Journal of Vascular Access最新文献

Background: The peripherally inserted central catheter (PICC) has emerged as a useful option for long-term intravenous access in children, which has been increasingly required with the advancements in pediatric care. Long-term maintenance of PICCs is important for their functions, but little is known about this. We aimed to describe the PICC dwelling time in general pediatric wards, taking both complications and intentional routine removal into consideration, and explore the factors for long-term maintenance.

Methods: We retrospectively examined the records of procedures performed by the pediatric PICC team between April 2020 and September 2023 at a children's hospital in Japan. We conducted a survival time analysis to depict PICC dwelling time and regression analyses to explore factors associated with successful PICC insertion and long-term maintenance of catheters.

Results: The PICC team conducted 78 procedures during the study period, 66 (85%) achieved central venous access, and 57 (78%) of 73 inserted PICCs could be used until treatment completion. The most common indication was administration of antibiotics. Radioscopy was utilized in 18% of procedures. The median PICC survival time was 170 days, and the 75% PICC survival time was 52 days. Failure of PICC insertion was associated with the 4.5 Fr double catheter (odds ratio (OR), 0.16) and lower extremity puncture (OR, 0.24). Longer catheter survival was associated with the catheter tip in the superior vena cava (SVC; hazard ratio (HR), 0.15), which was confirmed by additional multivariate analysis (HR, 0.14).

Conclusions: PICCs could be used for several months in children until complications required removal. Single-lumen catheter insertion into the SVC might be associated with longer catheter survival. Developing appropriate methods to reach the SVC remains our task.

Based on the patient's life planning, arteriovenous fistula (AVF) and arteriovenous graft (AVG) is better than tunnel-cuffed catheter (TCC) due to catheter-related central venous disease. However, the successful establishment of AVF or AVG requires sufficient vascular conditions. This case report described the reconstruction of an abandoned AVG in a young patient with a small-caliber and high bifurcation artery that was initially unsuitable for AVG creation. We designed a procedure in which an AVF was first established to achieve arterial dilation, and after sufficient enlargement of the artery in a few days, the abandoned graft was reutilized by graft interposition in arterial and venous side separately. We salvaged an AVG by using a simple and inexpensive method to create sufficient arterial condition for AVG establishment making a young patient able to transition from a TCC to an AVG.

Background: The radial artery deviation and reimplantation (RADAR) technique uses an artery-to-vein (end-to-side) configuration. We have developed a modified RADAR (M-RADAR) technique. This new technique enables a side-to-side anastomosis between the vessels, and furthermore, the distal cephalic vein is ligated. The VAC Study (Paradigm Shift in Vascular Access Creation) is a multicenter randomized controlled trial comparing the clinical outcomes of radiocephalic fistula created using the conventional technique (CT group) versus the modified RADAR method (M-RADAR group).

Methods: Prospective, multicenter, randomized study starting in December 2024. Participant recruitment has commenced. All data are collected via paper-based Case Report Forms (CRFs). The primary clinical endpoints include the 1-year primary patency rate of AVF and the incidence of venous juxta-anastomotic stenosis. Secondary endpoints include the 1-year access-assisted primary patency, access cumulative patency, hospitalization rates, mortality, and an analysis of the economic costs associated with maintaining vascular access. An estimated 408 participants will be recruited from approximately 29 dialysis units across China.

Discussion: A high-quality, adequately powered multicenter randomized controlled trial (RCT) is still needed to provide clear guidance for clinicians on selecting optimal treatment strategies for the cephalic vein during AVF surgery.

Trial registration: Registration number: ChiCTR2400093537, Registered on 2024-12-06.

Background: Cephalic arch stenosis is a common complication in haemodialysis patients with brachiocephalic arteriovenous fistula (AVF) that can lead to access dysfunction. For resistant lesions that fail conventional endovascular treatment, a possible salvage approach to avoid open surgery is via sharp recanalization using re-entry catheters.

