Journal of Vascular Access最新文献

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.

Hemodialysis access induced distal ischemia (HAIDI) represents a serious complication following arteriovenous fistula (AVF) creation, with increased risk in elderly patients with arterial abnormalities. Bilateral congenital absence of ulnar arteries is an exceptionally rare anatomical variant with optimal AVF creation strategies remain undefined due to the theoretical high risk of HAIDI. We report a female patient in her 80s with chronic kidney disease G5. She had bilateral congenital absence of ulnar arteries and required vascular access creation. Preoperative assessment revealed radial artery dominance with negative modified Allen tests bilaterally. Standard ultrasound evaluation was inconclusive for distal arterial anatomy, necessitating angiographic evaluation. Angiography revealed bilateral absence of the ulnar arteries and demonstrated the presence of radial arteries and the ulnar trunks continuing into the common interosseous arteries, which were suitable for surgical access. Based on the need to preserve radial circulation and create the most distal feasible access, we performed anastomosis between the ulnar trunk and antecubital perforating vein using 7-0 polypropylene sutures. The patient successfully initiated hemodialysis 7 months postoperatively with optimal AVF maturation, with no clinical signs of HAIDI during 12 months of follow-up from the initiation of dialysis. When standard preoperative assessments are inconclusive, angiography provides crucial anatomical detail enabling safer vascular access planning in patients with rare anatomical variants.

Background: Drug-coated balloons (DCBs) have shown promise in prolonging arteriovenous fistula (AVF) patency by inhibiting neointimal hyperplasia. However, few studies have longitudinally evaluated vascular remodeling after DCB treatment using ultrasound. This study aimed to evaluate vascular remodeling after DCB treatment using high-frequency ultrasound.

Methods: In this retrospective single-center study, 50 patients with single AVF stenosis were treated with DCB and followed by ultrasound at four time points: pre-treatment, immediately post-treatment, 3 months, and 6 months. Patients were classified into short-term (n = 24; reintervention within 6-9 months) and long-term (n = 26; patency ⩾18 months) groups. The mean follow-up time in the long-term group was 24.5 months. Nineteen patients had complete ultrasound data every 3 months up to 15 months. Parameters included lumen cross-sectional area (L-CSA), external cross-sectional area (E-CSA), and intima-media thickness area (IMT area).

Results: Baseline demographics were similar between groups. L-CSA was significantly larger in the long-term group both immediately post-DCB (14.4 ± 5.9 vs 9.9 ± 3.9 mm², p < 0.001) and at 6 months (5.3 ± 2.2 vs 3.1 ± 1.3 mm², p < 0.001). E-CSA was also greater in the long-term group at 6 months (21.7 ± 8.8 vs 14.7 ± 5.0 mm², p < 0.001). While there was no significant difference in IMT area immediately post-treatment, it was significantly greater in the long-term group at 6 months (16.3 ± 7.8 vs 11.6 ± 7.8 mm², p < 0.001). No significant changes in L-CSA, E-CSA, or IMT were observed beyond 6 months.

Conclusions: Regular ultrasound examinations enable accurate evaluation of vascular remodeling. Initial vessel dilation and sustained external diameter enlargement may contribute to long-term morphological stability and patency following DCB treatment.

Background: Umbilical arterial catheterisation is a routine procedure in neonatal intensive care units but is associated with thrombotic and other complications. This study evaluated the safety of an innovative ultralow umbilical artery catheter (UL-UAC) positioning technique in a cohort of 235 neonates.

Methods: This retrospective study assessed acute complications and thrombotic events following UAC placement with the UL-UAC technique, in which the catheter tip is positioned at the junction of the umbilical and internal iliac arteries under real-time ultrasound guidance. All catheter-related adverse events were recorded.

Results: No thrombotic complications were observed. Other adverse events, including minor bleeding after catheter removal, accidental dislodgment and central line-associated bloodstream infections (CLABSI), occurred in only 4.8% of cases.

Conclusions: The ultrasound-guided UL-UAC method is safe and has the potential to reduce the risk of thrombosis while maintaining a low overall complication rate, therefore it can be considered an alternative to the standard and well-established technique.

Background: The arteriovenous fistula (AVF) is the preferred vascular access for patients undergoing hemodialysis, and early identification of complications such as stenosis or dysfunction is essential to preserve access patency and reduce morbidity.

Method: AVF bruit recordings were collected from 65 patients across 12 dialysis centers in Europe and Asia using a digital stethoscope connected to the medical record of the patients. A deep learning model was developed to detect high-pitched bruits-an acoustic marker commonly associated with AVF stenosis. Expert-annotated recordings served as the reference standard for supervised training and evaluation.

Results: Mean age of patients was 68, and the average blood flow during the dialysis session was 352 ml/min. The model demonstrated excellent performance on independent testing datasets, achieving a sensitivity of 97.1%, specificity of 73.8%, and an overall accuracy of 82%. The area under the receiver operating characteristic curve (ROC-AUC) was 94%, reflecting strong discriminative ability. The model showed excellent calibration. Model performance across different experimental retraining folds indicates a stable and reliable training process.

Conclusion: The integration of this deep learning tool into clinical workflows could provide clinicians with a sensitive, objective, and time-efficient method for detecting high-pitched bruits which may be used in combination with other clinical signs for the detection of AVF complications such as stenosis. Implemented through a low-cost phono angiography protocol requiring minimal training, this approach has the potential to support earlier interventions and improve outcomes in the hemodialysis population.

Peripherally inserted central catheters (PICCs) rarely develop true knots, but when they do, forceful removal can precipitate catheter fracture and embolization. Bedside strategies that restore internal support before extraction may prevent escalation to invasive retrieval. An older adult female requiring prolonged intravenous antibiotics underwent ultrasound-guided right basilic PICC insertion (4 Fr, single lumen, polyurethane, power-injectable) using a standard Seldinger technique. After advancement through a peel-away sheath, flushing and aspiration were unsuccessful and intracavitary ECG did not show the expected P-wave augmentation. Gentle traction met immediate resistance. A 0.018-inch nitinol, straight-tip guidewire was reintroduced into the catheter to restore column strength; with controlled, gentle rotational traction the PICC was removed intact. Inspection showed a single loose knot approximately 2 cm proximal to the distal tip. A new PICC was placed contralaterally during the same session. No complications occurred and the patient was discharged without device-related sequelae. This case illustrates a pragmatic bedside maneuver for difficult PICC removal: pause traction, consider mechanical causes such as looping or knotting, reintroduce a guidewire to increase axial rigidity, and attempt controlled extraction while preparing an escalation plan. The approach may obviate fluoroscopic snare retrieval or surgical cut-down when there is no evidence of adherence, vascular injury, or partial fracture. When unexpected resistance is encountered during PICC removal, avoid forceful traction. Guidewire reintroduction can permit safe extraction of a knotted catheter and should be part of a stepwise troubleshooting algorithm.