Aging Adult Vascular Changes PDF

# Aging Adult Population-Related Vascular Changes - Cumulative damage to vasculature due to multiple organ system involvement from aging process - Chronic diseases affect primarily arterial circulation - Diabetes mellitus - Hypertension - Chronic kidney disease -...

# Aging Adult Population-Related Vascular Changes - Cumulative damage to vasculature due to multiple organ system involvement from aging process - Chronic diseases affect primarily arterial circulation - Diabetes mellitus - Hypertension - Chronic kidney disease - Hyper and Hypothyroid - Hepatitis C - Inflammatory Bowel disease - Cancer - Skin changes - Age related collagen depletion - Circulating hormone reduction - Dehydration - Environmental exposure/cigarette smoke exposure - Lifestyle factors affecting individuals' circulatory systems and general well-being - Poor nutritional intake - Chronic stress - Alcohol - Smoking - IV drug use # Laboratory Values to Consider Prior to Device Placement | Component | Normal Range for Adults | Comments | |---|---|---| | White blood cells (WBC) also called leukocytes | 4.5-10 thousand per microliter (mcL) | Leukocytosis: Increase in number of leukocytes (above 10,000/mm3) in circulating blood. Infection is the most common cause. Fever in patients with elevated WBC or WBC trending upwards may indicate active infection that has not yet responded to antibiotic therapy. Other causes include trauma/hemorrhage, coronary occlusion, malignancy, pregnancy (toxemia). It is thought that VAD devices dwelling with a concurrent and untreated bacteremia may initiate bacterial "seeding" of the catheter. Consult with licensed independent provider (often infectious disease provider) to guide appropriate device and determine appropriate timing of insertion of long term or implantable devices | # Kidney Function | Component | Normal Range for Adults | Comments | |---|---|---| | Glomerular Filtration Rate (GFR) | 90-120 mL/min/1.73 m² | Glomerular filtration rate (GFR) is a test used to check how well the kidneys are working. Specifically, it estimates how much blood passes through the glomeruli each minute. Glomeruli are the tiny filters in the kidneys that filter waste from the blood. Indirect measurement of kidney function. Mathematical formula that compares the excretion of creatinine to age, gender, and ethnicity. Utilized to determine the level of kidney function and disease. eGFR is estimated GFR calculated by the abbreviated MDRD equation: 186 x (Creatinine/88.4)-1.154 x (Age)-0.203 x (0.742 if female) x (1.210 if black). Chronic Kidney Disease is defined as a GFR less than 60 mL/min/1.73 m2 for more than 3 months irrespective of the cause. Most reliable source for early identification of person with CKD who requires vessel preservation should they continue toward requiring dialysis. Indicates need for comprehensive vascular access plan in consultation with nephrologist and other health care team members before venipuncture and/or insertion of venous access device | | Creatinine (Cr) | 0.7-1.3 mg/dL in adult male 0.4-1.1 mg/dL in adult female | Serum creatinine is a measure of kidney function (GFR). Chemical waste molecule generated from muscle metabolism. Transported via blood to kidneys, and filtered into the urine. Elevated serum creatinine 2 mg/dL. or greater should be correlated with GFR or eGFR and receive expert vascular access assessment before placement of any vascular access device. A criterion for early identification of person with CKD who may need hemodialysis fistula or graft. Indicates need for comprehensive vascular access | # Coagulation Studies | Component | Normal Range for Adults | Comments | |---|---|---| | Platelets (PLT) | 150-450 thousand per mcl | Placement of VAD in thrombocytopenic patients should be directed by the licensed independent practitioner, hospital policy, the skill and comfort of the inserter and considerations of sites that allow for optimal compressibility. In hypercoagulable patients a PICC may be the most appropriate device. Coagulation profiles should not be a determining contraindication for PICC placement. Platelet transfusions can be administered before or concurrently with VAD Insertion at the discretion of the ordering provider with consideration to patient's long-term need for platelet transfusion and the risks associated with transfusion of blood products | | International Normalized Ratio (INR) | 1.0-1.2 2.1-3.0 for anticoagulant therapy | International normalized ratio (INR) is the preferred test of choice for patients taking vitamin Kantagonists (VKA). It can also be used to assess the risk of bleeding or the coagulation status of the patients. Patients taking oral anticoagulants are required to monitor INR to adjust the VKA doses because these vary between patients. The INR is derived from prothrombin time (PT) which is calculated as a ratio of the patient's PT to a control PT standardized for the potency of the thromboplastin reagent developed by the World Health Organization (WHO) using the following formula: INR-Patient PT Control PT Be cautious if the specimen is taken from a vascular access device because there may be possible heparin contamination that may |