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- Radio-cephalic fistula recovered with drainage to forearm basilic veinPublication . Norton de Matos, António; Sousa, Clemente Neves; Almeida, Paulo; Teles, Paulo; Loureiro, Luís; Teixeira, Gabriela; Rego, Duarte; Teixeira, SérgioDysfunction problems with vascular access are a concern to patients and dialysis units. The vascular surgeon should analyse such dysfunction and perform a careful assessment of the vascular network in order to find new fistula layouts. We introduce and discuss the case of creation of a radio-cephalic fistula with outflow into the forearm basilic vein through rotation of the forearm basilic vein toward the cephalic vein in the forearm of an 88-year-old hemodialysis male patient. This technique enables extending fistula patency and improves cost efficiency.
- Effect of Dialysis Day on Intradialytic Hypotension RiskPublication . Rocha, Ana; Sousa, Clemente Neves; Teles, Paulo; Coelho, Augusto; Xavier, EvaBackground/Aims: Intradialytic hypotension (IDH) is a serious and frequent complication of hemodialysis (HD). Thus far, data are scarcely available to assess the impact of first versus subsequent HD sessions of the week in IDH. Therefore, the purpose of this work was to evaluate IDH risk in patients on thrice-weekly HD. Methods: We conducted an analysis of all blood pressure (BP) measurements obtained during 492 HD treatments given to 41 prevalent adult patients over a one month period. A logistic regression model for repeated binary observations was used to determine the association between hypotension and patient and dialysis factors. Results: The incidence of IDH was 32.5%. First dialysis session of the week was associated with a 9% higher risk of hypotension relatively to the second one. The risk was even higher from the first to the third session of the week (60%) and from the second to the third (50%). A higher hypotension odds ratio was also associated with age (1.03, 90%CI: 1.01-1.06), higher predialysis BP (1.04, 90%CI: 1.03-1.05) and higher phosphorus level (1.38, 90%CI: 1.07-1.76). The risk decreased 24.4% for each additional antihypertensive drug taken by the patient. Conclusions: The odds of hypotension occurrence decrease throughout dialysis sessions of the week. Minimizing modifiable risk factors may decrease IDH episodes.
- Self-care in Preserving the Vascular Network: Old Problem, New Challenge for the Medical StaffPublication . Sousa, Clemente Neves; Ligeiro, Inês; Teles, Paulo; Paixão, Lúcia; Dias, Vanessa FF; Cristovão, António FTeaching/educating patients with end stage renal disease (ESRD) and identifying their self-care behaviors for vascular network preservation are very important. However, the self-care behaviors regularly performed by patients are still unknown. We compared self-care behaviors for vascular network preservation performed by patients who are/are not followed-up by the nephrologist. The study design was a prospective, observational and comparative study. Inclusion criteria were as follows: ESRD patients (at stages 4 or 5); at least 18 years old; in pre-dialysis with at least a 6-month follow-up period by the nephrologist or who started dialysis in emergency and were not followed-up by the nephrologist; with no memory problems; and medically stable. Primary outcome was the frequency of self-care behaviors for vascular network preservation. Secondary outcome was the comparison between self-care behaviors by ESRD patients who were/were not followed-up by the nephrologist. The study involved 145 patients, 64.1% were female, the mean age was 69.5 years and the self-care behaviors mean score was 36.8% (with a SD of 39.8%). The number of patients followed-up and not followed-up by the nephrologist was 109 (group 1) and 36 (group 2), respectively. Social characteristics were similar in the two groups (P > 0.05). The mean self-care behaviors were 29.4% and 59.2% in groups 1 and 2, respectively (P = 0.000). Patients performed self-care behaviors for vascular network preservation with a relatively low frequency (the mean score was 36.8% only). Patients not followed by the nephrologist performed self-care behaviors more often than those who were followed (59.2% vs. 29.4% respectively, P = 0.000).
- Construction and validation of a scale of assessment of self-care behaviors with arteriovenous fistula in hemodialysisPublication . Sousa, Clemente Neves; Apóstolo, João Luís Alves; Figueiredo, Maria; Dias, Vanessa Filipa Ferreira; Teles, Paulo; Martins, MMSeveral guidelines recommend the importance of educating the patient about the care of vascular access. Nurses have a key role in promoting the development of self-care behaviors by providing the necessary knowledge to patients, so that they develop the necessary skills to take care of the arteriovenous fistula (AVF). This article describes the process of building a scale of assessment of self-care behaviors with arteriovenous fistula in hemodialysis (ASBHD-AVF). This is a cross-sectional study in which the development, construction, and validation process followed the directions of the authors Streiner and Norman. This is a convenience sample, sequential, and nonprobabilistic constituted by 218 patients. The study was conducted in two stages during 2012-2014. The first phase corresponds to the scale construction process, 64 patients participated, while the second corresponds to the evaluation of metric properties and 154 patients participated. The principal component analysis revealed a two-factor structure, with factorial weights between 0.805 and 0.511 and between 0.700 and 0.369, respectively, explaining 39.12% of the total variance of the responses. The Cronbach's alpha of the subscale management of signs and symptoms is 0.797 and from the subscale prevention of complications is 0.722. The ASBHD-AVF revealed properties that allow its use to assess the self-care behaviors in the maintenance and conservation of the AVF.
