• 한국의료질향상학회지
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• 제23권1호
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• pp.55-67
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• 2017

Purpose:The purpose of this study was to apply the disinfection method using chlorhexidine in practice on disinfection of vascular access for hemodialysis. Methods: This study was designed as a randomized controlled trial for examining effectiveness on infection of the vascular access device for hemodialysis when using chlorhexidine and betadine/alcohol. One-hundred-thirty study participants were separated into two groups randomly. Infection signs of the vascular access device for hemodialysis were observed and recorded before disinfection on vascular access device. Result: Before the study, there was no difference between the experimental group (chlorhexidine group) and the control group (betadine/alcohol group) in general characteristics and hematological index. Incidence of infection rate of chlorhexidine group was 0 percent and the betadine/alcohol group was 1.5 percent. There was no significant difference between the two groups. Conclusion: This study examined the effectiveness of prevention of infection with the disinfection method using chlorhexidine and betadine/alcohol. The disinfection method using chlorhexidine is considered an effective and alternative method of betadine/alcohol.

• The Korean journal of internal medicine
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• 제33권6호
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• pp.1160-1168
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• 2018

Background/Aims: The Republic of Korea is a country where the hemodialysis population is growing rapidly. It is believed that the numbers of treatments related to vascular access-related complications are also increasing. This study investigated the current status of treatment and medical expenses for vascular access in Korean patients on hemodialysis. Methods: This was a descriptive observational study. We inspected the insurance claims of patients with chronic kidney disease who underwent hemodialysis between January 2008 and December 2016. We calculated descriptive statistics of the frequencies and medical expenses of procedures for vascular access. Results: The national medical expenses for access-related treatment were 7.12 billion KRW (equivalent to 6.36 million USD) in 2008, and these expenses increased to 42.12 billion KRW (equivalent to 37.67 million USD) in 2016. The population of hemodialysis patients, the annual frequency of access-related procedures, and the total medical cost for access-related procedures increased by 1.6-, 2.6-, and 5.9-fold, respectively, over the past 9 years. The frequency and costs of access care increased as the number of patients on hemodialysis increased. The increase in vascular access-related costs has largely been driven by increased numbers of percutaneous angioplasty. Conclusions: The increasing proportion of medical costs for percutaneous angioplasty represents a challenge in the management of end-stage renal disease in Korea. It is essential to identify the clinical and physiological aspects as well as anatomical abnormalities before planning angioplasty. A timely surgical correction could be a viable option to control the rapid growth of access-related medical expenses.

• 임상간호연구
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• 제21권2호
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• pp.215-222
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• 2015

Purpose: For hemodialysis, a vascular access which can maintain a certain speed for a long time is required. The prevention of the vascular access dysfunction is very important to decrease morbidity and to improvethe quality of life of patients receiving hemodialysis It is reported that far infrared heat increases the blood flow by expanding capillaries and micro-arteriovenouses. This study aimed to evaluate the effect of far infrared heat therapy as a new nursing intervention for maintaining vascular access function and improving the blood flow of patients receiving hemodialysis. Methods: The quasi-experimental research of nonequivalent control group pre-post test design was carried out for 59 patients receiving hemodialysis 3 times per week at K medical center. A far infrared heat was applied to the experimental group for 3 months. Results: The arteriovenous fistula blood flow of the experimental group (far infrared heat therapy group) increased significantly when compared to the control group (p=.047). However, static intra-access pressure ratio(SIAPR)was not different statistically (p=.101). Conclusion: The far infrared therapy could be considered as nursing intervention of choice as it demonstrated increase in the arteriovenous fistula blood flow in the patients receiving hemodialysis.

• Journal of Korean Neurosurgical Society
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• 제60권2호
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• pp.250-256
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• 2017

Objective : Cases of a ruptured pericallosal artery aneurysm with a high risk of intraoperative premature rupture and technical difficulties for proximal vascular control require a technique for the early and safe establishment of proximal vascular control. Methods : A combined pterional or subfrontal approach exposes the bilateral A1 segments or the origin of the ipsilateral A2 segment of the anterior cerebral artery (ACA) for proximal vascular control. Proximal control far from the ruptured aneurysm facilitates tentative clipping of the rupture point of the aneurysm without a catastrophic premature rupture. The proximal control is then switched to the pericallosal artery just proximal to the aneurysm and its intermittent clipping facilitates complete aneurysm dissection and neck clipping. Results : Three such cases are reported : a ruptured pericallosal artery aneurysm with a contained leak of the contrast from the proximal side of the aneurysm, a low-lying ruptured pericallosal artery aneurysm with irregularities on its proximal wall, and a multilobulated ruptured pericallosal artery aneurysm with the parasagittal bridging veins hindering surgical access to the proximal parent artery. In each case, the proposed combined pterional-interhemispheric or subfrontal-interhemispheric approach was successfully performed to establish proximal vascular control far from the ruptured aneurysm and facilitated aneurysm clipping via the interhemispheric approach. Conclusion : When using an anterior interhemispheric approach for a ruptured pericallosal artery aneurysm with a high risk of premature rupture, a pterional or subfrontal approach can be combined to establish early proximal vascular control at the bilateral A1 segments or the origin of the A2 segment.

