Journal of Vascular Access最新文献

Background: Central venous stenosis (CVS) is a clinically significant complication in patients who depend on long-term hemodialysis access. While digital subtraction angiography remains the diagnostic gold standard, it is invasive, costly, and exposes patients to contrast and radiation. This study examined the diagnostic value of a simple, non-invasive, radiation-free alternative-the ultrasound-guided "sniff test," which assesses dynamic changes in subclavian vein diameter during a forceful sniff to screen for CVS. Despite its potential advantages, the diagnostic performance of this method has not been well established.

Method: A prospective study was conducted among 71 end-stage kidney disease (ESKD) patients scheduled for angiography. Each participant underwent a sniff test before the procedure. A reduction of more than 40% in subclavian vein diameter during sniffing was considered normal, indicating absence of stenosis. Angiographic findings were used as the reference standard. Clinical signs-specifically ipsilateral arm swelling and visible chest wall veins-were also evaluated for diagnostic utility.

Results: Angiography confirmed CVS in 32 patients (45.1%). The sniff test showed a strong association with stenosis (OR 20.9) and demonstrated solid diagnostic performance, with sensitivity of 84.4%, specificity of 79.5%, and an AUC of 0.82. A normal sniff test accurately excluded stenosis in the majority of patients without CVS (86.1%), whereas an abnormal result was predominantly seen among those with stenosis (77.1%). Arm swelling was also significantly associated with stenosis (OR 20.40) and showed good standalone diagnostic accuracy (sensitivity 75.0%, specificity 87.2%, AUC 0.81). Importantly, combining the sniff test with clinical assessment enhanced overall performance, achieving higher specificity (94.9%) and excellent discriminative ability (AUC 0.90).

Conclusion: In conclusion, the ultrasound sniff test is a promising, accessible, and accurate screening tool for CVS. Used alone or alongside clinical findings, it offers a practical method to identify patients who may benefit from confirmatory angiography-particularly valuable in resource-limited or radiation-averse settings.

Background: Peripherally Inserted Central Catheters-Related Thrombosis (PICC-RT) is a challenging complication associated with PICC in cancer patients. Risk assessment models (RAMs) help identify patients at high risk of PICC-RT. This study compares the predictive performance of the Michigan RAM, the Caprini RAM, and the Maneval RAM in cancer patients with PICCs. The results could help recommend an optimal RAM for PICC-RT risk assessment in practice.

Methods: A prospective observational study was conducted in a large cancer center in Guangzhou, China. 281 patients with cancer who underwent PICC insertions were enrolled from April 2023 to January 2024. The extracted data included basic information on patients and catheters, the scores of the Michigan, Caprini, and Maneval RAMs, and the occurrence of PICC-RT. The sensitivity, specificity, and area under the receiver operating characteristics (AUC) values were used to compare the predictive performance of these three RAMs.

Results: 275 participants were finally included for data analysis. Eighteen patients (6.5%) developed symptomatic PICC-RT. The average time between catheter insertion and PICC-RT diagnosis was 83.40 ± 34.63 days (range 28-143 days). The sensitivity/specificity of the Michigan, Caprini, and Maneval RAM were 0.06/0.97, 0.44/0.78, and 0.89/0.68, respectively. The AUC of the Maneval RAM (0.85, 95% CI: 0.78-0.91) was higher than that of Michigan (0.50, 95% CI: 0.37-0.64) and Caprini RAM (0.62, 95% CI: 0.47-0.76).

Conclusions: Maneval RAM has a better predictive value for PICC-RT than Michigan and Caprini RAM. Maneval RAM is recommended for predicting the risk of PICC-RT in patients with cancer.

Background: Percutaneous transluminal angioplasty (PTA) of brachiocephalic arteriovenous fistulas (BC AVF) can be painful, particularly during balloon dilatation of cephalic arch or outflow vein. This study evaluated the effectiveness and safety of interscalene nerve block (ISB) for analgesia during endovascular treatment of BC AVFs.

