Program Book - Keck School of Medicine of USC - University of ...

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Bacteriology of Access Infection• Staph aureus• Coag (-) Staph• Enterococcus• Gram –negative organisms• Candida• MRSA and VRE are both increasing• 2005, CDC reported 15.4% of all MRSA infectionsoccur in dialysis population and estimated 100X riskof colonization versus non-dialysis patients*Varies by access typeBacteriology of Access InfectionTaylor et al, Infect Control HospEpidemiol, 2002; 23:716-20.Prevention of HemodialysisAccess Infection• Construct fistulas whenever possible• Minimize duration of catheter use• May be some benefit to antimicrobialimpregnated catheters and antimicrobial“lock” solutions but limited data• Meticulous surgical technique, perioperativeantibiotics, avoidance ofhematomas• Education and training of patients, dialysisunit staff101
Prevention of HemodialysisAccess InfectionsCDC MMWR 3/16/12Tunneled Catheter InfectionsCatheter Related Bacteremia (CRB)• Three types, may co-exist• Exit-site infection• Erythema, induration, purulence at exit site• Tunnel infection• Systemic signs of infection: fever, chills (on dialysis),erythema over tunnel• Catheter/Fibrin Sheath Infection• Biofilm• Diagnostic criteria by Infectious Disease Societyof North America• Based on timed quantitative cultures• Decision usually made empiricallyManagement of CRB• Blood cultures, peripheral and catheter• Initiate broad spectrum antibiotics (Vancomycinand aminoglycoside or 3 rd gen Cephalosporin)• Consideration of access site preservationimportant• Five strategies:• Antibiotic Therapy and Preservation• Exchange of catheter over guidewire via existingtunnel• Exchange of catheter over guidewire via new tunnel• Catheter removal/immediate replacement at new site• Catheter removal/delayed replacement102
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Program Book
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Needs AssessmentOver 370,000 patien
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ACKNOWLEDGEMENTSWe would like to th
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No relevant financial relationships
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2:25 pm Vascular Access Infections,
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ESRD in 2012: Socio-economicImpactJ
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Geographic variations in adjustedin
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Adjusted all-cause & cause specific
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ESRD-International ComparisonsPreva
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Outcomes for first-time wait-listed
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NOTES______________________________
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Vascular Access Planning andPreoper
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• Veins not circular but ovoid, m
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VENOGRAM+ -CFDI+ 17(true positive)-
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• Thorough preoperative assessmen
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NOTES______________________________
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Options and Strategies forUpper Ext
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Cimino (radiocephalic) AVFPotential
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Two Stage BBAVFStage 1 anastomosis
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Brachial Artery-Brachial Vein AVFSu
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Forearm AV GraftsLarge surface area
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Comparison of brachial-basilic AVfi
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Racial differences in AVfistula rat
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THANK YOU!46
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Lower ExtremityDialysis AccessAhmed
Page 51 and 52: Lower Extremity Dialysis AccessWhat
Page 53 and 54: Lower Extremity Dialysis AccessData
Page 55 and 56: Lower Extremity Dialysis AccessData
Page 57 and 58: Thank You!LLUMC56
Page 59 and 60: NOTES______________________________
Page 61 and 62: NOTES______________________________
Page 63 and 64: When to Break the Guidelines in Vas
Page 65 and 66: efore initiation of dialysis. It fu
Page 67 and 68: NOTES______________________________
Page 69 and 70: Vascular AccessSurveillanceIs it wo
Page 71 and 72: Monitoring Vs. SurveillanceClinical
Page 73 and 74: Vascular Access Surveillance• Obs
Page 75 and 76: Vascular Access SurveillanceRandomi
Page 77 and 78: Vascular Access SurveillanceRandomi
Page 79 and 80: So why does preemptiveangioplasty n
Page 81 and 82: • ConclusionAccess Surveillance
Page 83 and 84: Management of the Non-MaturingArter
Page 85 and 86: Specific Definition• “…use of
Page 87 and 88: AVF Maturation in Clinical Practice
Page 89 and 90: Hemodialysis Fistula MaturationCons
Page 91 and 92: Physical Exam of AVF• Has an accu
Page 93 and 94: Significant Accessory VeinsSurgical
Page 95 and 96: Venous Stenosis in AVF Body/Outflow
Page 97 and 98: Deep or Excessively Tortuous AVF•
Page 99 and 100: Robert Hye, MD September 27, 2012Ka
Page 101: Influence of Access Type onInfectio
Page 105 and 106: Summary of CatheterManagement in CR
Page 107 and 108: Partial versus Total GraftExcision
Page 109 and 110: Infected Autogenous DialysisFistula
Page 111 and 112: Ischemic Steal Syndrome due to Hemo
Page 113 and 114: Figure 2: (From JACS 2000: Wixon et
Page 115 and 116: Theoretically the presence of a lar
Page 117 and 118: Treatment of Ischemic Steal Syndrom
Page 119 and 120: performing a femoral-femoral bypass
Page 121 and 122: Ligation may still be an option for
Page 123 and 124: arterio-venous fistula. Acta Chir S
Page 125 and 126: David Shavelle, MD September 27, 20
Page 127 and 128: Definitions• Early (Primary) Fail
Page 129 and 130: Dual-Sheath TechniqueStep 1: Thromb
Page 131 and 132: Role of Stent Placement• Stenting
Page 133 and 134: ComplicationsPulmonary Embolism~10%
Page 135 and 136: PrePostMedical Therapy• Clopidogr
Page 137 and 138: Karen Woo, MD September 27, 2012Ass
Page 139 and 140: Dilation occurs over several years
Page 141 and 142: Replace with interposition graft◦
Page 143 and 144: Heparin Proximal and distal control
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Page 147 and 148: Perioperative variableOperative tim
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Page 151 and 152: POLICY ON CULTURAL AND LINGUISTIC C
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KECK SCHOOL OF MEDICINE OF THE UNIV
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