Hemodialysis vascular access: everything you always wanted to know about it (but were afraid to ask)

Torreggiani, Massimo; Scaramuzzi, Maria Lucia; Manini, Alessandra; Castoldi, Francesca; Serpieri, Nicoletta; Maggi, N; Sileno, Giuseppe; Migotto, C.; Esposito, Vittoria; Montagna, Francesca; Esposito, Ciro

doi:10.5301/jn.5000209

Cited by 14 publications

(13 citation statements)

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“…Approaches that depend on eluting bactericidal agents have many drawbacks, namely the limitation of the amount loaded, difficulty in controlling the release rate and the concentration of the released agents during the application period [21,22]. In particular, antiseptics and antibiotics can induce bacteria resistance as a consequence of their prolonged use [23] and loose efficiency along time due to leaching [8]. Therefore, permanent modification of the catheter surface with antimicrobial properties is the ideal solution, aiming preventive strategies that act at the frontline by avoiding bacteria adhesion, colonization and consequent biofilm formation.…”

Section: Introductionmentioning

confidence: 99%

Exposure of Smaller and Oxidized Graphene on Polyurethane Surface Improves its Antimicrobial Performance

et al. 2020

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Catheter-related infections are a common worldwide health problem, highlighting the need for antimicrobial catheters. Here, antibacterial potential of graphene nanoplatelets (GNP) incorporated in the commonly used polymer for catheter manufacture—polyurethane (PU)—is investigated. Two strategies are explored: melt-blending, producing a composite, and dip coating, where a composite layer is deposited on top of PU. GNP with different lateral sizes and oxidation degrees—GNP-M5, GNP-M15, GNP-M5ox, GNP-M15ox—are applied in both strategies, and the antimicrobial potential towards Staphylococcus epidermidis of GNP dispersions and GNP-containing PU evaluated. As dispersions, oxidized and smaller GNP powders (GNP-M5ox) inhibit 74% bacteria growth at 128 µg/mL. As surfaces, GNP exposure strongly impacts their antimicrobial profile: GNP absence at the surface of composites yields no significant effects on bacteria, while by varying GNP: PU ratio and GNP concentration, coatings enhance GNP exposure, depicting an antimicrobial profile. Oxidized GNP-containing coatings induce higher antibacterial effect than non-oxidized forms, particularly with smaller GNPox, where a homogeneous layer of fused platelets is formed on PU, leading to 70% reduction in bacterial adhesion and 70% bacterial death. This pioneering work unravels how to turn a polymer clinically used to produce catheters into an antimicrobial surface, crucial to reducing risk of infection associated with catheterization.

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Section: Introductionmentioning

confidence: 99%

Exposure of Smaller and Oxidized Graphene on Polyurethane Surface Improves its Antimicrobial Performance

et al. 2020

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“…In recent years, a great effort has been made in encouraging the placement of an AVF as the first option vascular access. 4,5 However, the rate of AVF failure is still high, 6 mainly due to the development of stenosis and thrombosis, with increased morbidity, mortality, and an elevated economic burden because of the need of hospitalization and invasive procedures to restore the patency of the access. 7 It is thus crucial to establish a surveillance protocol to early identify AVFs at risk of complication, in order to timely act to preserve the patency and functionality of the vascular access.…”

Section: Introductionmentioning

confidence: 99%

Smart Flow for the evaluation of the hemodialysis arteriovenous fistula

et al. 2020

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Background: Smart Flow is an innovative tool available on the Carestream Touch Prime Ultrasound machines, which provides automated blood flow measurement and shows the vectors that form the blood flow in the vessel. We compared the use of Smart Flow with traditional Duplex Doppler Ultrasound to evaluate blood flow of arteriovenous fistulas in prevalent hemodialysis patients. Methods: A total of 31 chronic patients on hemodialysis were enrolled. Blood flow was measured on the brachial artery with Smart Flow and duplex Doppler ultrasound. In a subset of 26 patients, a video of the juxta-anastomotic efferent vein was recorded and analyzed to calculate an index of flow turbulence. Results: We enrolled 21 males and 10 females aged 68.52 ± 11.64 years at the time of evaluation with an average arteriovenous fistulas vintage of 50.23 ± 47.42 months and followed them up for 18.03 ± 5.18 months. Smart Flow and Duplex Doppler Ultrasound blood flow measurements positively correlated (p < 0.0001) in the same patient but Smart Flow gave higher blood flow values (995.0 vs 730.3 mL/min, p < 0.0001), and the Duplex Doppler Ultrasound blood flow standard deviation was similar to Smart Flow (125.4 vs 114.4 mL/min, p < 0.0001). The time needed to evaluate arteriovenous fistulas with Smart Flow was significantly shorter than Duplex Doppler Ultrasound (67.58 ± 19.89 vs 146.3 ± 26.35 s, p < 0.0001). No correlation was found between blood flow turbulence and the subsequent access failure. Conclusion: Smart Flow is reliable, reproducible, and faster than traditional duplex ultrasound. However, the additional information given by the Smart Flow technique does not seem to add any further benefits in terms of prediction of the access failure.

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“…Patients with end-stage renal disease (ESRD) on hemodialysis require adequate vascular access and the access of choice is arteriovenous fistula (AVF). [ 1 2 3 ] Also, the prevalence of obesity is growing and is twice as common in the dialysis population as compared to the general population. [ 4 ] Vascular accesses created in obese individuals are complex and have a higher failure rate.…”

Section: Introductionmentioning

confidence: 99%

“…[ 4 8 9 ] The various surgical options available include: outflow vein elevation, liposuction, and described below lipectomy. [ 1 2 3 8 ]…”

Section: Introductionmentioning

confidence: 99%

Lipectomy technique as a second-stage procedure for primarily matured, deep outflow vein in obese individuals

Sułkowski¹,

Matyja²,

Pasternak³

2018

Indian J Nephrol

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Prevalence of obesity is growing in the general population as well as among end-stage renal disease (ESRD) patients requiring dialysis. Obesity often leads to a situation when a mature outflow vein is located deeper than 6 mm and is difficult to cannulate. These obese patients usually require additional procedures to able to successfully cannulate the fistula. The available surgical options include: outflow vein elevation, liposuction, and lipectomy. We present a case of a 57-year-old obese female with ESRD and matured, deeply running, inadequate for cannulation arteriovenous fistula. We present a technique of lipectomy with wide resection of adipose tissue from superior and lateral surfaces of outflow vein. Postoperatively, the skin without the underlying adipose tissue collapses allowing easy cannulation of the long segment of outflow vein with two needles. Lipectomy of mature but deeply located outflow vein is a second-stage elective procedure. Wide resection of adipose tissue helps create easy to access cannulation zone in obese individuals.

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Hemodialysis vascular access: everything you always wanted to know about it (but were afraid to ask)

Cited by 14 publications

References 0 publications

Exposure of Smaller and Oxidized Graphene on Polyurethane Surface Improves its Antimicrobial Performance

Exposure of Smaller and Oxidized Graphene on Polyurethane Surface Improves its Antimicrobial Performance

Smart Flow for the evaluation of the hemodialysis arteriovenous fistula

Lipectomy technique as a second-stage procedure for primarily matured, deep outflow vein in obese individuals

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