End Stage Renal Disease Case Study

The blood vessel that Dr. Eltahawy was concerned about was thin and looked as though it would collapse in on itself. First, Dr. Eltahawy tried a balloon catheter. At the top of the catheter was a small balloon that could inflate to maintain a shape or structure of a blood vessel. However, because the blood vessel was so thin, the balloon catheter was not very effective. Instead, Dr. Eltahawy installed a stent. A stent is a wire mesh tube. It is placed in a blood vessel permanently to maintain the shape of the vessel and to allow for the free flow of blood. Throughout this entire independent study, I realize that shadowing in the medical field is less about learning about medicine and more about discovering about whether becoming a doctor is the right step. This independent study has been a step in the right

After the obstruction was detected with the arteriogram, the patient underwent percutaneous catheter-directed thrombolytic therapy with alteplase in order to regain blood flow and nutrients to the right foot and lower leg. This choice of therapy is chosen with the goal to quickly dissolve the arterial obstruction (National Institute of Health, 2014b). Although the TPA in alteplase will not restore the damaged or

Aortic arch angiogram: shows right aortic arch with the following branching pattern (from proximal to distal): left common carotid, right common carotid, right subclavian artery. The origin of left subclavian (with anomalous origin) was not seen as it was ligated previously. However, the distal portion is filled with diluted contrats likely through a retrograde flow through the left vertebral artery. Patent Rt MAPCA with no intimal ingrowth was seen in the previously placed stent at the origin of Rt MAPCA. Dilated tortus RIMA which is likely profusion the right upper lung lobe (aortopulmonary collaterals) left BT shunt is wide patent (connected left common carotid artery to the interposition graft) with good caliber with mild narrowing at its insertion in the interposition graft.

One of the most reliable long term central venous access devices is a Port-a-Cath. There are numerous health professionals that have confirmed that implanted port devices have a lower risk of any complications and infection. Typically, this type of access devices is also used because of the variety of medications that maybe pumped into this device without causing much damage to the vasculature. The intention of this paper is to show evidence based practice implications with the use of the Port-a-Cath device, as well as analyze any barriers to the practice implications.

All TAVI procedures were performed in a hybrid catheterization laboratory by the team comprised of interventional cardiologist, cardiac surgeon or vascular surgeon, anesthesiologist, echocardiographer, nurses and technicians as previously described [15]. The general or local anaesthesia and sedation, without the use of cardiopulmonary bypass was applied. Procedures were performed under angiographic and echocardiographic guidance. Before the procedure, a temporary pacing lead was inserted into the right ventricle through a jugular or femoral vein. Arterial access was obtained by cannulation of the right or left common femoral artery, with postprocedural haemostatasis achieved by using vascular closure systems (StarClose or Proglide), or by direct

In reviewing Heparin flushes in Central Venous Catheters (CVCs); one must first understand the importance of their placement. To properly investigate central venous catheter (CVC) care; documentation will focus on Heparin flushes as it relates to renal care. The renal dialysis patient undergoes CVC placement as a basis of receiving hemodialysis treatments. It is essentially the first access point placed in preparation of a more permanent access point. Central venous catheters, fistulas, and grafts are considered the lifeline of a dialysis patient. Their function and patency is of the utmost importance to the morbidity and mortality rate of a renal patient. “Venous catheters generally develop a fibrin sheath at the tip, which evolve into a clot due to body’s physiological response to the vein injury and the foreign catheter 1 and subsequent catheter obstruction.” (Journal of Evolution of Medical and Dental Sciences, 2014, pg. 46).