Methods: We describe the unprecedented use of the BeBack re-entry catheter (Bentley InnoMed GmbH), previously the GoBack catheter (Upstream Peripheral Technologies), to overcome a recalcitrant cephalic arch occlusion by sharp recanalization in a 73-year-old female with thrombosed left brachiocephalic AVF that failed revascularization using conventional catheter and wire techniques. During the procedure, there was a contained perforation subcutaneously but the BeBack catheter was manoeuvred to re-enter into the axillary and subclavian vein. This was followed by balloon angioplasty and insertion of Viabahn (Gore Medical) stent grafts across the revascularized track.

Results: Completion angiography at end of the procedure showed smooth flow through the cephalic system without subcutaneous extravasation and our patient avoided the need for open surgical bypass. No immediate postoperative complication was encountered.

Conclusions: Although the BeBack catheter has been predominantly used in difficult-to-treat lower limb chronic total occlusions, we have shown that it is also a potential feasible salvage option for sharp recanalization in the treatment of dysfunctional arteriovenous access.

Background: Ultrasound training requires proper instruction and guidance tailored both to novice and advanced ultrasound users. The aim of the current investigation was to compare the performance of novice and advanced sonographers using a tofu model for IV cannula placement using either ultrasound static (US) or dynamic (UD) techniques.

Methods: Eighty volunteers were allocated to either the novice or advanced group according to prior ultrasonography experience. Participants were randomly assigned (1:1) to either the US or UD group. A modified version of the global rating scale was used to assess performance. The primary outcome was the assessment scale composite score. Secondary outcomes included time to procedure completion and the number of needle passes.

Results: In the novice cohort, the US group scored significantly higher than participants in the UD, median difference 9 (95% CI: 0-19), p = 0.01. In the advanced cohort, there was no difference in the performance score. Advanced participants performed the UD technique in less time than those using the US technique, 28.5 s (IQR 24-40) vs 42.5 s (IQR 30-55), median difference 14 (95% CI: 1-27), p = 0.02, respectively. Novices showed no difference in time to completion for either technique. In the novice cohort, the number of needle passes was less in the US group, median of 1 (IQR 1-2) compared to the UD group, median of 2 (IQR 1-3.75), median difference -1 (95% CI: -2 to 0), p = 0.03. There was no difference in the number of needle passes in either techniques involving the advanced users.

Conclusion: Compared to the real time UD method, the US technique for intravenous cannulation is more fitted for novice users and should be considered more widely as the introductory technique to improve their procedural efficiency of ultrasound guided intravenous cannulation.

We present an inadvertent unusual complication of a double square knot found within a PICC in this case report. PICCs are known to cause catheter-related bloodstream infection, catheter malfunction, thromboembolism, catheter migration, and catheter fracture is reported. But the occurrence of double square knot is the rarest complication during insertion which led to unexpected challenges during removal and to our knowledge there are no case reports of this rarest event. We discuss the case presentation, management, and clinical implications of this rare complication.

Objectives: Cetuximab-based therapy is prone to develop skin complications. Our study aims to identify the impact on the central venous access by cetuximab-based therapy in patients with head and neck squamous cell carcinoma (HNSCC).

Methods: We conducted a single center retrospective study to explore the prevalence and type of skin complications between totally implantable venous port (TIVP) implanted in the subcutaneous tissue of the anterior chest wall and peripherally inserted central catheter (PICC) for patients with HNSCC who received cetuximab-based therapy.

Results: In the current study, 34 patients had TIVP and 34 patients had PICC. 32.4% (11/34) patients with TIVP had skin complications, while only 11.8% (4/34) skin complications occurred in patients with PICC. Most patients with skin complications were grade 1. However, two patients with TIVP suffered infection by skin complications and experienced TIVP removal. In the correlation analysis, significant (p < 0.05) risk factors for skin complications were prophylactic use of topical steroid ointment and male sex.

Conclusion: TIVP implanted in the anterior chest wall was potentially related with higher incidence of cutaneous complications in patients with R/M HNSCC who received cetuximab based therapy, that requires cancer nurses deep concern and uses evidence-based preventative and treatment strategies.

