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- Radio‐cephalic fistula recovered with drainage to median basilic vein by straightening of the forearm cephalic vein: A case reportPublication . Costa, Luísa Lemos; Matos, António Norton; Almeida, Paulo; Teles, Paulo; Loureiro, Luís; Campos, Luís; Delgado, Elisabete; Oliveira, Debora; Campos, Tiago; Inácio, Marta; Fernandes, Filipa; Coutinho, Sara; Ventura, Ana; Pereira, Susana; Castro, Ana; Xavier, Eva; Sousa, Clemente NevesThe distal arteriovenous fistula (AVF) has less complications and better patency than the proximal fistula, when it works properly. The complications of outflow of the fistula are complex, and it is necessary to analyze all solutions to solve the problem. We introduce a novel approach to solve outflow problems of a radio-cephalic AVF by straightening of the forearm cephalic vein with drainage into the median basilic vein.
- Physical examination of arteriovenous fistula: The influence of professional experience in the detection of complicationsPublication . Sousa, Clemente Neves; Teles, Paulo; Dias, Vanessa Filipa Ferreira; Apóstolo, João Luís Alves; Figueiredo, Maria; Martins, MMVascular access is one of the leading causes of mobilization of financial resources in health systems for people with chronic kidney disease on hemodialysis. Physical examination of the arteriovenous fistula (AVF) has demonstrated its effectiveness in identifying complications. We decided to evaluate the influence of nurses' professional experience in the detection of complications of the AVF (venous stenosis and steal syndrome). The study took place in eight hemodialysis centers between May and September of 2011 in the north of Portugal. Sample was constituted by registered nurses. The nurses involved in the experiment were divided in two groups: those who had more than 5 years of experience and those who had less than 5 years of experience. Ninety-two nurses participated in the study: 34 nurses had less than 5 years of professional experience and 58 had more than 5 years of professional experience. In the practices considered by nurses in the detection of venous stenosis, there were no differences observed between the groups (P > 0.05). In steal syndrome, there were no differences observed between the groups in the practices of the nurses in the detection of this complication of the AVF (P > 0.05). We concluded that professional experience does not influence the detection of venous stenosis and steal syndrome.
- 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.
- Scale of Assessment of Self-Care Behaviors with Arteriovenous Fistula in Hemodialysis: A Psychometric Study in BrazilPublication . Lira, Marta Nunes; Sousa, Clemente Neves; Wanderley, Maria Carolina Medeiros; Pessoa, Natália Ramos Costa; Lemos, Kelly Cristiane Rocha; Manzini, Carlene Souza Silva; Nicole, Andressa Garcia; Morais, Sheila Coelho Ramalho Vasconcelos; Frazão, Cecília Maria Farias de Queiroz; Ramos, Vânia Pinheiro; Teles, Paulo; Ribeiro, Olga; Dias, Vanessa Filipa Ferreira; de Souza, Lara Helk; Ribeiro, Rita Cássia Helú Mendonça; Magalhães, Anna Luiza Pereira; de Sá Basílio Lins, Silvia Maria; Pressi, Maira Maria Trevisan; Dourado, Polyana Bezerra Mendonça; Delgado, Millena Freire; Mendonça, Ana Elza Oliveira; Pinheiro, Jacielly Andes Araújo; Ozen, NurtenThe purpose of this study was to evaluate the psychometric properties of the Brazilian Scale for the Assessment of Self-Care Behaviors with Arteriovenous Fistula in Hemodialysis. Cross-sectional validation study, followed the recommendation provided by Sousa and Rojjanasrirat. Content validity, explanatory and confirmatory factor analyses used to check validity and Cronbach's alpha was the reliability measure. Three hundred hemodialysis patients with arteriovenous fistula were included in the study. The expert committee assessed the content validity. Exploratory factor analysis confirmed the same two-factor structure found for the original scale, explaining 60.10% of the variance. Such solution was checked by confirmatory factor analysis with Cronbach's alpha equal to 0.920, 0.810, and 0.884 for the overall scale, the self-care in management of signs and symptoms and the self-care in prevention of complications subscales respectively. The scale has good psychometric properties to assess self-care behaviors and can be used with Brazilian patients on hemodialysis with arteriovenous fistula.
- Effects of demographic and clinical character on differences in self‐care behavior levels with arteriovenous fistula by hemodialysis patients: An ordinal logistic regression approachPublication . Sousa, Clemente Neves; Teles, Paulo; Paquete, Ana Rita Cabral; Dias, Vanessa Filipa Ferreira; Manzini, Carlene Souza Silva; Nicole, Andressa Garcia; Sousa, Rui André Saldanha Santos; de Souza, Lara Helk; Ribeiro, Olga; Lira, Marta Nunes; de Queiroz Frazão, Cecília Maria Farias; Ramos, Vânia Pinheiro; Leal, Luciana; Ribeiro, Rita Cássia Helú Mendonça; Magalhães, Anna Luiza Pereira; de Sá Basílio Lins, Sílvia Maria; Mendonça, Ana Elza Oliveira; Delgado, Millena Freire; Pressi, Maira Maria Trevisan; Pressi, Nicole Trevisan; Campos, Luís; Campos, Tiago; Gonçalves, Diana; Ribeiro, Edgar; Ozen, NurtenIntroduction: Hemodialysis (HD) patients should be trained to develop selfcare behaviors in order to prevent and preserve their arteriovenous fistula (AVF). The aim of this study was identifying the factors that affect the levels of self-care behavior with AVF by HD patients. Methods: A cross-sectional study was conducted involving 89 patients. Results: Self-care levels were negatively affected by patients' location (Azores) and positively affected by marital status, education, employment, AVF duration, and absence of complications with the AVF. Concerning the management of signs and symptoms, self-care levels were negatively affected by patients' location. Regarding prevention of complications, self-care levels were negatively affected by age and marital status and positively affected by marital status, employment, chronic kidney disease etiology, AVF duration, and previous AVF. Conclusion: Further studies are required in order to confirm whether the considered factors affect levels of self-care behaviors with AVF, or whether other factors are needed as well.
- 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.
- Ruptured arteriovenous fistula pseudoaneurysm treatment by balloon‐assisted direct percutaneous thrombin injectionPublication . Loureiro, Luís; Mendes, Daniel; Sousa, Clemente Neves; Almeida, Paulo; Norton de Matos, António; Teles, Paulo; Rego, Duarte; Teixeira, Gabriela; Teixeira, Sérgio; Antunes, Inês; Costa, Luísa Lemos
- 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.