Impact of needle type on substitution volume during online hemodiafiltration: plastic cannulae versus metal needles
Ajin ChoHayne Cho ParkDo Hyoung KimHan Byul ChoiGi Hyun SongHyunsuk KimSeokhyung KimGwangho ChoiJwa-Kyung KimYoung Rim SongJong‐Woo YoonYoung‐Ki Lee
2
Citation
44
Reference
10
Related Paper
Citation Trend
Abstract:
Plastic cannulae have attracted increasing interest as an alternative to traditional metal needles with the aim of reducing cannulation-related complications. We investigated whether the substitution volumes during hemodiafiltration differ using these two types of needles in dialysis patients.An intervention study involving 26 hemodialysis patients was conducted in Korea between March and September in 2021. Patients first received online hemodiafiltration using traditional metal needles, and thereafter plastic cannulae were used in a stepwise protocol. Repeated-measures design and linear mixed-effect models were used to compare substitution volumes between the two needle types with the same inner diameter.The mean patient age was 62.7 years, and their mean dialysis vintage was 95.2 months. Most patients (92.3%) had an arteriovenous fistula as the vascular access. The substitution volume increased as blood flow and needle size increased for both plastic cannulae and metal needles. The substitution volume was significantly higher with 17-gauge (G) plastic cannulae than with 16-G metal needles at blood flow rates of 280, 300, and 330 mL/min. Similar results were obtained for 15-G metal needles and 16-G plastic cannulae at a blood flow rate of 330 mL/min. However, the patient ratings of pain on a visual analogue scale were higher for plastic cannulae.Higher substitution volumes were obtained at the same prescribed blood flow rate with plastic cannulae than with metal needles during online hemodiafiltration. Plastic cannulae are an option for achieving high-volume hemodiafiltration for patients with low blood flow rates.To report surgical experience in pseudoaneurysm (PA) repair of arteriovenous fistula (AVF) for renal hemodialysis.Twenty patients undergoing PA repair of AVF for renal hemodialysis were treated in Central Hospital Conde S. Januario of Macao. Sixteen patients had PAs of AVF in upper extremities, 4 in lower extremities. All patients were treated with surgical therapy.All operations were finished without death. One patient suffered from acute thrombosis, recovered without any complication through instant thrombectomy. One patient with postoperative incision bleeding recovered after low molecular weight heparin was ceased. And one AVF could not be mature six weeks later, was recovered after ligation of branch vein. And one patient died due to recurrent cerebral infarction.Surgical repair is the best choice for PA of AVF for renal hemodialysis.
Pseudoaneurysm
Cite
Citations (7)
From August 1989 to August 1994, 173 arteriovenous fistules were constructed in 162 patients for permanent hemodialysis: 49 autogenous and 124 graft fistulas (polytetraflouroethylene (PTFE)-119, others-5). Previous access procedures were noted in 93 graft fistulas (76%) versus 8 autogenous fistulas (16.3%). In the immediate postoperative period, 13 graft fistulas (10.6%) developed complications (5 anastomotic hemorrhages, 4 thrombosis, 3 hypotension without hemorrhage, and 1 sepsis), while 2 (4.1%) autogenous fistulas developed immediate postoperative complications (1 anastomotic hemorrhage and 1 thrombosis). Graft fistulas had a higher, although not statistically significant incidence of immediate postoperative complications versus autogenous fistulas. These graft fistula complications were associated with multiple access procedures and required surgical exploration. Based on these results, we should make every effort to construct the autogenous fistula as the first choice of hemodialysis access procedure in properly selected patients.
