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- Interventions to promote self-care of people with arteriovenous fistulaPublication . Sousa, Clemente Neves; Apóstolo, João Luís; Figueiredo, Maria; Martins, MM; Dias, Vanessa FThe literature shows many self-care behaviours related to people with end-stage renal disease (ESRD). Our aim is to identify interventions within the 'teaching' that promote self-care (behaviour) with arteriovenous fistula (AVF).
- 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.
- Two-Stage Basilic Vein Transposition: Second Stage ResultsPublication . Rego, Duarte; Nogueira, Clara; Matos, António; Almeida, Paulo; Queirós, José; Silva, Fernanda; Sousa, Clemente Neves; Almeida, RuiThe increasing survival of hemodialysis patients results in the depletion of superficial venous capital justifying the use of the basilic vein. Many groups still prefer an arteriovenous graft due to transposition complexity and the time needed to achieve maturation. In this work we review the results of our series of basilic vein transpositions (BVT). BVTs were performed in two stages: first, creation of the fistula; second, transposition of the vein using three small incisions in the arm. All patients had to have direct arterialization of the basilic vein, therefore, patients with previous ipsilateral wrist fistulas also followed a two-stage protocol. Data were retrospectively revised from all transposition procedures made between September 2005 and November 2012. Patency and complication rates were the primary outcomes evaluated. A total of 276 basilic veins were transposed. Usage rate was 82.2%. 8% (N = 22) of the fistulas were never used due to thrombosis. Secondary patency rates at 1 and 2 years were, respectively, 84% and 66.3%. Complications occurred in 61.6% (N = 170) of fistulas and 65.9% (N = 112) of which had to undergo surgical or endovascular revision. The most frequent complication was vein stenosis (39.7% of late complications, N = 92). Albeit its greater technical complexity, the transposed basilic vein represents a hemodialysis access with good patency rates. Complication rates, although high, are less than those of CVC or prosthetic grafts. These results support the use of the transposed basilic vein as hemodialysis access after the brachiocephalic fistula.
- 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).
- Self‐Care Behavior of Hemodialysis Patients With Arteriovenous Fistula in China: A Multicenter, Cross‐Sectional StudyPublication . Yang, Miao‐miao; Zhao, Hui‐hua; Ding, Xiao‐qiang; Zhu, Guo‐hong; Yang, Zhen‐hua; Ding, Lin; Yang, Xiong‐hao; Zhao, Yuan; Chen, Lei; Yang, Ren‐mei; Fang, Jian; Sousa, Clemente NevesImproving the level of arteriovenous fistula (AVF) self-care behavior by people receiving hemodialysis is an effective way to reduce the occurrence of complications and mortality. The aim of this study was to assess the self-care behavior of Chinese patients undergoing hemodialysis with arteriovenous fistula. The assessment of self-care behaviors with arteriovenous fistula in hemodialysis (ASBHD-AVF, Portuguese version) was translated into Chinese using Brislin's translation model. The content validity was evaluated by six experts. Then we involved 301 hemodialysis patients with AVF to explore the construct validity of the Chinese version of ASBHD-AVF. Ultimately 216 patients from eight dialysis centers of general hospitals in China were recruited to evaluate the patients' self-care behavior about AVF. Measures included demographic questionnaire, and the Chinese ASBHD-AVF. The Chinese ASBHD-AVF that included 12 items has a good internal consistency (α = 0.865) and content validity (CVI = 0.979). Principal component analysis generated two factors which explained 53.525% of the total variance. About 69.9% of hemodialysis patients' AVF self-care behavior were at a low or moderate level. The level of self-care behavior and knowledge need to be improved. Nurses should give specific guidance according to the patients' own characteristics and different influence factors, in order to improve the recipients' self-care behavior.
- 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.
- Brachial-cephalic fistula recovered with drainage for the basilic vein: Case reportPublication . Sousa, Clemente Neves; Norton de Matos, António; Rocha, Ana; Almeida, Paulo; Xavier, EvaVascular access is essential for the implementation of hemodialysis (HD). The arteriovenous fistula (AVF) can be constructed in various locations using various veins. However, the quality of the veins will influence the construction site, as well as the functioning of the AVF. Careful analysis of the vascular network allows options for the development of new fistulas presentations. We present and discuss the case of a woman aged 69 years in HD in which a brachial-cephalic fistula with drainage to basilic vein was created, through rotation of the cephalic vein on the forearm level. This kind of access serves to prolong the time spent dialyzing through native fistulae, with their reduced complications and greater cost-effectiveness.
- Radiocephalic Fistula Recovery Using the Brachial Vein and Forearm Basilic Vein: A Case Series and Literature ReviewPublication . Norton de Matos, António; Sousa, Clemente Neves; Almeida, Paulo; Teles, Paulo; Rego, Duarte; Teixeira, Gabriela; Loureiro, Luís; Teixeira, Sérgio; Antunes, InêsVascular access dysfunction is a serious problem in dialysis units. Some patients have complex dysfunctions that are difficult to resolve. In this article, we report the case a of two patients with radiocephalic arteriovenous fistulae (RC-AVF) who had stenosis/occlusion of the forearm median vein and where we used the basilic vein of the forearm as a solution. We reviewed the use of this surgical solution in RC-AVF. Two male patients on hemodialysis exhibited stenosis/occlusion of the forearm median vein. The forearm basilic vein was isolated and rotated toward the forearm median vein in order to solve RC-AVF problems. One patient had fistula thrombosis 5 months after the procedure, while for the other patient, the fistula continues to work without problems. Literature describes only a few cases using the forearm basilic vein or the brachial vein for fistula recovery. This procedure increased the patency of fistulas. This approach has been proven to be a good solution for solving outflow problems using the superficial or deep veins, increasing fistula patency and avoiding the need to place a central venous catheter and all the related complications.