Background: Peripherally inserted central catheters (PICCs) provide a valuable alternative to traditional central venous access, offering smaller-diameter lines and supporting prolonged infusion therapy. Although recent advancements have addressed many of the initial challenges of PICC insertion, some catheter-related complications remain significant. In cases of mechanical complications, shearing of the peel-away sheath typically occurs while inserting the sheath-dilator, necessitating further dermatotomy and thereby increasing patient morbidity.

Materials and methods: The alternative technique involved disassembling the sheath-dilator apparatus into its individual components: the peel-away sheath and introducer dilator. After successfully advancing the guidewire through the needle, the dilator alone was inserted over the guidewire and then removed. Subsequently, the dilator and sheath were reassembled and inserted simultaneously through the skin. The study included four patients (mean age, 55.75 (range: 26-78) years), all of whom underwent PICC placement using the proposed method.

Results: Advanced dilator insertion effectively prevented sheath shearing and facilitated successful PICC placement on the first attempt in all patients. No haematomas or catheter-related complications were observed.

Conclusions: Using the alternative technique, a high success rate of first-attempt PICC insertions was achieved. This approach may reduce the need for additional dermatotomy, thus minimising patient morbidity and improving procedural outcomes.

Evidence of the costly effects of first-attempt peripheral intravenous catheter (PIVC) insertion failures continues to mount. This study was conducted to determine if a unique catheter design can improve operative error, promote PIVC first-stick success and reduce the costs of first-attempt failures. In Phase One of this comparative simulation use in vitro study, 16 nurses from acute care hospitals inserted four PIVC types into a training model, each type characterized by distinct timing of flashback occurrence and needle design. Each nurse performed three attempts per catheter type (12 total per inserter). Insertions were video-recorded and analyzed for the effect of the needle on a vessel during insertion, double punctures and catheter placement failure or success. In Phase Two, 100 nurses and 25 purchasing agents nationwide identified items used and associated costs for PIVC insertions. In Phase One, nurses using a grooved needle flashback with a thin-tipped needle were 20% more successful with catheter placement than those using a notched needle flashback and 22% more successful than those placing a capillary flashback design. Catheter placement success with a grooved needle flashback was 15% higher than with a capillary flashback and 13% higher than with a notched needle flashback. Double punctures were highest among nurses using a capillary flashback catheter, and catheter placement failure was highest among nurses using notched needle flashback. In Phase Two, nurses reported an average of 51% first-attempt success. The authors calculated the estimated annual cost of first-stick failure to be $US 35,919.15 per nurse, including labor and materials used in the second and third attempts. In this study, the authors found the insertion technique with grooved flashback needle design reduced operative error, double punctures and improved first-attempt success. This flashback needle design could significantly improve patient outcomes, speed time to treatment and reduce hospital costs.

Partial anomalous pulmonary venous return is a congenital defect where one or more pulmonary veins drain into the right atrium instead of the left. Most cases are asymptomatic and are discovered incidentally. Anomalous left upper pulmonary venous return is considered the most common type. We present a case of an 84-year-old male who presented to the hospital with altered mentation and suprapubic pain. He was found to be hypotensive and tachycardic and was diagnosed with septic shock of urinary source. He was resuscitated with fluids and antibiotics were started. He continued to be hypotensive and norepinephrine was started. A left internal jugular central venous catheter was inserted with no difficulty and a chest Xray was done for placement confirmation. Xray showed the catheter passing midline to the right hemithorax and pointing toward the right upper lung. A blood gas was drawn from the central catheter and showed pO₂ of 80 mmHg. A CT scan was performed and showed the catheter coursing into the superior vena cava and pointing toward the right upper lung, wedging into the right upper pulmonary vein that is draining into the superior vena cava. This represents an anomalous right upper pulmonary venous return into the superior vena cava. This would also explain the imaging findings and the unexpected arterial levels of oxygen in the catheter blood gas. The catheter was removed and a femoral central venous access was established.