Hemodialysis access
Cite
Citations (4)
Seroma
Wound dehiscence
Incisional Hernia
Fat necrosis
Cite
Citations (15)
We reviewed a consecutive series of 16 patients above 60 years of age (mean age 71 years) who underwent reconstruction with pedicled flaps in the lower extremity. The soft tissue defects ranged from 9 to 50 cm and were caused in 11 patients (70%) by surgical complications from previous surgeries. Of these, 5 patients underwent a total joint replacement of the knee (4 cases) and of the ankle (1 case). Surgery consisted of 19 muscular flaps, and 3 fasciocutaneous flaps. Six patients were treated with a combination of 2 flaps. The overall surgical complication rate after reconstruction was 44%. There was no perioperative mortality and there were no medical complications. One patient required an above-the-knee amputation because of uncontrollable postoperative bleeding. A thrombectomy was performed in another patient to treat a postoperative popliteal artery occlusion with critical ischemia of the leg. Other complications included recurrent total joint replacement infections (2 cases), marginal flap necrosis (4 cases), and skin necrosis at the donor site (1 case). The mean hospitalization stay was 46 days. All patients but 1 completely healed, although secondary surgery was performed in 7 patients. The occurrence of complications was not correlated with the preoperative morbidity or an age above 75 years. The local complication rate was higher than reported for free flap in the same age category, but the lack of perioperative mortality and medical complications make it a low-risk option for reconstruction of small- to middle-sized defects in the elderly.
Cite
Citations (8)
Cite
Citations (15)
Abstract Some 114 patients (median age 52 years) underwent laparoscopic hernia repair as a day-case procedure. Twenty-one patients had bilateral and 11 recurrent hernias. Some 113 patients underwent transabdominal preperitoneal mesh repair but one required conversion to open operation. Mean operating time was 24 min for unilateral and 38 min for bilateral repair. In an operating session of 3·5 h, up to five patients (mean 4·4) underwent surgery and as many as seven hernias were repaired. More than 10 per cent of patients were found to have a previously undiagnosed hernia on the opposite side. A total of 111 patients were discharged home on the day of surgery. Major complications included one omental bleed and one small bowel obstruction. Seroma was the commonest minor complication and occurred in 7 per cent of patients. More than 35 per cent of patients needed no postoperative analgesia. To date there has been one recurrence (follow-up range 2–18 months).
Seroma
Bleed
Hernia Repair
Cite
Citations (40)
Objective To investigate the causes, the indications and operative procedures of reoperation for postoperative recurrence of hyperthyroidism. Method Clinical data of 34 cases of postoperative recurrence of hyperthyroidism received reoperation were analyzed retrospectively .Results The reoperative procedures including bilateral subtotal thyroidectomy in 29 cases, unilateral thyroidectomy in 5. All the 34 patients were cured by reoperation.The incidence of postoperative complication was 5.9%,which was not significantly different compared with primary operation treatment during the same time in our hospital.All the 34 case were followed up for 1～10 years,the results showed that all patients were alive well without recurrence or hypothyroidism .Conclusions Extension of the resected thyoid is not enough in the primary surgery is the main cause of postoperative recurrence of hyperthyroidism.Reoperation is the choise of therapy in selective patients with postoperative hyperthyroidsm recurrence .Careful intraoperative dissection can help to avoid injuries of recurrent nerve and parathyroid,and to prevent massive bleeding.
Cite
Citations (0)
Chylothorax
Cite
Citations (312)
Incisional hernias develop in up to 11% of surgical abdominal wounds with a possible recurrence following repair of 44%. We describe our experience with a combined fascial and prosthetic mesh repair. Thirty-five patients (16M:19F) have been treated. The original operation was bowel related in 19 cases, gynaecological in 8, hepatopancreaticobiliary in 3 patients, aortic aneurysm repair in 2 and involved a thoraco-laparotomy in 3. The incisions were midline in 26 cases, transverse in 6, paramedian in 2 and rooftop in one patient. The hernias were considered subjectively to be large in 15, medium in 14 and small in 6 of the patients. A proforma was completed for each patient noting intra-operative and post-operative complications, post-operative hospital stay and analgesic requirements. Post-operative complications included seroma formation in 6 patients, deep vein thrombosis in one and a non-fatal pulmonary embolism in another. One patient developed a wound haematoma and one had a superficial wound infection. Post-operative in-hospital stay ranged from 1 to 27 days with a mean of 6.2 days. Of the 35 patients 33 were available for follow-up. Follow-up was for a median of 20.3 months (range 6.0 to 54.1 months). Two of these (6%) patients reported a persistent lump and one (3%) reported persistent pain but none of the remaining 33 was found to have a recurrence. We advocate this technique because it is applicable to all hernias, most of the mesh is behind the rectus sheath and has 2 points of fixation, it is relatively pain-free allowing early mobilisation, has a modest complication rate and a low recurrence rate.
Seroma
Incisional Hernia
Cite
Citations (57)