Journal of Vascular Access最新文献

Background: This study investigates the relationship between national catheter use among hemodialysis (HD) patients and kidney transplantation (KTX) activity, exploring the hypothesis that higher KTX activity may be associated with increased catheter usage. The rationale is based on the idea that shorter waiting times for transplants in high-activity countries could make central venous catheters (CVCs) more favorable as a temporary bridge to transplantation compared to arteriovenous fistulas or grafts which require longer maturation times.

Methods: Nine national dialysis and transplant registries (Argentina, Australia, Austria, New Zealand, Portugal, Scotland, Sweden, USA, Turkey) were included in this analysis. The included descriptive analysis of baseline information from included countries, followed by crude association analyses using correlation and regression analyses to explore the relationship between CVC usage and kidney transplants per million inhabitants, considering relevant confounders. Adjusted analyses were performed to account for these confounders, providing a more nuanced understanding of the relationship.

Results: Data from nine different national registries was analyzed. CVC use and KTX activity had a weak to moderate positive correlation (r = 0.23, 95% CI: 0.07, 0.39). In all included countries CVC use increased over time. Adjusting for temporal patterns, country-specific factors, and the proportion of female HD patients, there was still strong evidence for a moderate increase of CVCs among prevalent HD patients with increasing KTX activity.

Conclusion: Higher national KTX activity is associated with a moderate increase in CVCs among prevalent HD patients.

Objective: To investigate the applicability, safety, and efficacy of long peripheral catheters in the infusion therapy of lung cancer patients.

Methods: A retrospective analysis was conducted to examine the baseline data, catheter placement procedures, associated complications, as well as the costs of catheter placement and maintenance among patients who underwent long peripheral catheter insertion in our lung oncology unit from June to December 2023.

Results: The average catheterization time was approximately 20 min, achieving a success rate of 71.15% for a single puncture. The catheters remained in place for a duration ranging from 2 to 20 days, with a mean of 10.04 ± 4.61 days. During this period, there were three instances of venous thrombosis, eight cases of fluid leakage from the puncture site, four occurrences of occlusion, three cases of pain, and six instances of swelling at the puncture site. Notably, no cases of catheter-associated bloodstream infection, catheter fracture, or difficulty in catheter removal were reported. Complications in most patients appeared 7 days after insertion of the catheter, with only two patients experiencing complications within the initial 7-day period. The cost of catheter placement and maintenance varied between 654 and 742 RMB.

Conclusion: The selection of an intravenous infusion route necessitates careful consideration, taking into account the patient's preferences. If the patient receives a short-term infusion therapy, the infused drug is not vesicant, and the patient actively refuses to have a central venous catheter inserted, a long peripheral catheter may be a viable alternative to meet the needs of routine treatment of patients with lung cancer.

Background and aims: Ventriculoatrial (VA) shunts are frequently used for hydrocephalus (HS) management when peritoneal catheter placement is inappropriate. Historically, open surgical cut-down (OSC) on the internal jugular vein has been the standard method for distal catheter insertion. In contrast, percutaneous Seldinger-type ultrasound-guided (USG) venipuncture offers advantages such as reduced operating times and lower postoperative pain. However, its use in pediatric patients is limited.

Methods: This study reviewed patients diagnosed with HS who underwent VA shunt procedures (OSC vs USG) at Bambino Gesù Children's Hospital from January 1, 2014, to February 29, 2024. The analysis focused on surgical times for VA shunt placements and associated neurosurgical operations, as well as catheter replacement rates.

Results: Thirteen patients (6 males, 7 females; median age 12 years, range 0.5-14.2) were enrolled, with a total of 23 procedures performed. The mean surgical time for distal VA placement using the USG technique was significantly shorter than for the OSC method (13.36 min vs 30.22 min, p = 0.00001). Conversely, neurosurgical operations performed using OSC had a 15-min reduction in average operative time compared to USG, though this difference was not statistically significant. Catheter replacement was required in 35.7% of the USG group compared to 55.5% in the OSC group (p = ns).

Conclusions: USG VA shunt placement demonstrates reduced operating times and lower perioperative complication rates compared to OSC. Our findings indicate that percutaneous VA shunts are technically simpler and do not necessitate specialized pediatric vascular surgery skills, enhancing their applicability in pediatric hydrocephalus management.

Background: Intravenous infusion is a key aspect of therapy in hospitalised patients. Choosing the right vascular catheter is important to minimise damage to the patient's tissues, improve the quality of medical care and reduce costs associated with treatment complications. The purpose of this study was to review the effectiveness of midline catheters as a strategic component of intravenous infusions in a Polish hospital.

Material and methods: The study material consists of medical records of patients with midline catheters at Czerniakowski Hospital in Warsaw over the period from 5th October 2021 to 19th May 2023. An analysis of 341 infusion observation charts was performed, excluding illegible and incomplete data. In this article, all of the catheters we used were inserted under ultrasound guidance.

