Journal of Vascular Access最新文献

Objective: To develop and validate a nomogram model for predicting central venous catheter-related infections (CRI) in patients with maintenance hemodialysis (MHD).

Methods: MHD patients with central venous catheters (CVCs) visiting the outpatient hemodialysis (HD) center of Xuzhou Medical University Affiliated Hospital from January 2020 to December 2023 were retrospectively selected through a HD monitoring system. Patient data were collected, and the patients were divided into training and validation sets in a 7:3 ratio. The training set was used to establish the model, which was verified using the validation set. Multiple logistic regression analysis was performed to identify risk factors for central venous CRI and develop a nomogram prediction model.

Results: A total of 300 MHD patients were enrolled. Multivariate analysis showed that catheter duration, catheter site, catheter reinsertion, history of catheter infection, diabetes, and albumin <35 g/L were risk factors for central venous CRI. The area under the receiver operating characteristic (ROC) curve (AUC) for the training set was 0.902 (95% confidence interval (CI) = 0.862-0.941), with a sensitivity of 85.7%, specificity of 80%, and a Youden index of 65.7%, and that for the validation set was 0.826 (95% CI = 0.726-0.905), with a sensitivity of 80.5%, specificity of 77.9%, and a Youden index of 58.4%. The model demonstrated good discrimination and calibration (Hosmer-Lemeshow goodness-of-fit test statistics: training set: χ² = 4.709, p = 0.788; validation set: χ² = 7.171, p = 0.518).

Conclusion: This study identified six risk factors associated with central venous CRI in MHD patients. This predictive model demonstrates good prognostic performance and can be used by clinicians to screen for high-risk patients with central venous CRI, thereby enabling the early implementation of risk management strategies.

Background: Although conventional pre-operative venography can accurately delineate venous anatomy as an alternative to ultrasound for hemodialysis access planning, it may carry a risk of contrast-induced acute kidney injury (AKI) and progression of renal failure in chronic kidney disease (CKD) patients not yet on dialysis. Therefore, the objective of this study was to evaluate the safety and efficacy of pre-operative venograms in pre-end-stage kidney disease (ESKD) patients.

Methods: We performed a retrospective cohort study (2018-2022) of consecutive pre-ESKD patients who underwent staged bilateral venograms for preoperative vein mapping prior to hemodialysis access creation at a tertiary care medical center. Patients were identified through an institutional database and data were extracted with chart review adjudication. The primary safety outcome was a composite of unplanned dialysis initiation within 7 days of venogram or development of contrast-induced AKI. Secondary outcomes included vascular access creation within 1 year of index venogram.

Results: A total of 142 pre-ESKD patients underwent 284 venograms. Mean (SD) age was 67 (14) years; 55% were female; and 65% of patients had stage 5 CKD, whereas 35% had stage 3 or 4 CKD. Rate of the primary safety outcome was 2.5%, which was driven by a 2.5% rate of contrast-induced AKI with no instances of unplanned dialysis initiation within 7 days of either venogram. Ultimately, 120 (85%) vascular accesses were created, of which 96% were autogenous fistulas. Forearm arteriovenous fistulas (AVFs) were the most common configuration (69%) followed by upper arm AVFs (27%); AV grafts were created in 4% of cases.

Conclusion: In a population of pre-ESKD patients, staged bilateral venograms led to few cases of reversible contrast-induced AKI with no instances of unplanned dialysis initiation. Furthermore, access creation was achieved in 85% of patients with the majority consisting of forearm AVFs. Therefore, preoperative venography for access planning appears safe in pre-ESKD patients.

Background: Extracorporeal membrane oxygenation (ECMO) is a critical treatment for severe cardiopulmonary failure. However, traditional ECMO decannulation methods, such as manual compression and surgical repair, are associated with significant complications. This study evaluates suture-mediated closure devices, specifically Perclose ProGlide, as a potentially favorable decannulation strategy.

Methods: A retrospective review was conducted on 31 patients who underwent arterial decannulation with the post-closing technique using Perclose ProGlide devices between September 2023 and June 2024. Patients were selected using various inclusion criteria for the approach. Decannulation was performed at the bedside by well-trained vascular surgeons. Outcome parameters like the hemostatic result, wound complication, and limb ischemia were analyzed.

