Rousseau-Gagnon Mathieu, Faratro Rose, D'Gama Celine, Fung Stella, Wong Elizabeth, Chan Christopher T
Division of Nephrology, University Health Network, Toronto, Ontario, Canada.
Hemodial Int. 2016 Apr;20(2):298-305. doi: 10.1111/hdi.12372. Epub 2015 Oct 14.
Vascular access-related infection is an important adverse event in home hemodialysis (HHD). We hypothesize that errors in self-cannulation or manipulation of dialysis vascular access are associated with increased incidence of access-related infection. We conducted a retrospective cohort study of all prevalent HHD patients at the University Health Network. All vascular access-related infections were recorded from 2006 to 2013. Errors in dialysis access were ascertained by nurse-administered vascular access checklist. Ninety-two patients had completed at least one vascular access audit. Median HHD vintage was 2.3 (0.9-5.0) years in patients with appropriate vascular access technique and 5.8 (1.5-9.4) years in patients with erroneous vascular access technique. The overall rate of infection between patients with and without appropriate vascular access technique was similar (0.27 and 0.28 infections per year, P = 0.166). Among patients who were identified with errors in dialysis access manipulation, patients with five or more errors were associated with higher rate of access-related infection (mean of 0.47 vs. 0.16 infection per patient-year, P < 0.001). The use of vascular access audit is a feasible strategy, which can identify errors in vascular access technique. Patients with a longer median HHD vintage are associated with higher risk of inappropriate vascular access technique. Patients with multiple errors in vascular access technique are associated with a higher risk of dialysis access-related infection. Prospective evaluation of the impact of vascular access audit on adverse vascular access events is warranted.
血管通路相关感染是家庭血液透析（HHD）中的一项重要不良事件。我们推测，自体动静脉内瘘穿刺或透析血管通路操作失误与血管通路相关感染发生率增加有关。我们对大学健康网络中所有现患的HHD患者进行了一项回顾性队列研究。记录了2006年至2013年期间所有血管通路相关感染情况。通过护士管理的血管通路检查表确定透析通路失误情况。92例患者完成了至少一次血管通路评估。血管通路技术正确的患者HHD中位病程为2.3（0.9 - 5.0）年，血管通路技术有误的患者为5.8（1.5 - 9.4）年。血管通路技术正确和不正确的患者总体感染率相似（每年0.27例和0.28例感染，P = 0.166）。在被确定存在透析通路操作失误的患者中，失误达5次或更多次的患者与血管通路相关感染率较高有关（每位患者每年平均感染0.47例 vs. 0.16例，P < 0.001）。使用血管通路评估是一种可行的策略，可识别血管通路技术中的失误。HHD中位病程较长的患者血管通路技术不当风险较高。血管通路技术存在多次失误的患者发生透析血管通路相关感染的风险较高。有必要对血管通路评估对不良血管通路事件的影响进行前瞻性评估。
