Gauly Adelheid, Parisotto Maria Teresa, Skinder Aleksandra, Schoder Volker, Furlan Andreja, Schuh Erika, Marcelli Daniele
Clinical Research, Fresenius Medical Care, Bad Homburg, Germany.
J Vasc Access. 2011 Oct-Dec;12(4):358-64. doi: 10.5301/JVA.2011.8413.
The appropriate use of vascular access is of fundamental importance in the treatment of hemodialysis (HD) patients. This survey entailed collecting data on current practice of vascular access cannulation to assess its relation to dialysis dose.
This international, multicenter, observational, cross-sectional survey was performed in 171 dialysis centers of the European dialysis network of Fresenius Medical Care in Europe and South Africa during April 2009. Practice patterns of vascular access cannulations were documented by means of a 24-item questionnaire. Dialysis dose from the documented hemodialysis treatments was derived from the clinical database EuCliD®.
In total, 10,807 cannulations in hemodialysis patients with either arteriovenous fistula (91%) or arteriovenous graft (9%) were documented. For the puncture, the area technique was applied most frequently using 15G and 16G needles. Blood flow rates were mostly between 300 and 400 mL/min and adjusted to the needle size used. In two-thirds of cases the arterial needle was placed first, mostly in an antegrade direction, with an average distance to the venous needle of 7.0±3.7 cm. More than two-thirds of the cannulations were performed by nurses with more than 5 years of experience in dialysis. A logistic regression model revealed a significantly higher odds ratio to attain Kt/V = 1.2 for retrograde placement of the arterial needle, and for using needles with bigger diameter.
This survey covered a broad number of countries and centers and provides information on current practice of vascular access cannulation, their effect on dialysis dose, and serves as feedback to the dialysis centers for their quality management process.
血管通路的合理使用在血液透析（HD）患者的治疗中至关重要。本次调查旨在收集血管通路插管的当前实践数据，以评估其与透析剂量的关系。
2009年4月，在欧洲和南非费森尤斯医疗护理公司欧洲透析网络的171个透析中心进行了这项国际多中心观察性横断面调查。通过一份包含24个项目的问卷记录血管通路插管的实践模式。记录的血液透析治疗的透析剂量来自临床数据库EuCliD®。
总共记录了10807例血液透析患者的插管情况，其中动静脉内瘘患者占91%，动静脉移植物患者占9%。穿刺时，最常采用区域技术，使用15G和16G针头。血流速度大多在300至400 mL/分钟之间，并根据所使用的针头尺寸进行调整。在三分之二的病例中，动脉针先插入，大多为顺行方向，与静脉针的平均距离为7.0±3.7厘米。超过三分之二的插管由具有超过5年透析经验的护士进行。逻辑回归模型显示，动脉针逆行放置以及使用较大直径的针头时，达到Kt/V = 1.2的优势比显著更高。
本次调查覆盖了众多国家和中心，提供了血管通路插管的当前实践及其对透析剂量影响的信息，并为透析中心的质量管理过程提供反馈。
