TAILIEUCHUNG - Access for Dialysis: Surgical and Radiologic Procedures, 2nd Edition - Part 2 (END)

This publication represents a comprehensive guide to current common diagnostic, operative and percutaneous techniques used in creating and maintaining access for dialysis. When writing the text, the authors have focused on surgeons in training, interventional radiologists and clinically active nephrologists and fellows, dialysis nurses and technicians, health professionals involved in the care of end stage renal disease. Many dialysis patients may also benefit from this handbook. | Chapter 8 Common Dialysis Access Management Strategies Ingemar . Davidson Men occasionally stumble over the truth but none of them pick themselves up and hurry off as if nothing had happened Sir Winston Churchill Introduction Thrombectomies with or without revisions currently constitute approximately half of all vascular access OR procedures Appendix V not counting dialysis catheter placements. With increasing dialysis access surveillance programs revision prior to thrombectomy is a likely and highly desirable trend Chapter 10 . The benefits of access surveillance programs include increased dialysis efficiency from prospective monitoring and routine troubleshooting avoiding placement of temporary dialysis catheters associated with clotting episodes thereby saving central veins for future access. Second the surgery can be planned causing less interruption in the dialysis routine as well as for the surgeon and the operating room scheduling. Also the patient is less likely to be admitted for complications associated with thrombosis such as fluid overload congestive heart failure and hyperkalemia. Many effective surveillance options are available from straightforward dialysis machine-driven testing to invasive fistulography. Even though surveillance programs are associated with some cost proactive interaction is likely to save dollars for society in addition to the improved quality of life for patients and dialysis access team members. This chapter outlines the authors overall approach to some common access management problems. Specific examples are also illustrated in Appendix I case reports. In general the safest and correct approach is to carefully perform physical exam on each patient then consider further tests such as duplex Doppler fistulagram and central venograms before presenting to the patient his or her options as well as a prediction of outcome. Another basic principle is not to take the easy road . placing a central venous catheter just to avoid or

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