Results: The study included 31 patients with a need for decannulation of ECMO arterial cannula, with a mean age of 51.1 years. Thirty patients (96.8%) achieved successful primary hemostasis. The patient who failed primary hemostasis developed acute ischemia due to septic shock caused by the use of inotropic agents. No significant complications were observed in the rest of the patients.

Conclusion: The post-closing technique using suture-mediated closure devices demonstrated high success and low complication rates, making it a safer and more effective alternative to traditional ECMO decannulation methods. This study showed outstanding results compared to previously published articles. This technique can provide various significant advantages under certain clinical situations.

Introduction: In many countries, hemodialysis is still the most common method of renal replacement. Significant regional variations exist in creating and maintaining vascular access for hemodialysis. Therefore, analyzing national registries with vascular access data is essential for developing effective national treatment strategies. The Serbian national vascular surgery registry was established as part of the VascuNet collaboration network in 2019. The registry comprehensively records vascular procedures across Serbia, including those related to vascular access for hemodialysis.

Objectives: This study aims to evaluate the prevalence of different vascular access methods for hemodialysis in Serbia, focusing on both new and prevalent patients and examining demographic differences and risk factors.

Patients and methods: The data were collected from the vascular accesses section of the SerbVasc registry over a 3-year observational period, focusing on the following aspects: number of incident and prevalent patients with types of vascular access, as well as comparison of patients with arteriovenous fistulas (AVF), arteriovenous grafts (AVG), central venous catheters (CVC), and tCVC based on age, gender, smoking, and comorbidities.

Results: There were total of 1024 incident hemodialysis patients. AVF was created in 219 patients (21.4%), AVG in 5 patients (0.5%), and tCVC in 150 patients (14.6%), while hemodialysis via CVC was initiated in 650 (63.5%) patients. The total number of permanent vascular accesses for HD was 1402, comprising 686 (48.9%) distal AFVs, 220 (15.7%) proximal AVFs, 91 (6.4%) AVGs, and 405 (28.8%) tCVCs. The prevalence of current smoking was highest in the tCVC (48.3%) and lowest in the dAVF group (18.40%).

Conclusion: The percentage of patients starting hemodialysis with AVF remains suboptimal. tCVC is used substantially as first and permanent access, particularly among older patients.

This case report describes a surgical treatment combined with interventional therapy for a patient with refractory hemodialysis access combined with catheter-related right atrial thrombosis (CRAT). During surgery, an artificial graft was established from the left brachiocephalic vein to the right atrium and the right atrial thrombus was removed. After the operation, the tunneled cuffed catheter (TCC) was replaced with digital subtraction angiography (DSA). The hemodialysis access issue was addressed for this patient, and the access remained functional for normal hemodialysis during the subsequent 10-month follow-up.

Background: Short peripheral catheter (SPC) placement is a routine invasive procedure in clinical settings that is crucial for administering fluids, medications, or blood components. Approximately 11% of adult patients arriving at the Emergency Department (ED) experience difficulties with intravenous access (DIVA), necessitating advanced techniques for successful placement. The Enhanced Adult DIVA (EA-DIVA) score serves as a validated tool to promptly identify patients with DIVA. This study aimed to determine the prevalence of DIVA in the ED by using the EA-DIVA scale, evaluate the time required for venous cannulation in patients with and without DIVA, and establish EA-DIVA score thresholds for the adoption of ultrasound-guided techniques.

Methods: This prospective observational study was conducted from May 2023 to January 2024 at the ED of Empoli Hospital, Italy. This study focused on adult patients requiring SPC placement. The nursing staff at the ED performed SPC placements using standard techniques according to clinical protocols.

Results: Among 1280 patients, 29.22% required more than one attempt at cannulation independently from their EA-DIVA score, with 12.58% scoring an EA-DIVA of 8 or higher. The time and attempts needed for successful cannulation increased with higher EA-DIVA scores, and ultrasound-guided techniques were more time-consuming but beneficial for these patients. An optimal threshold of 6 on the EA-DIVA scale balanced high sensitivity (96.52%) and specificity (81.37%) for identifying patients who would benefit from ultrasound guidance, minimizing failed attempts and optimizing resource use.

Conclusion: The EA-DIVA scale, originally validated in a preoperative setting, was effectively implemented for the first time in the ED. This study established a lower cutoff score for expert intervention utilizing ultrasound guidance compared with previous applications of the EA-DIVA scale. Further validation across diverse clinical settings and among healthcare providers with varying expertise in vascular access is necessary to confirm these findings and broaden their applicability.

