2009;5:78–85.
Ms. Bardsley functions as a hemodialysis liaison and leader in clinical practice with the following roles: charge nurse, preceptor, and mentor for her colleagues. She is the resource person for the Hct-Line monitoring tool. The tool is used to monitor patient’s fluid removal during treatment to avoid hypotensive episodes associated with decreased perfusion to the heart. She routinely monitors the patient outcomes which to date has resulted in 0 admissions. She recently updated the policy to make it more user friendly for the staff and to maintain staff competency.
First, you must obtain all of the necessary supplies: gloves, alcohol or Betadine preps, a tourniquet, tape, an appropriately sized IV catheter, a bag of IV solution, the IV tubing, and gauze pads. While obtaining the supplies, you should inform the patient that IV catheter placement is necessary, and why. Do not lie to the patient and tell him or her that it is a painless procedure. Instead, be honest with them and explain that the initial puncture feels like a sharp pinch on the skin and that the pain and discomfort associated with the IV placement is only temporary. You may find it helpful to demonstrate to the patient the amount of pain to expect by pinching the skin on the back of their hand. This is especially helpful for younger patients or patients who are more concrete in their thinking.
After further multidisciplinary team meetings with the involvement of John the treatment option of automated peritoneal dialysis was implemented (NSF 2004). Once the Tenchkoff catheter had been inserted, education and training completed John was ready for discharge home.
Currently there are two types of renal replacement therapy. The original dialysis which we called it hemodialysis used for patients with chronic renal failure, needs the patients to come to hospital 2-3 times per week. This type of dialysis called the intermittent hemodialysis .However the intermittent hemodialysis is difficult to do it in the intensive care population with acute renal failure because of the hemodynamic instability and those type of patients usually are the most sick and critically ill patients within the intensive care units and have multiorgan dysfunctions, so medically is too difficult to do for them intermittent hemodialysis. In addition intermittent hemodialysis will increase the mortality and morbidity among them. Within the modern intensive care units new way of dialysis has been developed 30 years ago called continuous renal replacement therapy (CRRT).The definition of (CRRT) is any extracorporeal blood purification therapy intended to substitute for impaired renal function over an extended period of time and applied for or aimed at being applied for 24 hours/day, Bellomo R., Ronco., Mehata R. The CRRT was found because the traditional way of ...
United States Renal Data System (USRDS). (2008). Annual data report: Incidence and prevalence. Retrieved July 8, 2009, from http://www.usrds.org/2008/pdf/V2-02-2008.pdf
Before your first treatment, an access to your bloodstream must be made. The access provides a way for blood to be carried from your body to the dialysis machine and then back into your body. The access can be internal (inside the body -- usually under your skin) or external (outside the body).
I was able to change central line sterile dressing and hung IV normal saline my preceptor gave me a good complement. In lab we practice IV and helped me to perform with confidence. I helped with monthly recapping.
The cavity is the space surrounding the intestines and internal organs, such as the stomach. The PD catheter is inserted surgically below the belly button to allow fluid to be instilled into the peritoneal cavity, thereby allowing diffusion to occur naturally between the capillaries in the peritoneal lining and the fluid, which is called a dialysate.... ... middle of paper ... ... HD patients are aware of the risk of access infections, but tend to rely on the clinic nurse to recognize and treat the infection.
Ottawa Hospital Research Institute. (2010). Outcomes of saddle pulmonary embolism: a nested case-control study. International Society on Thrombosis and Hemostasis, 867-869.
After almost one hour of “tube procedure connections”, I got up to go to the restroom with an IV pole following my s...
One day, this writer happened to see another nurse changing a Peripherally Inserted Central Catheter Line dressing. As a nurse leader, this writer asked the nurse why she is changing the dressing. The caregiver explained dressing changes can prevent infection to the site and there are lot of patients readmitted because of central line infections and subsequent complications. This nurse demonstrated good kn...