Materials and methods: We retrospectively reviewed 22 endovascular procedures in 21 patients with dysfunctional BC AVFs (March-September 2025) at our institution. All procedures were performed under ISB, with 13 (59%) also receiving supplementary supraclavicular cutaneous nerve block (SCNB). Pain during balloon inflation of the culprit stenosis was assessed using the visual analogue scale (VAS), serving as the primary endpoint of the study. Secondary endpoints included sedative requirements and factors associated with lower pain scores.

Results: The mean patient age was 72 years, and 14 patients (67%) were female. The median VAS score was 2 (0-3) with most procedures resulting in no pain (32%) or mild pain (59%). Sedative use was significantly reduced compared with patients' prior procedures without nerve blocks (midazolam reduction: 1.2 ± 0.8 mg, 95% CI [0.8, 1.6], p < 0.001; fentanyl reduction: 28 ± 16 µg, 95% CI [20, 36], p < 0.001). Combined ISB and SCNB provided superior analgesia compared with ISB alone (median VAS: 1.5 (0-2) vs 3 (2-5), 95% CI of the difference [0.2, 3.2], p < 0.05) when the culprit stenotic lesion was in the shoulder/clavicular region. Higher local anaesthetic volumes correlated with lower pain scores (p < 0.001). No block-related complications occurred, and all patients had full recovery of sensory and motor function within 4 hours.

Conclusion: ISB, with or without SCNB, offers safe and effective analgesia for endovascular treatment of BC AVFs, significantly reducing pain and sedative needs. It may be a useful alternative to systemic sedation, particularly for patients at higher risk from sedative medications.

Background: Femoral vein transposition arteriovenous fistula (FV tAVF) has been used for vascular access in hemodialysis patients with exhausted upper limb options or central venous occlusion. This study evaluated the safety and 60-month primary patency of femoral vein FV tAVFs for hemodialysis access.

Methods: This multicenter, retrospective study included 32 adult patients undergoing FV tAVF creation. Patients included in the study had exhaustion or unavailability of upper arm veins or bilateral upper central venous occlusion and adequate lower extremity circulation. Primary and secondary patency rates were evaluated at 6, 12, 24, and 60 months. Complications were also analyzed. Exploratory analyses included the impact of demographic and clinical variables on primary and secondary patency rates.

Results: Technical success was achieved in 90.63% of cases. Primary patency rates were 90.63% at 6 months, 84.38% at 12 months, 60% at 24 months, and 18.18% at 60 months. Secondary patency rates were 90.63% at 6 and 12 months, 79.31% at 24 months, and 36.84% at 60 months. Wound complications occurred in 46.88% of patients, with most managed conservatively. Steal syndrome and venous thrombosis were observed in 18.15% and 12.5% of patients, respectively. Female sex and wound complications impacted secondary patency, while a shorter duration of hemodialysis (<27 months) correlated with higher primary patency loss.

Conclusion: FV tAVF is a feasible and reliable vascular access option for complex patients, providing robust maturation and patency rates, with manageable complication profiles.

Background: In pediatric oncology, totally implantable venous access devices (TIVADs), or ports, are frequently used for long-term intravenous therapy. While insertion-related complications are well documented, difficulties during removal are rare but clinically significant.

Methods: A retrospective review involved 851 pediatric patients underwent port removals between July 2012 and July 2024. Patient demographics, insertion site, catheter dwell time, and removal techniques were analyzed, with a focus on catheter removal-related complications.

Results: Removal was uncomplicated among 830 patients (97.5%). However, 21 patients (2.5%) experienced complications due to catheter adherence or migration. These cases required additional interventions, including extensive dissection (n = 10), controlled venotomy (n = 5), interventional radiology (n = 5), and guidewire-assisted stenting (n = 1). The mean catheter dwell time of the port devices in this cohort prior to removal was 39.35 months. Two patients experienced migrated fragments, which were successfully removed. One patient experienced bleeding during venotomy, which was successfully treated.

Conclusion: Long-term central venous catheters removal is often complicated by peri catheter adhesions and calcification. Owing to the risk of significant complications, removal should be performed only when clinically indicated and preferably in specialized centers with access to interventional radiology and cardiac surgery. Comprehensive informed consent is a critical prerequisite for this procedure. This study offers practical guidance for clinicians and an open avenue for future research on preventative strategies and optimized removal protocols.

