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Our experience for 4-7mm tapered graft
Results: When comparing to U.S. National Benchmark, hospitals using Maximal Barrier Precautions had a greater percentage that were better than U.S. National Benchmark, compared to Protected Catheter Alone, or undefined. The size of the hospital, as quantified by the average of Total Medicare Revenue, was proportional to the type of protective strategy used. Implications: This challenge of balancing three goals e improving patient outcomes, the quality of care, and managing costs is typical throughout healthcare and is consistently mentioned as a top issue with hospital CEOs and CFOs. 65% of the FY2015 Total HAC Score is attributable to either urinary tract catheter or vascular access device (VAD)-related, and both require more focus and resource allocation to form effective risk reduction strategies. Conclusions: With most U.S. hospitals operating at a less than 3% margin, this costs-analysis critically evaluates the impact of VAD-related complications, and supports substantial costsavings to hospitals that implement guideline-driven infection risk reduction strategies.
Our experience for 4-7mm tapered graft Tomohiro Nakamura Background: Tapered graft is proper for the patients that have a risk of steal syndrome, congestive heart failure, high flow complication. So we decided the indication for AVG with 4-7mm tapered graft as follows, 1. upper limb and thigh lesions 2. the fear of steal syndrome and congestive heart failure 3. the high flow shunt. Materials and Methods: From May 2012 to December 2015 we performed 89 bypass surgery in 88 patients using with 4-7mm tapered GORE INTERING. Basic AVG are brachial artery-proximal axillary vein bypass 14 cases and brachial artery-basilic vein of the upper limb loop bypass 28 cases and brachial artery-cephalic vein or brachial vein loop bypass 16 cases, and another bypass are 31 cases. Results: Ages were 25 to 92(Mean 71.8 ) with 39 males and 49 females. Mean follow up was 29 months (range 7-43 months). Primary & assisted patency at 12 months was 66% & 86%. The early complication is worse of cardiac failure due to severe aortic valve stenosis. This case was ligated of graft ten days later post operation. Except for one case, we
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didn’t have an early complication, postoperative graft obstruction and infection as well. Mean graft flow is 322〜 2280ml/min(average 731 409ml/min). In the late period, we had the two cases with graft infection and three with steal syndrome. We decided the ligation of graft over 1000ml/min shunt flow. Conclusions: 4-7mm tapered graft is suitable for AVG. But it seems to require attention in relation to indication for AVG in the case of severe aortic stenosis and result with high flow shunt.
Protecting the Vessels- Options for the Cystic Fibrosis Patient Cheryl Gillette Background: Cystic Fibrosis is a chronic debilitation disease affecting 70,000 worldwide and approximately 30,000 in the United States. The advancements in medical therapy have improved the quality of life and increased mortality rates to an average mean age of 40 years. Purpose: Development of vascular access preservation strategies to improve long term outcomes beginning from diagnosis through the pediatric years through the transition into adulthood. Project: The introduction of the long dwell intravenous catheter as an alternative venous access device versus a peripherally inserted central catheter for the in-hospital “tune up” admission. Results: There is evidence of improved patient satisfaction scores related to the use of the device. Due to the small sample size more data is needed to be conclusive. Implications: Early family education and participation in the care management of the cystic fibrosis patient is paramount to successful application of vascular access preservation. The introduction of advancing technology and vascular access options allows them to understand and anticipate the long term ramifications of vessel preservation in a chronic disease. Conclusions: Cystic Fibrosis is a debilitating chronic disease affecting children who are committed to lifelong medical interventions. Options for vascular access in collaboration with the family and medical providers should be individualized to meet patient’s needs with a long term goal of vessel preservation.
2016
Our experience for 4-7mm tapered graft Tomohiro Nakamura Background: Tapered graft is proper for the patients that have a risk of steal syndrome, congestive heart failure, high flow complication. So we decided the indication for AVG with 4-7mm tapered graft as follows, 1. upper limb and thigh lesions 2. the fear of steal syndrome and congestive heart failure 3. the high flow shunt. Materials and Methods: From May 2012 to December 2015 we performed 89 bypass surgery in 88 patients using with 4-7mm tapered GORE INTERING. Basic AVG are brachial artery-proximal axillary vein bypass 14 cases and brachial artery-basilic vein of the upper limb loop bypass 28 cases and brachial artery-cephalic vein or brachial vein loop bypass 16 cases, and another bypass are 31 cases. Results: Ages were 25 to 92(Mean 71.8 ) with 39 males and 49 females. Mean follow up was 29 months (range 7-43 months). Primary & assisted patency at 12 months was 66% & 86%. The early complication is worse of cardiac failure due to severe aortic valve stenosis. This case was ligated of graft ten days later post operation. Except for one case, we
270
j
JAVA
j
Vol 21 No 4
j
didn’t have an early complication, postoperative graft obstruction and infection as well. Mean graft flow is 322〜 2280ml/min(average 731 409ml/min). In the late period, we had the two cases with graft infection and three with steal syndrome. We decided the ligation of graft over 1000ml/min shunt flow. Conclusions: 4-7mm tapered graft is suitable for AVG. But it seems to require attention in relation to indication for AVG in the case of severe aortic stenosis and result with high flow shunt.
Protecting the Vessels- Options for the Cystic Fibrosis Patient Cheryl Gillette Background: Cystic Fibrosis is a chronic debilitation disease affecting 70,000 worldwide and approximately 30,000 in the United States. The advancements in medical therapy have improved the quality of life and increased mortality rates to an average mean age of 40 years. Purpose: Development of vascular access preservation strategies to improve long term outcomes beginning from diagnosis through the pediatric years through the transition into adulthood. Project: The introduction of the long dwell intravenous catheter as an alternative venous access device versus a peripherally inserted central catheter for the in-hospital “tune up” admission. Results: There is evidence of improved patient satisfaction scores related to the use of the device. Due to the small sample size more data is needed to be conclusive. Implications: Early family education and participation in the care management of the cystic fibrosis patient is paramount to successful application of vascular access preservation. The introduction of advancing technology and vascular access options allows them to understand and anticipate the long term ramifications of vessel preservation in a chronic disease. Conclusions: Cystic Fibrosis is a debilitating chronic disease affecting children who are committed to lifelong medical interventions. Options for vascular access in collaboration with the family and medical providers should be individualized to meet patient’s needs with a long term goal of vessel preservation.
2016