Unraveling the realities of vascular access: the Network 11 experience.
Unraveling the realities of vascular access: the Network 11 experience.
复制标题
揭开血管通路的真相：Network 11 体验。
DOI：
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发表时间：
2000
期刊：
影响因子：
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通讯作者：
A. Tello
中科院分区：
文献类型：
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作者：
A. Besarab;M. Adams;S. Amatucci;D. Bowe;J. Deane;K. Ketchen;K. Reynolds;A. Tello
动静脉（AV）瘘被公认为是血液透析首选的血管通道，然而国家数据显示，1997年只有23%的患者使用AV瘘。为了确定放置先天性房室瘘管的障碍，上中西部肾脏网络公司（终末期肾病[ESRD]网络11）发起了一项血管通路项目，以观察1999年前6个月开始血液透析的患者的转诊过程。在这些患者中，63%的患者以导管作为唯一的血液透析途径，22%的患者放置了房室瘘（但只有14%的患者在第一次透析治疗中使用了房室瘘），15%的患者从移植开始。大约40%的患者在透析前不到1个月就被转诊到肾病科，这使得永久通道放置的机会很小。然而，27%的患者在第一次血液透析治疗时使用了导管，并且在开始透析前1个多月由肾脏科医生检查，这表明存在改善的机会。在透析开始6个月后，25%使用导管开始透析的患者使用房室瘘，35%使用移植物。网络11计划利用这些信息促进患者早期转诊到肾病科，随后迅速转诊到血管外科医生。还指出了改善血管通路管理的其他活动。
Arteriovenous (AV) fistulae are well recognized as the preferred vascular access for hemodialysis, yet national data show that only 23% of patients used an AV fistula in 1997. To identify barriers to the placement of native AV fistulae, the Renal Network of the Upper Midwest, Inc. (End-Stage Renal Disease [ESRD] Network 11) initiated a vascular access project to look at the process of referral for patients beginning hemodialysis in the first 6 months of 1999. Of these patients, 63% began hemodialysis with a catheter as the only access, 22% had an AV fistula placed (but only 14% used an AV fistula for their first dialysis treatment), and 15% began with a graft. About 40% of patients were referred to a nephrologist less than 1 month before dialysis, allowing little chance for permanent access placement. Yet 27% of patients used a catheter on the first hemodialysis treatment and were seen by a nephrologist more than 1 month before starting dialysis, indicating the presence of an opportunity to improve. At 6 months after initiation of dialysis, 25% of patients who began dialysis using a catheter were using an AV fistula and 35% were using a graft. Network 11 plans to use this information to promote early referral of patients to a nephrologist and subsequent prompt referral of such patients to a vascular surgeon. Other activities to improve vascular access management are also indicated.