Journal of Vascular Access最新文献

Introduction: Vascular access (VA) is essential for patients with hemodialysis, and its dysfunction is a major complication that can reduce quality of life or even threaten life. VA patency is not only difficult to predict on an individual basis, but also challenging to predict in real-time. To overcome this challenge, this study aimed to develop a machine learning approach to predict 6-month primary patency (PP) using photoplethysmography (PPG) signals acquired from the tips of both index fingers.

Materials and methods: PPG signals were obtained from hemodialysis patients who received an arteriovenous fistula or an arteriovenous graft as primary VA in a single center from April 2023 to December 2023. With PPG wearables, we propose a method that can efficiently and quickly generate the morphological features of the PPG signal to recognize different groups of patients. For the generated features, an independent sample t-test was used to evaluate their effectiveness for machine learning. Then, two supervised learning algorithms, k-nearest neighbors (kNN) and support vector machine (SVM), are used further to identify VA patency in advance.

Results: The study involved 31 patients, of whom 14 had 6-month PP, while 17 did not. Using the kNN algorithm, machine learning classified patients into two groups with 82% precision based on PPG signals, while the SVM algorithm showed a precision of 82%.

Conclusions: Our approach can provide reliable classifications for VA patency. It is effective to use the proposed PPG signal features to predict 6-month PP of VA.

Background: The decision to place a subcutaneously tunneled catheter is an infection prevention strategy for long term venous access allowing the proceduralist to access a vein and relocate the catheter exit site to a region on the body where care and maintenance can be safely performed. Subcutaneously tunneled centrally inserted dialysis catheter (ST-CIDC) placement is commonly performed in patients with renal disease and is traditionally performed with fluoroscopy in the interventional radiology suite or the operating theater. However, today's interventional radiologists and surgeons perform advanced invasive procedures that can be time-consuming resulting in delays in the scheduling of elective tunneled catheter placements.

Methods: In this retrospective case series, we present data from a quality improvement initiative aimed at integrating available evidence for bedside tunneled dialysis catheter placement with electrocardiograph (ECG) tip positioning, to expedite care, improve patient safety outcomes, and reduce healthcare costs associated with the procedure.

Results: Most patients in the study had end-stage renal disease (59%) or acute kidney injury (37%) and were receiving placement for the first time (91%). The right jugular vein was cannulated in 84% of the placements and rates of post-insertion complications were <1%, regardless of the vessel cannulated. Performing bedside tunneled dialysis catheter placement resulted in a cost savings of $385,938.76 over a 2-year period.

Conclusions: The placement of ultrasound guided tunneled dialysis catheters at the bedside following a pre-procedural evaluation of the right jugular, brachiocephalic, and femoral veins is a safe option resulting in expedited patient care, decreased resource utilization, and significant cost savings. Non-bedside techniques performed in interventional radiology, or the operating room should remain a consideration for patients requiring left sided venous access, signs of central stenosis, a history of multiple tunneled catheters, or patients requiring moderate sedation outside of the ICU.

Background: The feasibility of creating arteriovenous (AV) access in hemodialysis patients with superior vena cava occlusion (SVCO) is debated due to impaired blood return to the right atrium. However, collateral venous networks may offer an alternative solution, allowing for the creation of peripheral AV access. This study evaluates the outcomes of AV access construction in hemodialysis patients with SVCO.

Methods: A retrospective review of 18 patients with SVCO and patent azygous veins was conducted between August 2021 and June 2023. These patients underwent peripheral AV access creation, including fistulas and grafts. Collected data included baseline demographics, preoperative 3D CT reconstruction of thoracic vessels, central venography, vascular access types, surgical details, postoperative complications, and the timing and methods of interventions.

Results: AV access was successfully created in all patients, including 15 AV fistulas and 3 AV grafts. The average brachial blood flow rate before cannulation was 848.67 ± 132.03 mL/min. The median follow-up period was 18.5 months (range: 10-32 months). During follow-up, six patients required interventions, such as flow reduction or percutaneous transluminal angioplasty, to optimize blood flow or resolve venous obstruction. Two cases were classified as failed access at 10 and 18 months post-creation. One patient transitioned to peritoneal dialysis due to AVG dysfunction, while the other underwent bypass surgery for chylothorax.

Conclusion: AV access can be successfully created and maintained in patients with SVCO and a patent azygous vein. Although mild venous obstruction symptoms may develop during follow-up, timely intervention can preserve access patency. For patients with limited vascular resources and challenging catheterization, this approach represents a viable option for establishing effective access.

Background: Peripheral Inserted Central Catheter (PICC) is a commonly utilized medical device for long-term intravenous therapy in healthcare settings. However, there has been a notable increase in anaphylaxis associated with PICC catheterization, which should not be neglected.

Aims: The purpose is to raise awareness about the occurrence of anaphylaxis or anaphylactoid reactions associated with PICC and to emphasize the need to explore effective methods to prevent this emergency event in the future.

Method: This retrospective observational study was conducted at Sun Yat-sen University Cancer Center between January 2021 and August 2023.

Results: 0.10% (13 out of 12,612) of cancer patients suffered from anaphylactic reactions during PICC catheterization. The duration time of anaphylaxis or anaphylactoid reactions was approximately 8 min, with a range of 5-10 min. The signs and symptoms combined with respiratory and cardiovascular system symptoms. Most patients were relieved spontaneously by oxygen inhalation and completed catheterization after their symptoms were alleviated.

