Lentini Paolo, de Cal Massimo, Chronopoulos Alexandra, Cruz Dinna, Nalesso Federico, Garzotto Francesco, Brendolan Alessandra, D'Angelo Angela, Ronco Claudio
Department of Nephrology, Dialysis and Transplantation, "San Bortolo" Hospital, Vicenza, Italy.
J Vasc Access. 2011 Jul-Sep;12(3):239-43. doi: 10.5301/JVA.2011.6224.
Vascular access care is a key topic for hemodialysis patients. The most cost-effective and lasting vascular access for chronic hemodialysis is the native arteriovenous fistula (AVF); however, bleeding after dialysis session from puncture site is a relevant problem. Achieving hemostasis is necessary and requires hand compression by the nurse or the patient if he or she is capable and cooperative.
We assessed a new vascular closure device, VITACLIP® (Serumwerk Bernburg Vertriebs GmbH) that is an adhesive silicone seal device, which can be set onto the skin and punctured by dialysis needle. After withdrawal of the needle, VITACLIP® prevents bleeding from the punctured vessels, making hand compression unnecessary.
We used this device in 5 chronic hemodialysis patients with native lateral-terminal AVFs. The patients' hemodialysis prescription and anticoagulants dose were not changed. This device allowed puncture of vascular access without complications such as bleeding at the end of hemodialysis; we did not observe any mechanical complications due to needle dislocation or any dermatological lesions at skin puncture site. However, the cannulation proved to be more difficult for the nurses with this device because the silicone hampers identification of the vessel for puncture for deeper AVFs.
This device helps patient management and improves patient safety by reducing the risk of AVF bleeding at the end of dialysis, decreasing the risk of staff contact with patients' blood, and theoretically eliminating the risk of massive bleeding in the case of an inadvertent needle dislodgement going unnoticed during treatment.
血管通路护理是血液透析患者的一个关键话题。对于慢性血液透析而言，最具成本效益且持久的血管通路是自体动静脉内瘘（AVF）；然而，透析 session 后穿刺部位出血是一个相关问题。实现止血是必要的，如果护士或患者有能力且配合，则需要进行手部按压。
我们评估了一种新型血管闭合装置 VITACLIP®（血清工厂伯恩堡销售有限公司），它是一种粘性硅酮密封装置，可放置在皮肤上并由透析针穿刺。拔出针后，VITACLIP®可防止穿刺血管出血，无需手部按压。
我们在 5 例患有自体外侧末端 AVF 的慢性血液透析患者中使用了该装置。患者的血液透析处方和抗凝剂剂量未改变。该装置允许进行血管通路穿刺，且在血液透析结束时无出血等并发症；我们未观察到因针移位导致的任何机械并发症或皮肤穿刺部位的任何皮肤病变。然而，使用该装置时，护士进行插管操作更困难，因为硅酮会妨碍对较深 AVF 进行穿刺时对血管的识别。
该装置有助于患者管理，并通过降低透析结束时 AVF 出血的风险、减少工作人员接触患者血液的风险以及理论上消除治疗期间意外针移位未被注意到情况下发生大出血的风险，提高了患者安全性。