• Journal of Chest Surgery
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• 제45권6호
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• pp.421-423
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• 2012

Transradial access is a widely accepted method for percutaneous coronary diagnostic and interventional procedures, and it has dramatically reduced access site vascular complications compared to transfemoral access. Arteriovenous fistula formation at the access site is an especially rare complication in transradial access. We report an extremely rare case of delayed radial arteriovenous fistula that developed one year after transradial coronary angiography, which was successfully treated by surgical repair.

• Journal of Chest Surgery
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• 제27권9호
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• pp.764-769
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• 1994

From november, 1985 to May, 1993, 222 arteriovenous fistulae were made in 201 patients with chronic renal failure. Among them, a total of 183 arteriovenous fistulae in 173 patients were reviewed to evaluate the factors influencing patency rate of the vascular access. The results were revealed as follows: There were 102 men and 71 women,aged 10 to 76 years [mean = 45.7 years]. Sixteen patients of them had previous shunts. The procedures included establishment of 214 radiocephalic or brachioocephalic fistulae, 203 side to end, 9 side to side, 2 end to end, 2 autologous saphenous vein grafts, 6 Gore-Tex grafts. There were 28 early shunt failures[12%] due to use of 23 inadequate veins and 5 thrombosis.There were 32 late complications[14%]; 19 thrombosis, 4 aneurysm, 4 venous hypertension, 3 steal syndrome, 2 infections. There were 32 diabetic patients [17 %]. No significant differences in graft patency were noted between diabetic and nondiabetic individuals. There were no significant difference in graft patency between male and female. Overall shunt patency in 183 cases with chronic renal failure was 96% at I month, 95% at 3 months, 93% at I year, 91% at 2 years, 84% at 3 years, 56% at 5years.This Study showed that early postoperative thrombosis and diabetic vasculopathy were most causes of the vascular access failure and suggested that prevention of thrombi and well control of diabetes mellitus were most important to enhance patency rates of the vascular access.

• Journal of Trauma and Injury
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• 제20권1호
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• pp.6-11
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• 2007

Purpose: Gaining vascular access is difficult and time-consuming in critically ill children, so nowdays, in many countries, intraosseous vascular access is frequently used for rapid vascular access in critically ill children. Its pharmacokinetics is close to that of the peripheral intravenous route, but its infusion flow rate is faster. The purpose of this study was to determine how widely the intraosseous infusion technique was being used in Korean emergency departments. Methods: We telephoned forty-two (42) randomly selected university-affiliated hospitals. We asked physicians if they use the intraosseous infusion technique. Responders were emergency and pediatric residents and emergency faculty. If they responded that they were not using the intraosseous infusion technique, we asked the reason. Also, we asked about their experiences with the intraosseous infusion technique. Results: Forty-two (42) hospitals were enrolled in this study. No hospital used the intraosseous infusion technique on a regular basis. However, 8 hospitals used the intraosseous infusion technique occasionally. None of the responders had experience with the intraosseous infusion technique. Conclusion: The intraosseous infusion technique is currently underrepresented at emergency departments in Korea.

• Archives of Plastic Surgery
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• 제48권3호
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• pp.287-292
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• 2021

Background We report the efficacy of a dual-plane approach using a Dufourmentel skin flap with a purse-string suture of the de-epithelized dermis to manage pseudoaneurysm at the vascular access site for hemodialysis. Methods A retrospective analysis was conducted of 61 patients from 2013 to 2018 with pseudoaneurysms at the arteriovenous fistula or graft who were treated with rhomboid excision, vessel repair with a purse-string suture, and a full-thickness Dufourmentel skin flap. The success rate was defined as the probability of complete wound closure and intact vascular access patency without infection or other complications. Results The success rate was 93.4% at 6 months postoperatively. Complications included newly occurring pseudoaneurysms (n=2), wound dehiscence (n=1) and bleeding (n=1). There were no complications such as stenosis or thrombosis from the procedure. Conclusions A dual-plane approach using a Dufourmentel skin flap with a purse-string suture for vessel repair was shown to be a favorable option for managing stable, small (diameter <2 cm) pseudoaneurysms without infection, rapid expansion, or patency issues of the vascular access.

• 국제학술발표논문집
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• The 3th International Conference on Construction Engineering and Project Management
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• pp.499-505
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• 2009

Along with the changing pattern that the construction project is getting complicated, large-scaled and up-to-dated, necessity of efficient management of manpower and resources of the construction site is being increased. In particular, considering that the construction site requires a lot of labor force and in terms of the construction cost, labor cost shares 30-40%, labor management has become a very important factor. In this study, in order to support a stable and successful construction project implementation and supplement the existing system being utilized at the current site, construction site access management automation system based on hand vascular pattern, a biometrics system, is intended to be developed. Relevant theory for the system development and the problem of existing RFID system were evaluated and based on this findings, a system design and DB composition chart were envisaged. In addition, by applying this developed system to a number of sites, its result was analyzed

• Korean Journal of Radiology
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• 제22권1호
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• pp.72-85
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• 2021

Transfemoral access (TFA) is a widely used first-line approach for most peripheral vascular interventions. Since its introduction in cardiologic and neurointerventional procedures, several advantages of transradial access (TRA) over TFA have been demonstrated, such as patient preference, lower complication rates, early ambulation, and shorter hospital stay. However, studies reporting the safety and efficacy of this approach for peripheral vascular interventions performed by interventional radiologists are relatively few. This review aimed to summarize the technique and clinical applications of TRA in percutaneous transcatheter visceral artery embolization and the management of complications.