Clinical Study Of The Establishment And Application Of Vascular Access In Maintenance Hemodialysis Patients

Purpose:Hemodialysis is one of the important ways to treat the end-stage renal disease.A good vascular access is key to the smooth progress of the hemodialysis for end-stage renal disease (ESRD) patients.Therefore establishing vascular access and maintainning its function is the prerequisite of hemodialysis.2006 Kidney/Dialysis Outcome and Quality Initiative(K / DOQI)guidelines states that,The native arteriovenous fistula(AVF) is the top priority in the various of vascular access methords.AVF should be established in a year before hemodialysis.Catheters not recommended.the Retention time of internal Jugular catheters shoud not are used for more than 7 days,and the femoral catheters requires no more than 5 days.However, most Patients with end-stage renal disease in China generally do not meet the standards above,and specific information on clinical investigation are still not completetly.In this paper, the data of treatment process and vascular access establishment situation in 72 maintenance hemodialysis patient in the third hospital of Hebei medical university blood dialysis center,To understand The establishment and application of vascular access.We studyed the factors which can effect of establishing vascular access early.Subjects and methods:From November 2010-2011 February,72 Patients received the therapy of hemodialysis in the third hospital of He Bei medical university.We investigated the establishment and application of vascular access in these Patients. We collect data such as Common information and vascular access situation et al by questionnaires communicated with patients face-to-face in uniform explanation language.The data was processed by statistical software SPSS 17.0,and had statistical significant difference when probability value was less than 0.05.Results:(1)After being told that they need dialysis treatment,35 patients (48.6%) began hemodialysis within a week ,The remaining patients did not followed by her/his doctors prescription,they delayed their hemodialysis 1 month to 3 years to start hemodialysis.(2) 44 patients (61.1%) were not informed to establish vascular access in advance before hemodialysis. In the 28 patients who were told to establish AVF ,only 11 patients followed prescription.(3) Hemodialysis vascular access used for the first time:Temporary central venous catheter in 51 cases (70.8%), arteriovenous fistula in 11 cases (15.3%), arteriovenous direct puncture in 10 cases (13.9%),temporary catheters are the Most used.(4) Vascular access used currently by all respondents:Arteriovenous fistula in 56 cases (77.8%), temporary central venous catheter in 8 cases (11.1%),these patients were established fistula to await fistula maturation.Cuffed central venous catheter(CVC)in 7 cases (9.7%), arteriovenous direct puncture in 1 case (1.4%).(5) Chi-square test results show that the influence independent factors of established vascular access in advance for HD Patients:Need to borrow money for treatment,whether there are serious symptoms in their first dialysis.(6) Correlation analysis showed that net family income levels and related to established vascular access in advance.(7)Regression analysis reveal that,being informed in advance is the protective factor for Vascular access pre-built,the economic conditions is the risk factors.Conclusion:This phenomenon of delaying their Initiate of hemodialysis is common in most patients.Most patients had not been informed to establish vascular access in advance.Untill the initiation of hemodialysis patients did not think about establishing a permanent vascular access,these results to a high temporary catheter usage anda longer retention time directly.Permanent vascular access, AVF are most widely used.Patient's education, including establishing vascular access and the situation of family economy are positively related to pre-establish AVF. Only to strengthen doctors and patients'consciousness of establishing vascular access in advabce ,improve therapy and make the medical environment better,patients'survival and prognosis can be better.