ArticleA review of patients with renal disease undergoing vascular access surgery: Is gray-scale ultrasound enough?
Section snippets
Literature review and synthesis
The purpose of this literature review was to identify the best evidence to support a preoperative protocol development for patients with ESRD. The appraisal of evidence was evaluated using the Johns Hopkins nursing evidence-based practice appraisal tools. These tools gauge the strength of the recommendations found in the studies or articles with levels 1 to 5. Level I indicates the strongest evidence, and level V indicates the weakest. The quality is graded with an A to C system. Grade A is
Theoretic framework
Evidence-based models have been developed to move evidence into practice. Many of the models share common phases, such as identifying clinical or potential problems, gathering best evidence, and appraising and evaluating potential change in practice, with implementation and evaluation.19 In nursing, the best evidence uses findings from research that are methodologically appropriate, rigorous, and clinically relevant. The intervention must be effective, using reliable and precise nursing
Purpose
The primary objective of the study was to determine whether the preoperative workup for patients who are receiving dialysis is adequate. This chart review will identity the frequency of revision surgery.
Study design
A chart review of all adult male and female patients who consecutively underwent fistula or graft creation surgery in a 13-month period from 2010 to 2011 were retrospectively identified through surgical procedural records. These represented the patients of the 2 surgeons who perform vascular access surgery at the study site. The database was Health Insurance and Portability Act compliant. The study was approved by the human research committees at both the study site medical center and Marquette
Results
The study cohort included 53 subjects with late-stage CKD, including 92.5% presenting in stage 5 and 7.5% presenting in stage 4. Most subjects were male, with 1.9% representing the female gender, which is representative of the study center's population. A majority of the subjects were white (58.5%), with the remainder being African American (41.5%). There were no Hispanics or Asian/Pacific Americans identified. Smoking status was examined with more subjects identified as nonsmokers within 1
Discussion
The KDOQI recommends duplex ultrasound for patients with prior neck, arm, or chest surgery; current or previous central catheters; current or previous pacemakers; edema or collateral vein development.3 Prior central or peripheral venous punctures to the veins cause scarring to the vessel that interferes with dilation of the vein, causes turbulent blood flow, and predisposes the fistula to stenosis.4 This review identified a substantial percentage of subjects (67.9%) with prior central lines or
Conclusions
The establishment of a formal preoperative protocol using duplex ultrasound should be explored for patients identified in the KDOQI guidelines and supported in the retrospective review. To influence a change in practice, an association between the evidence and the problem must be the initial step. The primary objective to identify those potential cases that may indicate the need for a more extensive preoperative workup was met. The current preoperative assessment used for identifying fistula
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Cited by (3)
Expert consensus on the establishment and maintenance of native arteriovenous fistula
2021, Chronic Diseases and Translational MedicineCitation Excerpt :1B) Physical examination, as a preliminary screening for evaluating the blood vessels, has certain limitations.26,29 For example, while visual inspection and palpation can help to identify more venous conditions, they cannot accurately assess the inner diameter of the artery or determine factors such as the speed of blood flow, and whether vascular calcification or plaques are present, which are of great significance in determining whether the internal fistula is mature.16,18,21
A narrative review on arteriovenous fistula for hemodialysis
2022, Giornale Italiano di Nefrologia
Conflicts of Interest: None.
This manuscript has not been presented at any conference or meetings, or submitted to any other journal. Institutional review board approval was obtained from the Zablocki VA Medical Center and Marquette University.