EMS World

MAR 2013

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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CE ARTICLE Dialysis access sites are common infection sources, and SIRS and sepsis can rapidly develop. patient carrying dialysate in the abdomen, it is removed. Hemodialysis removes the blood from the body via an access site and pulls it into the dialysis machine, which contains a semipermeable membrane. The dialysis machine circulates dialysate past the blood at a rate of 500 mL/min, which very rapidly pulls excess wastes, fluid and electrolytes from the blood- stream. Hemodialysis is much faster than peritoneal dialysis, but it is less comfortable for patients, as there are relatively fast fluid and electrolyte shifts to which the body must react. Transient hypotension frequently occurs and can cause cramping, nausea, headache, syncope, chest pain and fatigue. Generally a small fluid bolus is safe and can help the patient feel better. STAL Shield & Stand Saves Time, Saves Money, Reduces Sick-Leave 1-855-224-3109 "Practice Safe Suction" Management Considerations www.prodaptivemedical.com For More Information Circle 42 on Reader Service Card 56 MARCH 2013 | EMSWORLD.com It is not feasible to perform dialysis through traditional IV catheters, and if it were, the repetitive access would quickly cause a patient's veins to become fibrous and difficult to cannulate. For patients who require long-term dialysis, vascular surgeons typically insert one of three types of access ports. The fastest access port, often used when patients first or emergently need dialysis, is a centrally placed venous line with multiple lumens. Prehospital providers may observe patients with central access ports when patients are waiting for grafts or fistulas to be implanted or ready for use. When a patient leaves a hospital with a central access port, it is most commonly in the chest, in the right or left subclavian vein. These ports have two catheters sticking out of the chest that may be covered with gauze. If you see these ports, do not access them, as it requires strict sterile technique and there is a high risk for infection. One exception to this rule is during cardiac arrest, when it is reasonable to access these sites for rapid access to the circulatory system. Arteriovenous grafts are artificial lumens inserted in the patient's arm that connect a vein and an artery. While grafts are thought of as temporary devices, they may be used for several years. Like any foreign item in the body, a graft is prone to infection; their risk is particularly high, as they are regularly punctured and accessed. Additionally, grafts are at risk for clotting. The most permanent dialysis site is a fistula. A fistula connects an artery and a vein together and is surgically created in the upper or lower arm. Connecting the two increases the diameter of the new "vessel," making access easier. This increases the strength of the vessel's wall and allows an increased flow to support blood removal without inhibiting limb perfusion during dialysis. Traditionally, EMS providers are advised to not access fistulas, as they are not true venous access sites and improper access may damage them. Dialysis patients experience several common complications prehospital

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