监测动静脉瘘成熟的新方法：对导管停留时间的影响。

IF 2.2 3区医学 Q3 HEMATOLOGY

Blood Purification Pub Date : 2024-09-26 DOI:10.1159/000540306

Laura Rosales Merlo, Xiaoling Ye, Hanjie Zhang, Brenda Chan, Marilou Mateo, Seth Johnson, Frank M van der Sande, Jeroen P Kooman, Peter Kotanko

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引用次数: 0

摘要

导言动脉-静脉瘘（AVF）成熟度评估对于减少静脉导管停留时间至关重要。我们引入了中心静脉血氧饱和度（ScvO2）和估算的上半身血流量（eUBBF）来监测新建立的瘘管成熟度，并记录了有和没有基于 ScvO2 的瘘管成熟度的患者的导管时间。方法从 2017 年到 2019 年，我们在血液透析患者中开展了一项多中心质量改进项目（QIP），其明确目标是通过基于 ScvO2 的成熟度监测缩短 AVF 创建后的导管停留时间。在使用导管作为血管通路的患者中，我们跟踪了建立无创血管通路前后的 ScvO2 和 eUBBF。主要结果是导管在 AVF 创建后的停留时间。我们比较了 QIP 患者和对照组在建立无创动脉导管后的导管停留时间。一个对照组由同期患者组成，第二个对照组由历史对照组（2014-2016 年）组成。我们进行了卡普兰-梅耶尔分析，并构建了带变量调整的考克斯比例危险模型，以评估导管移除时间。结果 QIP 组有 44 名患者（59±17 岁），同期对照组有 48 名患者（59±16 岁），历史对照组有 57 名患者（58±15 岁）。在建立无创静脉输液系统后六个月，QIP 组中导管在位的非删节患者比例为 21%，同期对照组为 67%，历史对照组为 68%。在未调整和调整后的分析中，QIP 患者在瘘管创建后的导管停留时间短于任一对照组（P<0.001）。结论基于 ScvO2 的瘘管成熟度评估与 AVF 创建后导管停留时间缩短有关。

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Novel Method to Monitor Arteriovenous Fistula Maturation: Impact on Catheter Residence Time.

Introduction: Arteriovenous fistula (AVF) maturation assessment is essential to reduce venous catheter residence. We introduced central venous oxygen saturation (ScvO2) and estimated upper body blood flow (eUBBF) to monitor newly created fistula maturation and recorded catheter time in patients with and without ScvO2-based fistula maturation.

Methods: From 2017 to 2019, we conducted a multicenter quality improvement project (QIP) in hemodialysis patients with the explicit goal to shorten catheter residence time post-AVF creation through ScvO2-based maturation monitoring. In patients with a catheter as vascular access, we tracked ScvO2 and eUBBF pre- and post-AVF creation. The primary outcome was catheter residence time post-AVF creation. We compared catheter residence time post-AVF creation between QIP patients and controls. One control group comprised concurrent patients; a second control group comprised historic controls (2014-2016). We conducted Kaplan-Meier analysis and constructed a Cox proportional hazards model with variables adjustment to assess time-to-catheter removal.

Results: The QIP group comprised 44 patients (59 ± 17 years), the concurrent control group 48 patients (59 ± 16 years), the historic control group 57 patients (58 ± 15 years). Six-month post-AVF creation, the fraction of non-censored patients with catheter in place was 21% in the QIP cohort, 67% in the concurrent control group, and 68% in the historic control group. In unadjusted and adjusted analysis, catheter residence time post-fistula creation was shorter in QIP patients compared to either control groups (p < 0.001).

Conclusion: ScvO2-based assessment of fistula maturation is associated with shorter catheter residence post-AVF creation.

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来源期刊

Blood Purification 医学-泌尿学与肾脏学

CiteScore

5.80

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.