Background: The SPECTRA study compared first-attempt success between ultrasound-guided and conventional peripheral intravenous catheter (PIVC) insertion. This subanalysis evaluated the control group results to determine the number of puncture attempts until successful or failed venous device insertion, stratified according to the Adult Difficult IntraVenous Access Scale (A-DIVA).

Methods: Secondary analysis of the SPECTRA randomized clinical trial (RCT). Patients from the control group who underwent PIVC insertion without ultrasound guidance were included and stratified as high risk or low/moderate risk according to the A-DIVA. Statistical comparisons between the groups were conducted on the number of puncture attempts, insertion failures, catheter dwell time, and clinical outcomes related to PIVC insertion.

Results: Of all 84 patients analyzed, 35 were classified as high risk, and 49 as low/moderate risk; 53 (63.1%) were female, mean age 59 ± 16 years. The main reason for hospitalization was infection; high-risk patients experienced more punctures, with 20 (57%) undergoing four punctures, compared to only 8 (16%) of the low/moderate-risk group, p < 0.001; the overall success rate of PIVC insertion was 17 (48.5%) in high-risk patients versus 43 (88%) in low/moderate-risk patients. Insertion failure occurred in 18 (51.5%) high-risk versus 6 (12%) low/moderate-risk patients, p < 0.001; the high-risk group had a shorter PIVC dwell time: 3 (2-8) days versus 8 (2-8) days in low/moderate-risk group, p = 0.065; PIVC removal due to negative outcomes (obstruction, infiltration, accidental removal) was higher in high-risk patients: 32 (91%) versus 24 (49%), p < 0.001.

Conclusions: Patients classified as high risk in the A-DIVA scale required more puncture attempts, had shorter PIVC dwell times, and experienced more negative outcomes. Using technologies such as ultrasound is beneficial for patients at high risk of failure on the first attempt.

Arteriovenous Fistula (AVF) failure remains a significant challenge in patients on hemodialysis. No meta-analysis has concluded the relationship between fetuin-A serum levels, arterial calcification, and AVF failure. This study aims to evaluate the relationship between fetuin-A levels and AVF failure through vascular calcification in CKD patients undergoing hemodialysis. This meta-analysis was conducted according to the PRISMA guideline. On October 1st, 2024, a literature search was conducted in PubMed and ScienceDirect. Data were analyzed using Review Manager for pooled hazard ratio and standardized mean difference (SMD), while MedCalc software was used to calculate the pooled correlation coefficient. A total of 26 observational studies were included. Meta-analysis showed that fetuin-A levels were negatively correlated with vascular calcification (r = -0.530; 95% CI: -0.781 to -0.132; p = 0.011). The mean fetuin-A levels were lower in the group with vascular calcification than those without calcification (SMD = -1.71; 95% CI: -2.58 to -0.85; p = 0.0001). Patients with vascular calcification had a 2.98 times higher risk of AVF failure (OR = 2.98; 95% CI: 1.78-4.99; p < 0.0001). Three studies showed that high fetuin-A levels were a protective factor against AVF failure (HR = 0.76; 95% CI: 0.63-0.91; p = 0.003). Low fetuin-A levels were associated with increased vascular calcification and risk of AVF failure in CKD patients undergoing hemodialysis. These findings suggest the potential of fetuin-A as a predictive biomarker and therapeutic target in reducing AVF failure. Further studies with standard testing methods are recommended to confirm this association.

Background: Skin erosion over central venous access port (port skin erosion) is an uncommon complication; however, it usually necessitates port removal. This study retrospectively investigated risk factors for port skin erosion.

Methods: A total of 3776 adult (⩾18 years) patients (male/female, 1841/1935; mean age, 60 years) who had ports placed at a single academic institution between January 2013 and January 2022 were included in the study. Of these, 3590 had a history of cancer, while 186 patients had a non-oncologic history. Port skin erosion was defined as a condition where any part of the port is exposed to ambient atmosphere through a breach in skin without clinical signs of local infection. Proportional subdistribution hazards regression analysis was conducted to elucidate risk factors for port skin erosion.

