Factores predictores para la pesquisa precoz en la disfunción de catéteres venosos tunelizados en hemodiálisis

Abstract

A functional vascular access ensures a quality of life for all patients with ESRD who require optimal renal replacement therapy. Among the most frequent problems in dialysis centers regarding the management of vascular accesses is the lack of monitoring methods to detect early the dysfunction of a vascular access and thus preserve the optimal functioning of it. Purpose: in order to establish a non-invasive, specific, low-cost and reproducible method of monitoring that would achieve early detection of the dysfunction of a CVCT and be used in clinical practice by medical and nursing staff. Methodology: Aware of this problem, we performed a prospective analytical observational study in order to detect predictive factors in the dysfunction of a CVCT (tunneled central venous catheter) in hemodialysis. We analyzed 32 patients with CVCT from the dialysis center of the Pontificia Universidad Catolica de Chile, during the months of November 2016 to September 2017 (130 sessions of dialysis). We programmed all the CVCT with an effective QB (real flow registered in dialysis machine) of 300ml / min, monitoring PA (blood pressure of vascular access registered in dialysis machine) not at 150mmHg, evaluating the patient's depuration by measuring KT on line (depuration of the patient per unit of real time) in each dialysis session, taking a chest x-ray post catheter installation to evaluate the location of This and recirculation test. Results: The dysfunction of a CVCT would not be related to the type of catheter (DP-P) but to its location. The parameters of dysfunctional alert in a CVCT are decrease in BP 150mm / Hg when programming an effective QB of 300ml / min, accompanied by a deficient depuration of the patient, measured through KT on line ( men <50 liters, Women <45 liters).