Conclusion: The increasing incidence of anaphylaxis related to PICC catheterization necessitates greater awareness among healthcare providers. Further research is needed to identify the exact culprits during PICC insertion and develop effective strategies for preventing anaphylactic reactions.

Objective: To formulate an expert consensus on an evidence-based overview of all topics related to the Tunneled Peripherally Inserted Central Venous Catheters.

Methods: A Chinese consensus based on evidence has provided a definition and indications for Tunneled Peripherally Inserted Central Venous Catheters. The literature on Tunneled Peripherally Inserted Central Venous Catheter was reviewed from its inception to March 2024. The indications were developed using the RAND/UCLA Appropriateness Method.

Results: This consensus presents five indications for Tunneled Peripherally Inserted Central Venous Catheters, covering tunneling definitions, key processes, tunneling devices, various applications, and maintenance. The indications aim to enhance patient safety and optimize the efficacy of tunneled peripherally inserted central venous catheters.

Conclusions: This consensus is based on critical evidence review and the clinical experts aimed to assist clinicians in applying tunneling techniques. Further prospective studies are needed to evaluate the impact of complications related to the tunneling technique.

Introduction: Peripherally inserted central catheters (PICC) are the preferred vascular access for Outpatient Parenteral Antimicrobial Therapy (OPAT) due to user-friendliness and high safety level. Nevertheless, the lack of a validated tool hampers the yet ill-charted epidemiology and monitoring of PICC related complications in ambulatory care.

Methods: A sequential exploratory mixed-method three phase research design was used to develop and validate a monitoring tool for PICC complications in OPAT. A literature review and co-design approach allowed its development, followed by Delphi panel content validation. In a third phase, the tool was piloted and implemented for further evaluation, including adherence.

Results: Twelve and nine experts respectively participated in the first and second Delphi round (response rate: 92% resp. 69%). Scale-level Content Validity Index based on the Average Method was 0.99 and 0.90 in the first and the second Delphi round respectively. After the Delphi procedure, the tool consisted of the following relevant items: (1) functionality (injection and aspiration), (2) insertion site, (3) catheter fixation, (4) infection and (5) thrombosis. After positive pilot testing, the tool was implemented in 17 participants with outcomes measured in 15 participants. Two participants were readmitted and three experienced PICC complications. As for adherence, the monitoring tool was partially or fully completed 285 times (74,8%); external catheter length was rarely or never reported and systematic follow-up of the temperature scored poorly.

Conclusion: A tool for ambulatory monitoring of PICC-associated complications with a solid content validity was obtained. Future research should consist of a multicentric larger size assessment and digitalization.

Iliac artery aneurysms (IAA) associated with abdominal aortic aneurysms (AAA) are found in 10%-20% of AAAs. Isolated internal iliac artery aneurysms (IIAAs) are an uncommon entity, representing 0.3%-0.5% of all intra-abdominal aneurysms, incidentally discovered or late diagnosed with frank rupture. Despite the high mortality, shared and standardized guidelines on treatment management of IIAAs are currently lacking. We report the case of an 82-year-old male diagnosed and managed in our institution for a left internal iliac artery aneurysm excluded after aorto-bisiliac prosthesis surgery. After an initial endovascular attempt, the procedure was converted to a direct transabdominal puncture approach. Post-procedural evaluation demonstrated a clinical success without evidence of aneurismal sac filling and stable aneurysmal sac volume. The viability of transabdominal sac puncture, especially in cases with complex anatomy or when traditional access methods are inadequate, represents a promising alternative, particularly in poor candidates to conventional iliac surgery.

Objective: We report the 6-month outcomes of the Ark Cannulation Trial (ACT) I early feasibility study. This investigation examined the Ark as a potential innovative access tool for overcoming cannulation-related challenges and improving arteriovenous fistula (AVF) dependent hemodialysis through targeted cannulation.

Methods: During this first-in-human, interventional, prospective, single arm, single site investigation, 13 patients were treated. Cohort 1 included patients with existing fistulas meeting the criteria for Ark implantation at planned sites, including depth (4-15 mm), diameter (⩾4 mm), flow (⩾500 mL/min) and a poorly accessible cannulation zone. Cohort 2 included patients who underwent AVF creation and implantation of Arks at time of initial surgery. For both Cohorts, clinical need determined if one or two Arks were implanted. The primary endpoint was effective initial cannulation of the access site after Ark implantation. The secondary endpoint was continued access of the Ark cannulation zone for hemodialysis and evaluation of device or procedure-related adverse events collected for 6 months post-implantation. The exploratory endpoint evaluated the Ark implantation procedure.

Results: Of 13 patients, 2 were withdrawn prior to initial cannulation through the Ark-1 patient due to an exacerbated baseline condition and the other patient due to loss of follow-up. In the efficacy analysis, 11 of 13 treated patients demonstrated successful primary and secondary outcomes. Of the 11 treated patients who initiated cannulation through the Arks, 100% experienced successful primary and secondary outcomes. None of the patients experienced adverse events related to the Ark and surgeons had the necessary skills to implant Arks.

Conclusion: The results demonstrated the Ark could be used successfully in End-Stage Renal Disease (ESRD) patients undergoing hemodialysis three times a week. These results suggest preliminary safety and efficacy of the Ark as a promising cannulation tool for dialysis vascular access and warrant further exploration of long-term safety and effectiveness through a pivotal clinical study involving a larger population and extended follow-up.