Coritsidis George N, Machado Orlando N, Levi-Haim Farzin, Yaphe Sean, Patel Roshan A, Depa Jayaramakrishna
Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, NY, USA.
J Vasc Access. 2020 Nov;21(6):923-930. doi: 10.1177/1129729820913437. Epub 2020 Apr 27.
Point-of-care ultrasound in end-stage renal disease is on the rise. Presently the decision to cannulate an arteriovenous fistula is based on its duration since surgery and physical exam. This study examines the effects of point-of-care ultrasound on decreasing the time to arteriovenous fistula cannulation, time spent with a central venous catheter, and the complications and infections that arise.
Prospective point-of-care ultrasound patients were recruited between January 2015 and January 2018, while retrospective data (non-point-of-care ultrasound) were collected via chart review from patients who had fistula creation between November 2011 and May 2014. Patients had point-of-care ultrasound within 3 weeks after arteriovenous fistula creation and were followed for 1 year. Arteriovenous fistula cannulation was initiated when the following parameters were met: diameter > 6 mm (with no depreciable narrowing of more than 20% throughout), depth < 6 mm, and length > 6 cm. Demographic data, as well as time to cannulation and central venous catheter removal, number of infections, complications, and interventions were compared between point-of-care ultrasound and non-point-of-care ultrasound groups using unpaired t-test, chi-square, and Fisher exact test statistical analysis.
A total of 37 patients with new arteriovenous fistulas were followed by point-of-care ultrasound compared to 29 non-point-of-care ultrasound patients. Point-of-care ultrasound patients had earlier cannulations (35.5 vs 63.3 days, p < 0.05), shorter central venous catheter duration (68.2 vs 98.3 days, p < 0.05), and less infections (12 vs 19) without differences in complication compared to the non-point-of-care ultrasound.
Point-of-care ultrasound facilitates early and safe arteriovenous fistula cannulation leading to a reduction in central venous catheter time and risk of infection. Point-of-care ultrasound may also aid in earlier identification of complications and difficult cannulations.
终末期肾病患者的床旁超声应用正在增加。目前，动静脉内瘘插管的决策基于手术时间和体格检查。本研究探讨床旁超声对缩短动静脉内瘘插管时间、中心静脉导管使用时间以及减少并发症和感染的影响。
前瞻性招募2015年1月至2018年1月期间接受床旁超声检查的患者，同时通过回顾2011年11月至2014年5月期间行内瘘成形术患者的病历收集回顾性数据（非床旁超声检查）。患者在动静脉内瘘成形术后3周内接受床旁超声检查，并随访1年。当满足以下参数时开始动静脉内瘘插管：直径>6mm（全程无超过20%的明显狭窄）、深度<6mm且长度>6cm。使用非配对t检验、卡方检验和Fisher精确检验统计分析，比较床旁超声检查组和非床旁超声检查组的人口统计学数据、插管时间、中心静脉导管拔除时间、感染次数、并发症和干预情况。
共有37例新行动静脉内瘘的患者接受了床旁超声检查，与之相比，29例患者接受了非床旁超声检查。与非床旁超声检查组相比，床旁超声检查组插管时间更早（35.5天对63.3天，p<0.05）、中心静脉导管使用时间更短（68.2天对98.3天，p<0.05）且感染更少（12例对19例），并发症无差异。
床旁超声有助于早期安全地进行动静脉内瘘插管，从而减少中心静脉导管使用时间和感染风险。床旁超声还可能有助于更早地识别并发症和困难插管情况。
