Podcast
Questions and Answers
What is primarily responsible for the occurrence of stenosis in major vessels?
What is primarily responsible for the occurrence of stenosis in major vessels?
- Inadequate hydration
- Puncture of the vein wall
- Permanent scarring (correct)
- Infusion of irritant solutions
Which factor is involved in the activation of a blood clot at the vein wall injury site?
Which factor is involved in the activation of a blood clot at the vein wall injury site?
- Platelet plug formation (correct)
- Increased blood flow
- Decreased vascular permeability
- Catheter placement technique
Which of the following conditions frequently necessitates vascular access device (VAD) placement?
Which of the following conditions frequently necessitates vascular access device (VAD) placement?
- Asthma
- Cystic fibrosis (correct)
- Atherosclerosis
- Heart failure
Why is vein preservation important in patients with chronic kidney disease (CKD)?
Why is vein preservation important in patients with chronic kidney disease (CKD)?
What does excessive exposure to caustic infusates lead to in patients requiring hemodialysis?
What does excessive exposure to caustic infusates lead to in patients requiring hemodialysis?
Which veins are preferred for short peripheral IV catheters in CKD patients?
Which veins are preferred for short peripheral IV catheters in CKD patients?
What is a contraindication for using veins in the forearm or upper arm for venous access procedures?
What is a contraindication for using veins in the forearm or upper arm for venous access procedures?
What potential complication arises from an osmolality of $900 ext{ mOsm/L}$ during hemodialysis?
What potential complication arises from an osmolality of $900 ext{ mOsm/L}$ during hemodialysis?
What should be assessed in a patient with previous vascular injury regarding future hemodialysis access?
What should be assessed in a patient with previous vascular injury regarding future hemodialysis access?
What can trigger collagen and platelet activation when using a catheter?
What can trigger collagen and platelet activation when using a catheter?
Flashcards
Stenosis
Stenosis
Permanent scarring in major blood vessels that leads to narrowing, often occurring in patients with chronic medical conditions.
Endothelial Layer Damage
Endothelial Layer Damage
This is the initial step in blood vessel damage. It starts with a puncture in the vein wall, triggering a reaction where the collagen layer activates platelets to form a plug.
Fibrin Deposition on Platelet Plug
Fibrin Deposition on Platelet Plug
After a platelet plug forms, blood clotting factors are activated, leading to deposition of an even thicker layer of fibrin over the platelet plug. This solidifies the injury site.
Catheter Tip Irritation
Catheter Tip Irritation
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Cumulative Vein Damage in CKD
Cumulative Vein Damage in CKD
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Importance of Upper Extremity Veins in CKD
Importance of Upper Extremity Veins in CKD
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Caustic Infusates and Vein Damage
Caustic Infusates and Vein Damage
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Osmolality and Vascular Access
Osmolality and Vascular Access
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Vein Preservation for Other Therapies
Vein Preservation for Other Therapies
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Permanent Vascular Injury and Hemodialysis
Permanent Vascular Injury and Hemodialysis
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Study Notes
Additional Factors Related to Vascular Pathology
- Structural damage occurs as a result of permanent scarring in major vessels, common in patients with placement of a fistula.
- Endothelial layer damage initiates collagen layer reactions and platelet activation requiring frequent vascular access procedures.
- Platelet plug.
Patient Assessment and Vein Preservation for Patients with Chronic Kidney Disease
- Activation of blood coagulation and platelets occur when a catheter tip infuses against the vein wall or repeated venipuncture.
- Cumulative damage, receiving hemodyalasis or ongoing exposure to caustic infusates is critical with repeated venipuncture.
- Upper extremity peripheral vein preservation is important for patients.
Osmolality and Venous Access
- Irritant or vesicant infusates or arteriovenous fistulas (optimal vascular access for hemodialysis)
- Extremes in prescriptions require good quality peripheral veins.
- Receiving other renal replacement therapy (Peritoneal dialysis, Kidney transplant).
Assessing for Previous Vascular Injury
- Assess for previous, permanent vascular injury that renders vein unusable for future hemodialysis vascular access including Stenosis or Thrombosis.
- Device selection criteria in CKD stage 3 or greater (eGFR of less than 60 mL/min/1.73 m2) or serum creatinine level greater than 2.0 mg/dL.
- Dorsal metacarpal veins in the dominant hand are preferred for short peripheral IV catheters.
- Veins in the forearm, upper arm, and subclavian are critical location for hemodialysis fistula or graft.
Peripheral Vein Access Procedures
- Veins in these areas (forearm, upper arm, and subclavian) should not be used for venous access procedures (PIV/PICC/Midline).
- These veins should be used only when future hemodialysis vascular access is unlikely.
- Consultation with healthcare teams.
- Avoid prolonged reliance on and implement alternative long-term venous access solutions as soon as possible.
Central Venous Access
- Internal jugular vein is preferred vessel for central venous access.
- Central access using a small diameter (< 8 Fr) catheter intended for long-term use (>1 week) should be via subcutaneous tunnel.
- Subcutaneous tunnel approach reduces the incidence of CLABSI.
Subclavian Vein Access
- Subclavian vein access is not routinely used in this patient population.
- Patient's upper extremity veins should be evaluated using ultrasound or venography.
- If determined to be unsuitable for hemodialysis graft or fistula, ipsilateral subclavian vein may be used after consulting a healthcare team.
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