Читать книгу 40 Years of Continuous Renal Replacement Therapy - Группа авторов - Страница 31

Choice of vascular access site, catheter design, and competence of nursing staff in assuring correct circuit priming and monitoring, are all essential determinants of circuit survival [9, 10]. Early catheter dysfunction usually results from inadequate positioning (e.g., insertion in the wrong vessel, malposition of the catheter tip, catheter kinking) but may also be seen with strictures and hypovolemia [9, 10]. Late catheter dysfunction is most often due to thrombosis [9, 10]. Poor access causes blood flow reduction in the circuit leading to premature circuit clotting [9, 10]. The left internal jugular vein has a more tortuous path, which can lead to inadequate blood flow and early filter dysfunction [9, 10]. The subclavian access enhances the risk of catheter kinking and should be reserved for placing silicone catheters for chronic dialysis [1–3]. Femoral veins, though easily accessible in case of emergent resuscitation, do impair patient’s mobility and nursing care [11]. Low central venous pressure, high abdominal pressure, and high or very negative thoracic pressures may all result in a decreased catheter flow.