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Direct arterial puncture for hemodialysis, a neglected but simple and valuable vascular access
Chun-Yan Sun1, Mi Zhong1, Li Song1
1Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
Insights
Direct arterial puncture (DAP) can serve as a temporary vascular access for hemodialysis, especially for patients with poor cardiac or vascular function. However, it has limitations and is not recommended for long-term use if superior options exist.
Area of Science:
- Nephrology
- Vascular Surgery
- Dialysis Access
Background:
- Vascular access (VA) is crucial for hemodialysis.
- Direct arterial puncture (DAP) is an alternative VA method.
- Limited data exists on DAP's prevalence and outcomes in hemodialysis patients.
Purpose of the Study:
- To determine the prevalence and effects of DAP in hemodialysis patients.
- To evaluate DAP as a potential VA option for patients with compromised vascular or cardiac function.
Main Methods:
- Cross-sectional study design.
- Demographic and laboratory data extracted from healthcare systems.
- DAP information collected via questionnaire.
- Case-control matching to compare hemodialysis adequacy between DAP and other VAs.
Main Results:
- 38 out of 526 patients utilized DAP for hemodialysis.
- Primary reasons for DAP: cost (50%) and poor vascular/cardiac function (39.5%).
- Complications included aneurysm/pseudoaneurysm (42.1%) and infiltration (31.6%).
- No significant difference in hemodialysis adequacy between DAP and other VAs.
Conclusions:
- DAP can achieve adequate hemodialysis but has limitations.
- Not recommended as a primary long-term VA if better options are available.
- Considered a supplemental VA for specific patient groups with poor cardiac/vascular function in urgent situations.
Introduction:
The purpose of this study is to present the prevalence and effects of direct arterial puncture (DAP) for hemodialysis patients, and to introduce optimal option for the vascular access (VA) in certain hemodialysis patients with poor condition of vascular or cardiac function in a compelling situation.
Methods:
This was a cross-sectional study. Demographic characteristics and laboratory data were extracted from the health care system. Relevant DAP information was collected by a questionnaire. Case-control matching was performed to compare the hemodialysis adequacy between DAP and other VAs.
Results:
A total of 526 patients were selected for analysis by convenience sampling, of which 38 patients relied https://www.baidu.com/link?url=eaDh8Hn-yZGJyDB0_h4zBenKd7qY1yX-KNxO-qU49gktQOGTJJg3slTjIbG095st4hRfprQIHRjfhfeGOZyH73y8tvSUCwMmvWbUhyix2ZK on DAP for hemodialysis. The main reasons using DAP for hemodialysis included the cost of arteriovenous access creation or maintenance in 19(50%) patients and the poor condition of vascular or cardiac function in 14 (39.5%) patients. Some complications of DAP occurred, such as aneurysm or pseudoaneurysm in 16(42.1%) patients, infiltration in 12 (31.6%) patients. Differences in hemodialysis adequacy were not statistically significant between DAP and other types of VA.
Conclusion:
In conclusion, DAP can meet the need of prescription hemodialysis, yet it has several limitations. Although the patients in our study were long-term dependent on DAP for hemodialysis with various reasons, we do not recommend DAP as a long-term vascular access if better options are available. However, DAP should not be overlooked to be a supplemental VA for hemodialysis with adequate blood flow and availability for individuals with poor condition of vascular or cardiac function in a compelling situation.
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