Management of Difficult Dialysis Access Issues for Dialysis Patients

Dougherty, Matthew J.; Troutman, Douglas A.; Maloni, Krystal

doi:10.1016/j.yasu.2019.04.005

Cited by 3 publications

(13 citation statements)

References 74 publications

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“…Upon catheter insertion, proteins rapidly coat the surface, serving as a nidus for biofilm formation and thrombosis. 1,6 By lessening the initial adhesion of proteins to the surface, it is likely that the downstream formation of biofilms and thrombi may be attenuated. 4−6 Prior literature shows conflicting results in the effect of nitric oxide on surface protein adhesion.…”

Section: ■ Results and Discussionmentioning

confidence: 99%

“…Thrombosis is most frequently prevented during the interdialytic period with the widespread use of heparin lock solutions. , Lock solutions are placed in the catheter lumen(s) in between dialysis sessions and generally replaced every 48–72 h. Heparin lock solutions are notoriously ineffective as the heparin in the key distal portion of the catheter is known to leak out of the inlet and outlet holes of the TDC, necessitating the use of thrombolytic agents in the hemodialysis unit. In turn, the duration of the dialysis treatment is reduced (premature catheter removal), and the dialysis clearance lessened with resulting health complications. ,,, Care of the exit site and strict aseptic techniques when handling the TDC have been two preventative measures to reduce TDC infection. Unfortunately, such strategies are ineffective with about 15% of new TDCs experiencing an infection event within the first 6 weeks .…”

Section: Introductionmentioning

confidence: 99%

“…In turn, the duration of the dialysis treatment is reduced (premature catheter removal), and the dialysis clearance lessened with resulting health complications. 1,6,12,15 Care of the exit site and strict aseptic techniques when handling the TDC have been two preventative measures to reduce TDC infection. Unfortunately, such strategies are ineffective with about 15% of new TDCs experiencing an infection event within the first 6 weeks.…”

Section: ■ Introductionmentioning

confidence: 99%

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Nitric Oxide-Releasing Hemodialysis Catheter Lock Solutions

Maloney

Grayton

Wai

et al. 2023

ACS Appl. Mater. Interfaces

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In an attempt to address the significant morbidity, mortality, and economic cost associated with tunneled dialysis catheter (TDC) dysfunction, we report the development of nitric oxide (NO)-releasing dialysis catheter lock solutions. Catheter lock solutions with a range of NO payloads and release kinetics were prepared using low-molecular-weight N-diazeniumdiolate nitric oxide donors. Nitric oxide released through the catheter surface as a dissolved gas was maintained at therapeutically relevant levels for at least 72 h, supporting clinical translatability (interdialytic period). Slow, sustained NO release from the catheter surface prevented bacterial adhesion in vitro by 88.9 and 99.7% for Pseudomonas aeruginosa and Staphylococcus epidermidis, respectively, outperforming a burst NO-release profile. Furthermore, bacteria adhered to the catheter surface in vitro prior to lock solution use was reduced by 98.7 and 99.2% for P. aeruginosa and S. epidermidis, respectively, when using a slow releasing NO donor, demonstrating both preventative and treatment potential. The adhesion of proteins to the catheter surface, a process often preceding biofilm formation and thrombosis, was also lessened by 60−65% by sustained NO release. In vitro cytotoxicity of catheter extract solutions to mammalian cells was minimal, supporting the non-toxic nature of the NO-releasing lock solutions. The use of the NOreleasing lock solution in an in vivo TDC porcine model demonstrated decreased infection and thrombosis, enhanced catheter functionality, and improved outcome (i.e., likelihood of survival) as a result of catheter use.

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Section: ■ Results and Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: ■ Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Nitric Oxide-Releasing Hemodialysis Catheter Lock Solutions

Maloney

Grayton

Wai

et al. 2023

ACS Appl. Mater. Interfaces

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“…In addition, failure may arise due to surgeon factors and the accuracy of the vascular anastomosis. [3][4][5][6] Many complications can occur within AV shunt surgery, such as shunt failure, stenosis in the proximal venous leg (48%), thrombosis (9%), aneurysm (7%), heart failure due to shunt too large (greater than 20% of cardiac output), arterial steal syndrome and distal ischemia (1.6%), distal venous hypertension from shunt swelling, hyperpigmentation, skin induration, and occasional ulceration. 8,13,14,17 But after all, the mortality rate after AV shunt is 0%.…”

Section: Results and Possible Complication Of Av Shuntmentioning

confidence: 99%

Arteriovenous shunt as the best hemodialysis access in Chronic Kidney Disease (CKD) patients: a literature review

Sebayang

Hidayat

2021

JINAVascAccess

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Arteriovenous Shunt (AV Shunt) is a minor surgical operation that connects (creating anastomoses) the arteries and veins in the arm or other body part for the purpose of making connection access for hemodialysis. AV shunt is the primary choice in establishing vascular access for hemodialysis in patients with Chronic Kidney Disease (CKD). Therefore, this study aims to review the arteriovenous shunt as a hemodialysis access option in CKD patients. The literature study was conducted by searching various written sources, whether in the form of books, archives, articles and journals, or documents relevant to the problem being studied. The mortality rate after AV shunt is 0%, even though it still has postoperative complications. Based on the location of the operation, making the AV shunt is prioritized on the distal part that is not dominant to minimize the damage to the AV shunt. The location of the wrist, namely the brachiocephalic, is a top priority in making an AV shunt because it has many advantages. AV shunt is the primary choice of vascular access for hemodialysis in patients with chronic kidney disease. It is hoped that through the AV shunt, the life expectancy of patients with CKD can be increased, and patients with CKD must receive support from other disciplines such as interns, psychologists, and the patient's family.

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“…Skin biopsy results will be non-specific. When the shunt is compressed, there is often alleviation of symptoms as well as a return of the pulses to the radial and/or ulnar arteries [2].…”

Section: Cardiovascular Exam: Lue (Left Upper Extremity)mentioning

confidence: 99%