Results: The type of vein chosen has no significant effect on the catheter dwell time (p = 0.984). Catheter length correlates with catheter dwell time (r = 0.133; p = 0.016). Catheters with a length of 15 cm have the longest dwell time, while those with a length of 20 cm have the shortest. Completion of therapy or patient death was the most common reason for catheter removal (46.9%). Catheter size had an impact on catheter dwell time (p = 0.034). The text presents observations regarding the relationship between catheter diameter and total aspiration time, based on all days during which blood was aspirated through the catheter. The statistical test results (H = 118.268; p < 0.001) indicate a significant impact of catheter diameter size on total aspiration time.

Conclusions: Midline catheters are an effective solution for patients with difficult vascular access, increase the possibility of intravenous therapy. Moreover, they improve patient comfort and reduce the number of multiple cannulations. Developing vascular access teams can better control infusion management and care.

Autogenous arteriovenous fistula (AVF) is the preferred vascular access for long-term hemodialysis, and thrombosis is one of the most common complications. In recent years, it has been found that neutrophil extra-cellular traps (NETs) play an important role in thrombosis. NETs are a kind of network structure with DNA as a skeleton and intercalated with a variety of granule proteins, proteolytic enzymes, antimicrobial peptides and histone proteins, which are released into the extracellular space by neutrophils after stimulation. In this paper, the NETs in the role of AVF thrombus formation and NETs in the value of prevention and cure of AVF thrombus complications were reviewed.

Objective: This meta-analysis aimed to compare the efficacy and safety of arm ports (APs) and chest ports (CPs) in clinical practice.

Methods: Randomized controlled trials (RCTs), controlled clinical trials, and retrospective studies were searched in both English and Chinese databases, encompassing PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang Database, and SinoMed up to November 27, 2023. Data analysis was performed using Stata 15.0.

Results: Seventeen studies, including two RCTs, three cohort studies, and twelve case-control studies, were finally included, involving a total of 4168 participants, with 2151 participants in the CP group and 2017 in the AP group. The meta-analysis showed that there was no significant difference between CP and AP in the incidence rates of infections [OR = 0.98, 95% CI (0.68, 1.41)], catheter occlusion[OR = 0.95, 95% CI (0.55, 1.64)], thrombosis [OR = 0.85, 95% CI (0.60, 1.21)], exudation [OR = 1.32, 95% CI (0.52, 3.36)], fibrin sheath [OR = 1.68, 95% CI (0.46, 6.19)], catheter malposition [OR = 0.62, 95% CI (0.30, 1.29)], fracture[OR = 1.84, 95% CI (0.49, 6.96)], pneumothorax [OR = 5.73, 95% CI (0.94, 35.11)], and malfunction [OR = 1.87, 95% CI (0.65, 5.42)].

Conclusion: This study reveals no significant differences in the incidence of infections, catheter occlusion, thrombosis, exudation, fibrin sheath, catheter malposition, fracture, pneumothorax, and malfunction between the two implanted venous access ports. Thus, it can be concluded that AP is as safe as CP.

This study aimed to determine the factors affecting arteriovenous fistula (AVF) patency and the relationship between AVF self-care behaviors in hemodialysis (HD) patients. This was a descriptive and correlational study. The data were collected from 195 HD patients between August and December 2023. The mean score of the AVF Assessment Scale (AVF-AS) was significantly higher in diabetic patients and patients with the elbow AVF site. A significant positive correlation was found between the AVF-AS and the total number of AVF operations. AVF-AS was found to be lower in patients with very high levels of AVF self-care behaviors compared to high-level and moderate levels. A statistically significant negative correlation was found between the AVF-AS and the pump speed, Kt/V, URR, and AVF self-care behaviors. This study found that patient-related factors and self-care behaviors effectively maintain AVF patency.

A description of our experience establishing an advanced nursing vascular access programme in a tertiary Children's Hospital in Melbourne Australia; from need identification to executive approval, training programme development and deployment, equipment procurement and quality assurance.

Background: Central venous access devices (CVADs) are an essential and widely used tool for the treatment of the critically ill, patients undergoing major surgery, and for many patients requiring hemodialysis. Automation of centrally inserted central catheters (CICCs) could potentially make CVAD placement safer, more effective, and more accessible. A new device that uses ultrasound image-guided, robotic needle placement, in addition to traditional Seldinger technique, to place a CICC is described.

Objective: The device was used in a small, first-in-human, trial for placing non-tunneled hemodialysis catheters (NTHDCs), in order to determine feasibility of clinical use.

Methods: Consecutive patients requiring a NTHDC, at one institution, over a 48 h period, were recruited to consent to placing the catheter by the device. Observations of safety, efficacy, and efficiency of the procedure were recorded.

Results: There were 19 catheter placement attempts in 17 patients. All placements were successful (100%). The first placement attempt was successful in 16/19 catheterizations (84%). Two catheterizations required two attempts and one required three attempts. There were no complications for any catheterization. The device provided rapid access to the target central vein and required relatively little training time for operators.

Conclusions: The study demonstrates the feasibility for clinical application of a novel central venous access robotic device.