- Construction and validation of a scale of assessment of self-care behaviours anticipatory to creation of arteriovenous fistulaPublication . Sousa, Clemente Neves; Figueiredo, Maria; Dias, Vanessa Filipa; Teles, Paulo; Apóstolo, João LuísAims and objectives. We developed a scale to assess the self-care behaviours developed by patients with end-stage renal disease to preserve the vascular network prior to construction of arteriovenous fistula. Background. The possibility of creation of an arteriovenous fistula depends on the existence of an arterial and venous network in good condition, namely the size and elasticity of the vessels. It is essential to teach the person to develop self-care behaviours for the preservation of the vascular network, regardless of the modality of dialysis selected.Design. Methodological study. Methods. The scale was developed based on clinical experience and research conducted by the researcher in the area of the vascular access for haemodialysis. The content of the scale was judged by two panels of experts for content validity. The revised version of the scale was administered to a convenience sample of 90 patients with end-stage renal disease. In the statistical analysis, we used the Cronbach’s alpha, the Kaiser–Meyer–Olkin and scree plot and the principal component analysis with varimax rotation. Results. A principal component analysis confirmed the univariate structure of the scale (KMO = 0 759, Bartlett’s sphericity test-approximate v2 142 201, p < 0 000). Cronbach’s a is 0 831, varying between 0 711–0 879. Conclusion. This scale revealed properties that allow its use to assess the patients self-care behaviours regarding the preservation of the vascular network. Relevance to clinical practice. This scale can be used to evaluate educational programmes for the development of self-care behaviours in the preservation of vascular network. This scale can identify not only the patients that are able to take care of their vascular network but also the proportion of patients who are not able to do it, that need to be educated.
- Frequency of intradialytic hypotensive episodes: old problem, new insightsPublication . Rocha, Ana; Sousa, Clemente Neves; Teles, Paulo; Coelho, Augusto; Xavier, EvaSymptomatic intradialytic hypotension (IDH) continues to be an important complication of hemodialysis treatment. There is some evidence that besides an IDH episode, repeated episodes could represent an even more important independent risk factor for mortality in hemodialysis patients. A retrospective cross-sectional study was performed to study 18 dialysis treatments in 43 patients during 6 weeks. Relationships of IDH episodes with baseline variables were examined using a Poisson regression model (generalized linear model). IDH was frequent (93% of patients) and highly variable by patient (0%-100%). Multivariate analysis showed that patients who experienced frequent hypotensive episodes had a lower dry weight (90% confidence interval [CI]: 0.95-0.99), higher phosphorus levels (90% CI: 1.07-1.47), greater prevalence of diabetes mellitus (90% CI: 1.11-2.71), and hypertension (90% CI: 1.04-2.45). Dry weight, hypertension, and phosphorus levels are modifiable risk factors to possibly reduce the rate of IDH episodes. The potential protective role of phosphorus warrants further investigation.
- Arteriovenous access banding revisitedPublication . Teixeira, Gabriela; Almeida, Paulo; Sousa, Clemente Neves; Teles, Paulo; De Sousa, Paulo; Loureiro, Luís; Teixeira, Sérgio; Rego, Duarte; Almeida, Rui; Norton de Matos, AntónioThe aim of this study is to validate the current applicability of arteriovenous access banding in high flow access (HFA) and/or haemodialysis access-induced distal ischaemia (HAIDI). This retrospective study was conducted at the GEV (Grupo de Estudos Vasculares) vascular access centre. The clinical records of consecutive patients undergoing banding for HAIDI and HFA symptoms, between June 2011 and January 2015, were reviewed until April 2015. All vascular access patients’ consultation records and surgical notes were reviewed. We analysed and compared patients’ age, gender, comorbidities, symptoms and intraoperative ultrasound control. We defined technical failure as recurrence of symptoms, requiring new banding. Excessive banding, access thrombosis, rupture and false aneurysm development were registered as complications. Primary clinical success was defined as improvement of symptoms or effective flow reduction after banding, with no need for reintervention. If one reintervention was necessary, we have defined it as secondary clinical success. Overall, 119 patients underwent banding: 64 (54%) with HAIDI and 55 (46%) with HFA. The HAIDI group was significantly older (65 ± 13 years compared with 56 ± 22 years, p = 0.001) and had significantly greater number of patients with diabetes (56% vs 24%, p = 0.004). Primary success was achieved in 85 patients (71.4%) and the secondary success rate was 84.9%. Older age (p = 0.016) and intraoperative ultrasound control (p = 0.012) were significantly associated with primary success. Our results do not corroborate the high incidence of thrombosis previously reported as associated with AV access banding and suggest that ultrasound control is crucial for preventing technical failure. The procedure was effective on both compared groups.