Since the time that I had the Norwood procedure, a variation of this surgery has been created. Instead of using a connection

Catheter angiography can accurately evaluate aortic pararenal patency. This is especially important when placing engrafts at the iliac bifurcation site. CTA is more sensitive to assessing endoleaks occurring after EVAR procedures, but digit subtraction angiography (DSA) is more accurate in classifying endoleaks. This is possible because the direction of flow in or out of the aneurysm site can be evaluated via DSA. Catheter angiography plays a role in imaging intraoperative EVAR patients for endoleak classification and for post-operative re-intervention (Francois et al., 2012). Figure 5 illustrates an arteriogram taken in preparation for an EVAR procedure, while Figure 6 was taken after the EVAR procedure was

• A cuff may be placed around your upper leg to slow bleeding during the procedure.

From peg legs and hooks to mechanical arms and legs, prosthetics have improved drastically since the dawn of time. Prosthetics have allowed amputees to obtain more mobility and flexibility in their lives. The advancements in prosthetics have also led to a better understanding in the area of amputation and in the assembly of the prosthetics themselves. The question is what allowed the advancements of prosthetics to happen in the first place? The answer lies within technology and its role in the medical field. Technology has allowed for prosthetics to not only look like real limbs, but to function as though they are real. Progression in the fabrication of the prosthetic limbs from wood and leather, to now programmable microprocessor controls

We optimized his medical therapy, inotropic support and performed a successful cardioversion. Despite these interventions, the patient’s clinical status continued to decline with worsening fluid retention, progressive AKI (SCr 3.8mg/dl) and multiple episodes of ventricular tachycardia and ventricular fibrillation terminated by his implantable cardiac defibrillator (SAVE score -2) 5. We made the decision to insert a partial right ventricular assist device and a left ventricular assist device with extracorporeal membrane oxygenation for biventricular support and oxygenation. The patient underwent a left mini-thoracotomy, with off-pump trans-apical placement of a 31 French ProtekDuo® cannula. We secured the device using 3.0 Prolene purse-string sutures. The cannula provided a route for blood exchange with the inflow port located in the left ventricle and outflow port and cannula tips situated 2-3cm above the aortic valve. The blood circulated by the cannula passed through an extra-corporeal membrane oxygenator (TandemLung®) and pump (TandemHeart®). We also placed a 21 French IVC-SVC venous cannula via the femoral vein and connected the tubing to the inflow of the trans-apical ProtekDuo® cannula (figure 1). The LVAD was up-titrated to a flow of 4.4 L/min at 7000rpm.

The main treatment option for AAA is to eliminate the aneurysm wall from the systemic pressure to prevent further bulging of the AAA, using a vascular graft. In open surgery, a graft is sealed to the healthy part of the aorta by transabdominal surgery. Open surgery has a 30-day mortality rate of around 5% [greenhalgh et al 2004 from T] Endovascular aneurysm repair (EVAR) is an alternative treatment option to open surgery, it is a minimal invasive surgery whereby a stent graft is placed in the AAA through a small incision in the groin area. It has a

Facility has established high standards of clinical quality in certain parameters mentioned above, but specifically we focus on secondary access placement which is fistula or graft. Facility staff is working hard on the patient and family education to replace

Arterial remodelling is already observed in patients at the start of renal replacement therapy and is comparable in patients on peritoneal dialysis and patients treated by hemoidialysis. This suggests that non-hemodynamic factors could play an important role in the pathoiphysiology of vascular complications. As shown experimentally, the endothelium influences the mechanical and geometric properties of large arteries, and removing the endothelium causes an increase in arterial diameter (Levy et al., 1990). Endothelial function is altered in ESRD patients (Joannides et al., 1997) (Gris et al., 1994) (Van Guldener et al., 1998), and these alterations are associated with arterial

Hemodialysis (HD) is one of several renal replacement therapies used for the treatment of end stage kidney disease (ESKD) and kidney failure. Dialysis removes excess fluids and waste products and restores chemical and electrolyte balance. HD involves passing the patient’s blood through an artificial semipermeable membrane to perform the filtering and excretion functions of the kidney. One important step before starting regular hemodialysis sessions is preparing the vascular access; ideally, a vascular access should be placed weeks or months before you start dialysis. The