Ribitsch Werner, Schilcher Gernot, Hafner-Giessauf Hildegard, Krisper Peter, Horina Jörg H, Rosenkranz Alexander R, Schneditz Daniel
Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Austria.
Semin Dial. 2014 Sep-Oct;27(5):507-11. doi: 10.1111/sdi.12169. Epub 2013 Dec 17.
Venous needle dislodgement (VND) is a potentially fatal complication during hemodialysis (HD) treatment and the venous pressure monitor is the most widely used device for its detection. VND can only be detected by the venous sensor if the resulting pressure drop exceeds the difference between the actual venous pressure and the lower alarm limit. In clinical practice, the lower alarm limit is usually set 30-40 mmHg below the actual venous pressure to avoid a disproportionate high number of nuisance alarms. The aim of this study was to quantify the number of fistulas and grafts in a group of HD patients where venous pressure monitoring can be expected to detect VND. We determined intra-access pressures in 99 chronic HD patients. Sixty-five (65.7%) had a fistula and 34 (34.3%) had a prosthetic graft as a vascular access. Mean intra-access pressure (Pa ) in fistulas was 32.6 ± 23.5 mmHg, whereas in grafts mean Pa was 60.9 ± 19.5 mmHg. Nineteen (29.2%) of the fistulas and 32 (94.1%) of the grafts exhibited an intra-access pressure above 40 mmHg. Therefore, in our study nearly all grafts but only 29% of fistulas would fulfill the requirement for venous pressure monitoring to detect VND.
静脉穿刺针移位（VND）是血液透析（HD）治疗期间一种可能致命的并发症，静脉压力监测器是检测该并发症最广泛使用的设备。只有当由此产生的压力下降超过实际静脉压力与下限报警值之间的差值时，静脉传感器才能检测到VND。在临床实践中，下限报警值通常设置为比实际静脉压力低30 - 40 mmHg，以避免出现过多不必要的警报。本研究的目的是量化一组血液透析患者中有望通过静脉压力监测检测到VND的动静脉内瘘和移植物的数量。我们测定了99例慢性血液透析患者的血管通路内压力。65例（65.7%）有动静脉内瘘，34例（34.3%）有假体移植物作为血管通路。动静脉内瘘的平均血管通路内压力（Pa）为32.6 ± 23.5 mmHg，而移植物的平均Pa为60.9 ± 19.5 mmHg。19例（29.2%）动静脉内瘘和32例（94.1%）移植物的血管通路内压力高于40 mmHg。因此，在我们的研究中，几乎所有移植物但只有29%的动静脉内瘘符合通过静脉压力监测检测VND的要求。
