Journal of Vascular Access最新文献

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.

Background: The configuration of the arterial anastomosis in prosthetic arteriovenous grafts (AVGs) significantly affects hemodynamics, thrombogenicity, and long-term patency. While tapered grafts have been developed to optimize inflow, their use is limited by cost, availability, and reduced adaptability. We evaluated a surgeon-modified beveled end-to-side anastomosis using standard grafts as a simple, cost-neutral alternative for upper-limb AVG creation, including in high-risk and urgent settings.

Methods: We conducted a retrospective single-center study of 46 patients who received AVGs with a beveled anastomosis tailored to ~60°, based on a standardized cutting protocol. Data were collected prospectively. Outcomes included technical and clinical success, thrombosis, patency, and complications. Hemodynamic implications were contextualized using existing computational and clinical models.

Results: Technical success was achieved in 100% of cases; clinical success in 93.5%. Early thrombosis occurred in 4.3% and was managed with thrombectomy. Late thrombosis (15.2%) was mainly due to venous outflow stenosis; inflow-related stenosis was rare (4.3%). No cases of hand ischemia, pseudoaneurysm, or suture-related complications were observed. Intraoperative imaging and follow-up ultrasound confirmed stable graft geometry. The technique was feasible across graft types, with trilaminar grafts requiring reduced angles (~45°). In selected cases, it served as a temporary bridge to native AVF maturation.

Conclusions: This beveled anastomosis is a safe, reproducible technique for prosthetic AVG creation, with favorable hemodynamic characteristics and broad adaptability. It may offer specific advantages in complex or urgent cases.

The impact of arteriovenous anastomosis length on fistula flow rate and potential cardiovascular issues is not well established. However, it is widely recognized that proximal fistulas create a significant hemodynamic load, increasing the risk of high-output cardiac failure. Literature indicates that the anastomosis size varies from 3 to 15 mm. Nonetheless, common practice favors 6-10 mm for distal anastomoses, while the length reduces to 4-6 mm when the brachial artery is involved in the elbow or upper arm fistulas. It is advisable to avoid larger arteriotomies to prevent or lessen cardiovascular complications, especially when patients are monitored with access flow assessments and echocardiography for early detection of issues. Considering the high prevalence of elderly patients with cardiovascular risk among incident hemodialysis patients, a more careful approach to managing flow in arteriovenous access is crucial. The anastomotic length should be customized based on the patient's specific anatomical and physiological conditions, rather than applying a uniform standard.

Background: Ultrasound-guided peripheral intravenous catheter (USG-PIVC) insertion improves success rates in patients with difficult intravenous access (DIVA) and reduces complications. However, widespread implementation remains limited by training demands and workflow integration challenges. This quality improvement initiative aimed to assess the implementation of a nurse-led USG-PIVC pilot program in a tertiary emergency department using a service design approach.

Methods: A three-cohort nurse training program was conducted between June 2023 and February 2025 at the McGill University Health Centre. Training included didactic instruction, simulation, and supervised insertions. We conducted descriptive quantitative analysis of insertion outcomes and qualitative analysis of nurse interviews. Program adaptations were made between cohorts in response to participant feedback.

Results: A total of nine nurses participated across three cohorts and attempted 101 insertions. Independent insertion success rates were 67%, 63%, and 77% in Cohorts 1, 2, and 3 respectively. While no nurses achieved certification in the first cohort, 100% did so in subsequent cohorts. Common challenges included difficulty visualizing the needle tip and limited practice opportunities during routine shifts. Modifications using a service design approach, such as smaller training groups, protected practice time in a calmer setting, and individualized feedback with formal evaluations were associated with improved performance and skill retention.

Conclusion: Using the Tool+Team+Routine lens, we found that effective implementation required not only technical training (tool), but also team structure and dedicated learning environments (team and routine). These insights may inform broader implementation of nurse-led procedural innovations in acute care.