在 COVID-19 大流行期间管理透析通路方面的经验教训和未来方向：美国患者和提供者的经验。
Lessons learnt and future directions in managing dialysis access during the COVID 19 pandemic: Patient and provider experience in the United States.
机构信息
University of California San Francisco, Fresno, California, USA.
Louisiana State University, Shreveport, LA, USA.
出版信息
J Vasc Access. 2023 Mar;24(2):213-221. doi: 10.1177/11297298211027014. Epub 2021 Jun 24.
BACKGROUND
The COVID 19 pandemic adversely impacted delivery of preventive, routine, urgent, and essential care worldwide. Dialysis access care was particularly affected due to the lack of specific guidelines regarding procedures for its creation and maintenance. Early guidance by Centers for Medicare and Medicaid was inadvertently interpreted as guidance to stop dialysis access procedures. Prompt action by professional societies was needed to furnish detailed guidance to establish essential nature of these procedures.
METHODS
The American Society of Diagnostic and Interventional Nephrology (ASDIN) issued a joint statement with Vascular Access Society of the Americas (VASA) - "Maintaining Lifelines for ESKD Patients" to clearly establish the role of vascular access as a lifeline for ESKD (End Stage Kidney Disease) patients and the importance and urgency of its timely management. ASDIN also conducted a survey in mid-2020, that was administered to the ASDIN database as well as shared with the general public via the organization's social media platforms. The respondents reported their experiences in the care of dialysis access, practice patterns and the utility of the ASDIN-VASA statement during the COVID 19 pandemic.
RESULTS
Of the 2030 individual surveys sent, 581 were opened and 53 (9.1%) responses were received from different parts of the country and from different practice settings. ASDIN COVID 19 triage document was frequently utilized and 83% of respondents found the document valuable. The survey also revealed multiple obstacles, including logistical and financial issues that led to significant disruption of services.
CONCLUSIONS
The care of dialysis access was significantly affected in the United States during the COVID 19 pandemic due to multiple reasons. ASDIN actions provided valuable specific guidance regarding and explored barriers to dialysis access care. We describe those results and discuss strategies to prevent COVID 19 transmission with innovative strategies of providing access care. Individualized decision making is of essence when considering dialysis access procedures.
背景
COVID-19 大流行对全球范围内预防、常规、紧急和基本护理的提供产生了不利影响。由于缺乏有关创建和维护透析通路的具体指南，因此透析通路护理受到了特别影响。医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid）的早期指导无意中被解释为停止透析通路程序的指导。专业协会需要采取迅速行动，提供详细指导，以确定这些程序的必要性。
方法
美国诊断与介入肾脏病学会（American Society of Diagnostic and Interventional Nephrology，ASDIN）与美洲血管通路学会（Vascular Access Society of the Americas，VASA）联合发表了一份声明，题为“维持终末期肾病患者的生命线”，明确确立了血管通路作为终末期肾病（End Stage Kidney Disease，ESKD）患者生命线的作用，以及及时管理血管通路的重要性和紧迫性。ASDIN 还在 2020 年中期进行了一项调查，该调查通过 ASDIN 数据库以及通过该组织的社交媒体平台向公众发布。受访者报告了他们在 COVID-19 大流行期间对透析通路护理、实践模式和 ASDIN-VASA 声明的使用情况。
结果
在发出的 2030 份个人调查中，有 581 份被打开，来自全国各地不同实践环境的 53 名（9.1%）受访者做出了回应。ASDIN COVID-19 分诊文件被频繁使用，83%的受访者认为该文件很有价值。调查还揭示了多种障碍，包括后勤和财务问题，这些问题导致服务严重中断。
结论
由于多种原因，COVID-19 大流行期间美国的透析通路护理受到了重大影响。ASDIN 的行动就透析通路护理提供了有价值的具体指导，并探讨了其中的障碍。我们描述了这些结果，并讨论了通过提供创新的通路护理策略来预防 COVID-19 传播的策略。在考虑透析通路程序时，个体化决策至关重要。
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