Chhetri P K, Manandhar D N, Lamichhane S
Hemodialysis Unit, Department of Medicine, Nepal Medical College and Teaching Hospital, Atterkhel, Jorpati, Kathmandu, Nepal.
Nepal Med Coll J. 2009 Jun;11(2):111-4.
Good vascular access is an essential component for hemodialysis (HD). Studies in patterns of vascular accesses used for HD are very few. Eighty two (male 55, female 27) patients attending HD unit of Nepal Medical College and Teaching Hospital (NMCTH) over a period of one year were enrolled for the study. Average age was 46.12 years. Seventy four patients (90.0%) were suffering from chronic kidney disease (CKD) 5 and 8 (10.0%) patients had acute renal failure. Initial vascular access used was temporary vascular access in 76 (93.0%) and arteriovenous (AV) fistula in 6 (7.0%) patients. As a first temporary vascular access femoral catheterization was used in 54 (66.0%) patients followed by subclavian and internal jugular vein catheterization in 18 (22.0%) and 4 (5.0%) respectively. Fever was observed in 9 (11.0%) patients with first temporary access. There was no complication in 65 (79.0%) cases. Other complications were poor flow, malposition, infection, thrombosis, aneurysm and self removal of catheter. Only 47 patients were analyzed for the second vascular access. Trends towards use of second vascular access was subclavian and internal jugular vein cannulation in 20 (42.5%) and 10 (21.3%) respectively, AV fistula in 13 (27.7%), and femoral catheterization in 4 (8.5%). Second vascular access was associated with fever in 7 (14.9%) and limb swelling in 1 (2.1%). Temporary vascular access was the most common access to initiate HD in CKD 5. Only 7.0% of the patient had AV fistula to start HD. Femoral vein catheterization was the most commonly used first temporary vascular access. Complications with the vascular accesses were negligible.
良好的血管通路是血液透析（HD）的重要组成部分。关于用于血液透析的血管通路模式的研究非常少。在一年的时间里，尼泊尔医学院和教学医院（NMCTH）血液透析科的82名患者（男性55名，女性27名）被纳入该研究。平均年龄为46.12岁。74名患者（90.0%）患有慢性肾脏病（CKD）5期，8名患者（10.0%）患有急性肾衰竭。最初使用的血管通路中，76名患者（93.0%）采用临时血管通路，6名患者（7.0%）采用动静脉（AV）内瘘。作为首个临时血管通路，54名患者（66.0%）采用股静脉置管，其次分别有18名患者（22.0%）和4名患者（5.0%）采用锁骨下静脉和颈内静脉置管。9名使用首个临时血管通路的患者（11.0%）出现发热。65例（79.0%）无并发症。其他并发症包括血流量不足、位置不当、感染、血栓形成、动脉瘤和导管自行拔除。仅对47例患者的第二个血管通路进行了分析。第二个血管通路使用趋势分别为锁骨下静脉和颈内静脉置管20例（42.5%）和10例（21.3%），AV内瘘13例（27.7%），股静脉置管4例（8.5%）。第二个血管通路有7例（14.9%）出现发热，1例（2.1%）出现肢体肿胀。临时血管通路是CKD 5期开始血液透析最常用的通路。仅有7.0%的患者开始血液透析时采用AV内瘘。股静脉置管是最常用的首个临时血管通路。血管通路的并发症可忽略不计。
