Zusammenfassung
Die aufmerksame klinische Beobachtung des Shunts, die überwiegend durch das Pflegepersonal erfolgt, ist die wichtigste Säule des Monitorings. Die Wertigkeit anderer apparativer Verfahren ist bisher nicht eindeutig belegt. Aufgrund des größeren Anteils von nativen Fisteln in Deutschland sind die angloamerikanischen Daten zum Monitoring schwer übertragbar. Die Möglichkeiten des apparativen Monitorings konzentrieren sich auf Techniken der Shuntflussmessung. Hier scheinen Dopplersonographie und Transonic-Messungen am besten eingeführt und validiert. Inwieweit die apparative Untersuchung aller Patienten zu einer Reduktion von Shuntverschlüssen und zu einer längeren Shuntlaufzeit führt, ist nicht geklärt. Bei Patienten mit nativen AV-Fisteln scheint ein routinemäßiges apparatives Monitoring sinnvoll zu sein, für Prothesenshunts ist dessen Wertigkeit fraglich. Ohne Zweifel existieren aber auch hier Untergruppen, bei denen ein apparatives Monitoring indiziert ist. Dies betrifft insbesondere Patienten nach operativer oder interventioneller Revision.
Abstract
There is no doubt that careful physical examination of all fistulas and grafts, mainly carried out by the care staff, is the essential cornerstone of monitoring. The value of additional surveillance techniques is currently under discussion in Germany. Most data on surveillance programs have come from overseas where quite different standards apply in fistula creation, so that they cannot be compared with data recorded in Germany, where a higher proportion of patients have native fistulas and most monitoring programs depend on measurement of flow through the shunts; Doppler ultrasound and ultrasound dilution (Transonic) are the techniques that have been most widely introduced and validated for this. So far it has not been confirmed that such monitoring of all patients with regular assessment of access flow leads to a lower frequency of shunt occlusion or to longer shunt survival. In patients with native fistulas regular measurement of access flow seems to be more valuable than in those with grafts. However, there is no doubt in our minds that there are subgroups of patients with grafts in whom such monitoring is indicated; this is especially the case in patients who have recently undergone interventions for stenosis.
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Hollenbeck, M., Krumme, B. Klinisches und apparatives Monitoring von Dialysefisteln und Prothesenshunts. Nephrologe 2, 211–222 (2007). https://doi.org/10.1007/s11560-007-0066-2
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DOI: https://doi.org/10.1007/s11560-007-0066-2