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Hemodiyaliz Hastalarında Damar Giriş Yolu Olarak Kateter Kullanımı: Tek Merkez Deneyimi

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Use of Catheters for Vascular Access among Hemodialysis Patients: A Single Center’s Experience

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Sayfa Aralığı:: 
46-51

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Abstract (Original Language): 
GİRİŞ: Hemodiyaliz hastaları için damar giriş yolu hayati öneme sahiptir. Ülkemizde akut hemodiyalizin çoğu kateter takılarak yapılmaktadır. Bu çalışmada, akut ve/veya kronik hemodiyaliz hastalarında kalıcı ve geçici hemodiyaliz kateteri uygulamalarının erken dönem komplikasyonları incelenmiştir. GEREÇ ve YÖNTEM: Çalışmamıza Mart 2008 - Mayıs 2009 tarihleri arasında hastanemize başvurup acil hemodiyaliz endikasyonu konulan veya değişik nedenlerle damar giriş yolunda disfonksiyon olması nedeniyle kliniğimiz nefrologları tarafından kateter uygulanan hastalar dahil edildi. Toplam 362 hasta (164’ü kadın, %45,3) yaş, cins, kilo, beden kitle indeksi gibi demografik özellikleri yanında, kateter yeri, uygulama tekniği (ultrasonografi kılavuzluğu veya kör teknik), primer hastalıkları, arter ponksiyonu ve kanama gibi ilk üç gün içindeki akut komplikasyonlar ve kateterin kalıcı olup olmadığı, kateter takıldıktan sonra kontrol grafi çekilmesi yönünden değerlendirildi. Ayrıca kateter takılan hastaların kronik veya akut hemodiyaliz hastası olup olmadığı ve hastaların yattığı klinikler kaydedildi. Elde edilen sonuçlar SPSS ile değerlendirildi. BULGULAR: Hastaların ortalama yaşı 60,6±15,6 idi. Hastaların 275’ine (%76) geçici, 87’sine (%24) kalıcı kateter takıldı. Kateterlerin 225’i (sağ 190, sol 35) internal juguler, 135’i (sağ 100, sol 30) femoral ve 7’si (sağ 5, sol 2) subklavyan venlere uygulandı. İşlem sırasında 48 (%13,3) hastada arter ponksiyonu ve bunların 8’inde (%2,2) ciltaltı hematom gelişti. Komplikasyon nedeniyle kateteri çekilen, plevral komplikasyon ve akciğer parenkim hasarı olan veya cerrahi müdahale uygulanan hasta olmadı. SONUÇ: Kateter uygulamasında, çalışmamızda da olduğu gibi daha çok internal juguler ven tercih edilmektedir. Komplikasyon oranımızın düşük olması, diğer ana venlerde problem olmadığı sürece subklavyan venleri tercih etmememizden kaynaklanabilir. Hemodiyaliz kateterlerinin kullanımı özellikle uzun vadede yüksek komplikasyon oranı ile beraberdir. Ayrıca, nefroloji klinik hekimleri tarafından kateterlerin takılması, subklavyan ven kullanım oranlarının uluslararası standartlara çekilmesini sağlayabilir.
Abstract (2. Language): 
AIM: Vascular access is of prime importance for patients on hemodialysis. Most of the unplanned hemodialysis sessions are performed via venous catheters in our country. In the present study, we aimed to study early complications of placement of temporary or permanent hemodialysis catheters to patients with acute and/or chronic renal failure. MATERIAL and METHOD: Patients who were admitted to our clinic between March 2008 and May 2009 due to acute renal failure with need for urgent hemodialysis; and those on a chronic hemodialysis program but with vascular access dysfunction were included in the study. All catheter implantation procedures were performed by specialized nephrologists. A total of 362 patients (164 females, 45.3%) were examined for their demographic parameters such as age, gender, weight, body mass index; the type (permanent or temporary) and the location of the catheter (femoral, jugular or subclavian veins); technique of implantation (ultrasonography guided or blind technique); primary renal disease; acute complications within the first three days such as puncture of the artery, bleeding and findings on the follow-up chest x-ray. In addition we recorded the clinic in which they were visited and whether the patients needed urgent hemodialysis or were on a chronic hemodialysis program. Data were examined with the SPSS software. RESULTS: The mean age of the patients was 60.6±15.6 years. 275 (76%) of the catheters applied were temporary whereas 87 (24%) were permanent. 225 catheters were applied to the internal jugular vein (190 to the right, 35 to the left vein), 135 were applied to the femoral vein (100 to the right, 30 to the left vein) and 7 catheters were implanted to the subclavian veins (5 to the right, 2 to the left vein). Puncture of the artery occurred in 48 patients (13.3%) during the procedure, and 8 of these patients (2.2%) had a subcutaneous hematoma. No patient had lung trauma and there was therefore no need for removal of the catheter or a surgical intervention for the complications. CONCLUSION: The internal jugular vein is the preferred location for catheter insertion as in the present study. Our low complication rate may be related to not preferring the subclavian veins unless there is an anatomic abnormality of the other major veins. Use of hemodialysis catheters are related with high complication rates, especially in the long term. Insertion of the catheters by specialized nephrologists may decrease the rate of using the subclavian veins to international standards.
DOI: 
10.5262/tndt.2010.1001.07

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Aydın Z ve ark: Hemodiyaliz Hastalarında Damar Giriş Yolu Olarak
Kateter Kullanımı: Tek Merkez Deneyimi
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