Results: Cumulative follow-up period was 1,895,383 catheter-days (range 1-3405 days). A total of 45 patients (1.2%) had port skin erosion (rate 0.03/1000 catheter-days). The median time to port skin erosion was 188 catheter-days (range 32-1877 days). Multivariate analysis identified underweight (body mass index (BMI) < 18.5 kg/m²) at the time of port placement (hazard ratio (HR) = 4.24, 95% confidence interval (CI) = 1.77-10.15, p = 0.001), use of a double lumen port (HR = 2.29, 95% CI = 1.18-4.48, p = 0.02), and central nervous system (CNS) malignancy (HR = 7.12, 95% CI = 2.19-23.19, p = 0.001) as significant risk factors for port skin erosion.

Conclusions: Underweight patients (BMI < 18.5 kg/m²), the use of a double lumen port, and CNS malignancy were independent risk factors for port skin erosion.

Aim: To test the optimum flushing volume for power-injectable peripherally inserted central catheters after the injection of iodinated contrast agents.

Background: Pulsed infusion with saline solution was recommended for peripherally inserted central catheters flushing. However, evidence of flushing volume for power-injectable peripherally inserted central catheters after the injection of iodinated contrast agent was lacking.

Design: Empirical quantitative research in vitro experiment.

Methods: Single lumen power-injectable peripherally inserted central catheters were filled with an iodinated contrast agent. Sixty catheters were randomized into four groups: 10 ml flushing volume of 0.9% sodium chloride (Group A), 15 ml flushing volume of normal saline (Group B), 20 ml flushing volume of 0.9% sodium chloride (Group C), and 25 ml flushing volume of 0.9% sodium chloride (Group D). The same pulsatile flushing technique was performed for all four groups. Efficacy was measured based on the amount of iodine recovered from the lumen of the tested catheters.

Results: The iodine average recovery proportion was 98.5% ± 2.1% in Group A, 99.3% ± 1.4% in Group B, 98.4% ± 1.8% in Group C, and 97.2% ± 3.2% in Group D. The difference in proportion of iodine recovery between the control group (Group A) and the three experimental groups (Groups B, C, and D) was not significant.

Conclusion: We concluded that pulsed flushing with 10 ml normal saline immediately after the contrast agent injection was sufficient. Higher flushing volumes did not lead to a better flushing effect; rather, they would only bring unnecessary fluid burden and cost to patients.Patient or public contribution:No patient or public contribution.

Vascular access is essential for effective hemodialysis, a life-sustaining treatment for patients with chronic kidney disease, and nurses play a critical role in its management through infection prevention, patient education, and promotion of self-care. Despite a growing body of research on vascular access, bibliometric analyses that specifically explore nursing contributions remain limited. This study aimed to analyze trends in nursing research on vascular access in hemodialysis through a bibliometric approach. A total of 837 articles published in 275 sources between 1986 and 2025 were retrieved from the Web of Science database using MeSH terms. The data were analyzed with Biblioshiny and VOSviewer to examine publication trends, citation patterns, co-citation, and collaboration networks. Findings indicated a steady growth in the field, with an annual publication increase of 1.79%. The most productive journals were Nephrology Nursing Journal (n = 57), Journal of Vascular Access (n = 46), and BMC Nephrology (n = 33). Leading authors included Sousa C.N. (n = 20), Teles P. (n = 15), and Johnson D.W. (n = 13). Co-citation and co-occurrence analyses revealed both technical topics such as arteriovenous fistulas and patient-centered themes including quality of life and self-care. International collaboration was evident, with 16% of studies involving multi-country authorship, reflecting the global relevance of this research area. The study highlights the influential role of a small group of authors and journals in shaping nursing research on vascular access in hemodialysis and indicates a growing emphasis on patient-centered approaches. These findings provide direction for future nursing research to support evidence-based practice and enhance patient outcomes.