The Application And Analysis Of Vascular Access In 410 Cases Of Maintenance Hemodialysis Patients

Objective:To clarify the selection,establishment,and application of the first and current vascular access in hemodialysis patients in our center and analyze the complications of different vascular access.Methods:The study focused on 410 patients undergoing maintenance hemodialysis at the Second Hospital of Jilin University from May 1,2017 to October 31,2017.We collected the data through questionnaires,medical records,combined with the information of dialysis patient registration book and hemodialysis record sheet.The investigation included gender,age,primary disease,dialysis duration,dialysis mode and frequency,infectious disease,etc.Selection of first and current hemodialysis vascular access.The insertion site,the time following the catheter insertion,and the complications of NCTC and TCC,etc.In addition,the other information included the creation site,the time of put into use,life span and complications of AVF.Moreover,changes in vascular access and patient laboratory tests were collected.The statistical analysis was achieved by the software of SPSS21.0.Results:1.General Information: All 410 patients enrolled in our study included 220 males(53.7%)and 190 females(46.3%),the ratio for male to female was1.16:1,the age extent of the patients was from 22 to 87 years old,the averag e age was(58±14)years old,and 191 patients(46.6%)were over 60 years o ld;their dialysis duration was(5.0±3.5)years,the majority was(1-5)years(49.3%);hemodialysis combined with intermittent hemodiafiltration accounted for 60.7% as well as frequency of dialysis 3 times a week accounted for 95.1%;the most important infectious disease was Hepatitis B virus.2.Composition of primary disease: The primary disease consisted mainly of the following five causes: 115 cases of diabetic kidney disease(28%),112 cases of primary glomerulonephritis(27.3%),69 cases of hypertensive nephropathy(16.8%),and 29 cases of autosomal dominant polycystic kidney disease(7.1%),25 cases of interstitial nephropathy(6.1%).3.Vascular access and initiate HD: 277 cases of NCTC(67.6%),125 cases of AVF(30.5%),5 cases of TCC(1.2%)and 3 cases of arteriovenous puncture(0.7%).388(94.6%)MHD patients used AVF and 21(5.1%)ones used TCC,just 1(0.2%)patient used NCTC.The increasing age was associated with the reduced use of AVF and increased use of catheter.However,the rate of catheter use was reduced,and the use of AVF was increased as dialysis duration increases.4.Central venous catheter: The main insertion site was the right internal jugular vein;49(17.7%)patients needed to re-catheterization mainly due to the blockage of AVF.Most patients choosed TCC mainly because of poor vascular conditions;the average usage time of TCC was(1.6±1.5)years and up to 6 years,the average blood flow was(215.2±20.4)ml/min.The main complications of catheters were catheter infection,dysfunction and catheter slippage,but the incidence in each case was low.The main pathogenic bacteria was Gram-positive bacteria,and older patients were more susceptible to infection.Statistical analysis found that TCC was superior to NCTC in terms of life span,and the incidence of catheter infection and catheter slippage was lower than that of NCTC.In addition,the service time of internal jugular vein catheter in NCTC was significantly longer than that of femoral vein catheter.5.Arteriovenous fistula: The main reason for not using AVF in the first HD was that serum creatinine reached the level of uremia at the first visit.The main creation site of AVF was radiocephalic fistula,the preferred method of creation was end to side anastomosis and the time of put into use after surgery mainly ranged from 15 days to30 days.There was significant difference in the life span of AVF when created before and after the initiation of dialysis.The main complications of AVF included aneurysm,insufficient blood flow,limb edema and infection.Hypotension,stenosis andthrombosis were the main causes of arteriovenous fistula blockage,furthermore,dialysis duration and the number of changes in the vascular access were closely related to the occurrence of arteriovenous fistula blockage.AVF was superior to TCC in terms of life span,and the incidence of infection and thrombosis was significantly lower than that of TCC.Unfortunately,the use of AVG in our center was not yet universal.Conclusions:1.The mainly use of vascular access was AVF at present(94.6%),but the initial vascular access was mainly NCTC(67.6%).2.The right internal jugular vein was the most commonly selected puncture approach blood vessel,and the incidence of catheter infection and dysfunction was relatively low.3.The main creation site of AVF was radiocephalic fistula,the preferred method of creation was end to side anastomosis and the time of put into use after surgery was shorter than recommended.The use of AVG in our center was not yet universal.