Background: This study aimed to evaluate patency outcomes of arteriovenous grafts (AVGs) before and after using Duplex doppler ultrasonography (DUS) in preoperative mapping and surveillance of AVG.

Methods: In this single-centre, retrospective cohort study 212 patients receiving AVGs from January 2009 to December 2022 were included. In group 1, the creation of AVG as well as screening was based on physical examination alone. In contrast, DUS was used in the preoperative mapping and surveillance of AVG in group 2. The patients also received sulodexide as supplemental medication. Outcomes included primary and secondary patency. The Mann-Whitney U-test was used to compare the differences between groups in number of thrombectomies and preemptive percutaneous transluminal angioplasties (PTAs).

Results: Group 1 included 90 AVGs. The mean follow-up time was 333 days (range: 1-1230 days, standard deviation: 318 days). The primary and secondary graft patency rates were 13.3%, 62.2% at 6 months; 2.2%, 52.1% at 12 months; 0%, 44.3% at 24 months and 0%, 44.3% at 36 months respectively. During the 7-year surveillance of AVG, significantly more thrombectomies were performed than preemptive PTA (p < 0.0001). Group 2 included 122 AVGs. The mean follow-up time was 584 days (range: 1-2040 days, standard deviation: 463 days). The primary and secondary graft patency rates were 54.9%, 95.9% at 6 months; 29.5%, 77.8% at 12 months; and 9.8%, 56.5% at 24 months; 2.5%, 47.1% at 36 months respectively. The primary and secondary graft patency was significantly longer (p < 0.0001, p = 0.002). During the 7-year surveillance of AVG there were significantly more preemptive PTAs performed (p = 0.0004).

Conclusions: The primary and secondary patency of AVG were significantly improved after using DUS in preoperative mapping and surveillance. DUS surveillance led to a decrease in AVG occlusion. A potential positive effect of sulodexide on patency rate of AVG needs more research.

The fibroblastic sleeve is a structure potentially enveloping any intravascular device. At ultrasound scan, it typically presents as a thin layer of variably echogenic material covering the catheter surface, which usually tends to remain into the vessel after the catheter removal. However, several case reports have documented its migration toward the heart or pulmonary artery after a central venous catheter removal. No case of fibroblastic sleeve embolization has ever been documented after a peripheral catheter removal. Here we report the case of a 76-year-old woman with a 3 Fr/20 cm polyurethane midline catheter on which the development of a surrounding fibroblastic sleeve was documented during serial, routine ultrasound follow-up. A few minutes after the catheter removal, a 7 cm-echogenic floating mass attached to the anterior leaflet of the tricuspid valve-which was absent the days before-was noticed by a routinely-planned transthoracic cardiac ultrasonography. Due to the very close interval between the catheter removal and the appearance of the tricuspidal mass, together with the disappearance of the fibroblastic sleeve from the cannulated vein, the ultrasound finding was attributed to the acute embolization of the fibroblastic sleeve. No respiratory, cardiovascular, or septic complication was documented in the following weeks, during which the fibroblastic tricuspidal mass progressively reduced and completely disappeared after 45 days. Despite being an extremely frequent and totally expected occurrence associated to any intravascular device, fibroblastic sleeve may occasionally lead to potentially serious complications. An accurate ultrasound follow-up of catheters positioned either in central or in deep peripheral veins should be recommended to monitor the development and the evolution of a fibroblastic sleeve or thrombosis, both during the catheter dwelling time and after its removal.

Crisis intervention is crucial in managing acute medical crises to improve outcomes. Toxic Epidermal Necrolysis (TEN), a severe skin reaction often triggered by drug exposure, poses challenges, especially in chemotherapy patients. Evidence on nursing care for TEN patients with Peripherally Inserted Central Catheter (PICC) retention during chemotherapy is limited. We present a 69-year-old male with recurrent bladder tumor receiving atezolizumab via PICC, developing TEN and catheter-associated skin impairment (CASI). Despite extensive skin breakdown, PICC retention was essential and innovative PICC care was necessary. A crisis management team implemented a six-step crisis intervention model, ensuring safety and treatment adherence. A three-layer dressing protocol was used to optimize wound care, prevent further CASI, and ensure the patient's comfort. This case underscores the efficacy of crisis intervention in managing TEN with PICC during chemotherapy, highlighting interdisciplinary collaboration and innovation in complex medical scenarios.