Additional Factors Related to Vascular Pathology PDF

# Additional Factors Related to Vascular Pathology * **Structural damage:** Stenosis occurs as a result of permanent scarring in major vessels; common in patients with a history of chronic medical conditions, especially those requiring frequent VAD placement (i.e., cystic fibrosis patients) * **End...

# Additional Factors Related to Vascular Pathology * **Structural damage:** Stenosis occurs as a result of permanent scarring in major vessels; common in patients with a history of chronic medical conditions, especially those requiring frequent VAD placement (i.e., cystic fibrosis patients) * **Endothelial layer damage:** Begins with vein wall puncture and initiates collagen layer reaction for platelet activation to create platelet plug * **Activation of blood factors to deposit fibrin over platelet plug at the site of vein wall injury** * **Collagen and platelet activation occur when catheter tip is infusing against the vein wall or catheter movement.** * **Patient Assessment and Vein Preservation for Patients with Chronic Kidney Disease:** Primary damage occurs with repeated venipuncture. Upper extremity peripheral vein preservation is critical for patients: * Cumulative damage received by repeated dialysis or ongoing exposure to caustic infusates * Irritant or vesicant infusates in hemodialysis, in the future. * Osmolality 900 mOsm/L often creates arteriovenous fistula (optimal vascular access for hemodialysis) * Extremes in pH requires good quality peripheral veins in the arms * Receiving other renal replacement therapy * Peritoneal dialysis * Kidney transplant * Assess for previous, permanent vascular injury that renders vein unusable for future hemodialysis vascular access * Stenosis * Thrombosis * **Site and device selection 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 of dominant hand are preferred location for short peripheral IV catheters if needed for short term infusions of appropriate medications. * Veins in the forearm, upper arm, and subclavian are of critical importance for creation of hemodialysis fistula or graft. * These veins should not be used for venous access procedures (PIV/PICC/Midline). * These veins should be used only when future hemodialysis vascular access is unlikely and after consultation with healthcare team. * Avoid prolonged reliance on limited peripheral veins * Identify and implement alternative long-term venous access solutions as soon as possible * **Internal jugular vein is preferred vessel for central venous access.** * Central access via the internal jugular vein using a small diameter (< 8 Fr) catheter intended for long-term use (>1 week) should be inserted via subcutaneous tunnel * IJ access via subcutaneous tunnel has been shown to reduce the incidence of CLABSI * **Subclavian vein access:** * Should not be routinely used in this patient population * If patients' upper extremity veins are evaluated using ultrasound or venography and determined to be unsuited for hemodialysis graft or fistula, ipsilateral subclavian vein may be used after consulting healthcare team.