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Related Concept Videos

Hemodialysis II: Procedure and Complications01:24

Hemodialysis II: Procedure and Complications

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DialyzersA hemodialysis (HD) dialyzer is a plastic cartridge containing thousands of parallel hollow fibers, which serve as semipermeable membranes. These fibers are typically made from cellulose-based or other synthetic materials. During HD, blood is pumped into the top of the cartridge and distributed among these fibers. Simultaneously, dialysis fluid, known as dialysate, is introduced into the bottom of the cartridge, bathing the outside of the fibers. Across the semipermeable membrane,...
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Hemodialysis I: Introduction01:25

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Hemodialysis (HD) is a medical treatment that artificially removes waste products, excess fluids, and toxins from the blood when the kidneys are no longer able to perform these functions effectively. In this process, blood is filtered through a semipermeable membrane, allowing for the selective removal of waste while preserving necessary components like blood cells and proteins. Hemodialysis is typically performed in patients with end-stage renal disease (ESRD) or severe kidney...
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Parentral Nutrition: Centeral and Peripheral Parental Nutrition01:27

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Parenteral Nutrition (PN) delivers essential nutrients directly into the bloodstream, bypassing the digestive system. It is commonly used for individuals with severe digestive disorders or conditions that prevent normal nutrient absorption.
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
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Hemodialysis III: Nursing Management01:25

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The nursing management of a patient undergoing hemodialysis includes several critical steps, starting with a thorough assessment before the procedure.Before the Hemodialysis ProcedureFirst, record the patient's vital signs—blood pressure, heart rate, respiratory rate, and temperature—to establish a baseline. This baseline is essential for detecting conditions such as hypotension that could impact the patient's response to dialysis. Document the patient's pre-dialysis weight, as this...
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Continuous Renal Replacement Therapy01:30

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Continuous Renal Replacement Therapy, also known as CRRT, is a procedural treatment for acute kidney injury (AKI) that gradually removes uremic toxins and fluids while maintaining acid-base balance and stabilizing electrolytes. It is particularly useful for hemodynamically unstable patients. Unlike intermittent hemodialysis, which is faster, CRRT provides a gentler approach over 24 hours, closely mimicking the function of natural kidneys. However, CRRT is not ideal for patients with...
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Peritoneal Dialysis I: Introduction and Procedure01:30

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Peritoneal dialysis (PD) is a procedure that facilitates the exchange of solutes, waste products, electrolytes, and excess fluid between the blood in the peritoneal capillaries and a dialysis solution introduced into the peritoneal cavity.Principles of Peritoneal Dialysis (PD)Diffusion: Waste products such as urea and electrolytes move from high concentrations in the blood to low concentrations in the dialysate across the peritoneal membrane. This mechanism is driven by the concentration...
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Laparoscopic-Assisted Seldinger Technique for Peritoneal Dialysis Catheter Insertion
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Complex central venous catheter insertion for hemodialysis.

Steven Powell1, Jane Belfield

  • 1Royal Liverpool Hospital, Liverpool, Merseyside - UK.

The Journal of Vascular Access
|May 13, 2014
PubMed
Summary

Central venous catheter (CVC) use remains high in hemodialysis patients despite payment reforms. Longer patient survival increases CVC exposure, leading to central venous occlusion and access challenges.

Area of Science:

  • Nephrology
  • Vascular Access
  • Interventional Radiology

Background:

  • Central venous catheter (CVC) use has not decreased in the UK despite payment reforms.
  • Increased patient survival in hemodialysis leads to prolonged CVC exposure.
  • CVC use poses risks of infection, occlusion, and central venous stenosis, complicating future access.

Purpose of the Study:

  • To discuss the challenges of CVC insertion in hemodialysis patients with exhausted traditional access sites.
  • To present advanced CVC techniques for challenging venous access scenarios.
  • To detail techniques, complications, and functional longevity of alternative CVC placements.

Main Methods:

  • Review of advanced CVC insertion techniques for hemodialysis patients.
  • Discussion of specific methods including translumbar, transocclusion, transcollateral, transjugular IVC, and transhepatic catheterization.

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  • Analysis of associated complications and expected device function.

    • Main Results:

    • No decrease in CVC use observed despite policy changes.
    • Growing prevalence of central venous occlusion as a sequela of long-term CVC use.
    • Demonstration of feasibility for complex CVC placements in patients with limited options.

    Conclusions:

    • Central venous occlusion is an increasing challenge in hemodialysis vascular access.
    • Advanced CVC techniques offer solutions for patients with exhausted traditional sites.
    • Careful technique selection and management are crucial for optimizing outcomes in complex CVC cases.