Journal of Vascular Access最新文献

Background: Concern about unused vascular access devices has increased, but data on idle short peripherally intravascular catheters in medical-surgical units is still scarce. We aimed to assess the prevalence of unused short peripheral catheters in hospitalized patients and identify risk factors and reasons that lead nurses to maintain them in situ.

Methods: A cross-sectional observational study was performed in September 2022. Clinical observation (24h) and medical records review were assessed to collect patient demographics and catheter-related information. Nurses were asked the main reason for continuing the use of the unused catheter. The primary outcome was the prevalence of unused short peripheral catheters, which were no longer used for intravenous fluids or medications in the previous 24 h. Multivariate logistic regression has been performed to evaluate risk factors for unused catheters. The STROBE checklist was used to report our study.

Results: Seven hundred and sixty-four patients were included; out of the 621 patients with at least one short peripheral catheter, one-third had at least one unused catheter. The risk of having an unused peripherally intravascular catheter was almost double when the catheter was positioned in the emergency department. Catheters of smaller calibers and in situ for fewer days were less likely to be unused. The main reasons for keeping a peripherally intravascular catheter unused in situ were clinical conditions.

Conclusion: Unused short peripheral catheters are still quite frequent. While specific clinical needs justified some unused short peripheral catheters, a proportion remained unexplained and potentially avoidable. Nurses and policymakers can use the findings to inform decision-making and protocols to manage peripherally inserted catheters to reduce unused short peripheral catheters and, consequently, complications and costs and improve patient safety and quality of care.

Background: Needle-free connectors (NFCs) are recommended as closure systems for peripheral and central vascular catheters to reduce needlestick injuries and infections, while potentially reducing blood reflux. However, their performance in short-term dialysis catheters has never been evaluated. The aim of this study was to evaluate the backflow associated with two NFCs (Neutron™ and Tego™) compared to the standard closure.

Methods: In this bench study, the physiological blood pressure of the superior vena cava was simulated. Expert operators performed three sealing sequences for each combination of connector and lumens of the catheter, with and without closing the clamp. After that, the backflow was measured in millimeters using a high-precision digital caliper.

Results: No combination of caps, lumens, or clamping sequences eliminated the backflow. No differences were observed between standard caps and NFCs in both lumens, apart from the Tego™/No clamp combination in the proximal lumen that showed higher backflow (standard cap 15 [11; 17] mm vs Tego™ 23 [19; 25] mm, p < 0.001). Clamping reduced backflow in both the proximal (13 [11; 17] mm vs 20 [13; 25] mm) and distal lumens (12 [11; 16] mm vs 14 [12; 17] mm). No differences were found between standard caps and NFCs in the distal lumen, regardless of clamping. Proximal lumen consistently exhibited larger backflow (14 [12; 22] mm) compared to distal lumens (13 [11; 17] mm, p = 0.005).

Conclusion: NFCs do not seem to introduce any advantage on backflow reduction as compared to a standard cap combined with lumen and clamping. Our data suggest that clamping should become standard practice when NFCs are used in the management of short-term dialysis catheters.

Background: Distal radial artery access (DRA) has been emerged as an alternative for conventional transradial arterial access. While palpation of radial artery is mandatory prior coronary angiography, it remains unknown the clinical impact of palpation in DRA success. Aim of our study is to explore whether the palpability of distal radial artery is linked with higher rates of successful arterial access.

Methods: We conducted a post-hoc analysis using data from two randomized-controlled trials on DRA. All patients with available data on distal radial artery palpability and cannulation's success were included in our analysis. No procedure was performed with ultrasound guidance.

Results: Data on the palpability of the distal radial artery and the DRA success were available for 435 patients. Successful distal radial artery cannulation was attempted in 255 and 98 of patients with and without palpable distal radial artery, respectively. No significant difference between the two groups was observed (81.5% vs 80.3%, p = 0.786). Univariate analysis revealed statistically significant difference in gender, height, known CAD, valvular disease as indication for angiography and number of skin punctures. Multivariate analysis included these variables, as well as palpability of the distal radial artery and found that number of skin punctures and valvular disease as indication are significantly associated with DRA success.

Conclusion: According our post-hoc analysis, the palpability of the distal radial artery is not associated with higher rates of DRA success. Further studies are required for the validation of these results.

Background: Anxiety is common in pediatric patients, especially during vascular access procedures. Most well-studied affect and anxiety scales, including the Observation Scale of Behavioral Distress-Revised (OSBD-r), the modified Yale Preoperative Anxiety Scale (mYPAS), and the modified Induction Compliance Checklist (mICC), are too cumbersome for clinical use outside of research settings. HRAD± (Happy, Relaxed, Anxious, Distressed with yes/no to cooperation) is a clinically-efficient observational scale that evaluates pediatric procedural affect and cooperation. This study examined the clinical utility of HRAD± during vascular access procedures in children. The aims were to investigate the correlation of HRAD± to highly reliable, research-based affect and cooperation scales and to assess inter-rater reliability (IRR) between observers in this setting.

Methods: This was a prospective, observational study conducted at Lucile Packard Children's Hospital Stanford. Inpatient participants were 1 month to 25 years old and undergoing a peripheral intravenous insertion or phlebotomy. Two trained research assistants (RAs) scored each patient independently during the vascular access procedure using HRAD±, OSBD-r, mYPAS, and mICC. Correlation analyses computed the associations between HRAD± and reference scales. IRR between RAs and vascular access providers was calculated using Fleiss' Kappa.

Results: A total of 234 patients were included. HRAD± scores strongly correlated with OSBD-r and mYPAS (p < 0.0001, p < 0.0001, respectively). The cooperation assessment of HRAD± demonstrated strong correlation to mICC (p < 0.0001). IRR of HRAD± between research assistants and vascular access providers showed moderate agreement (p < 0.0001).

Conclusion: HRAD± demonstrated strong correlation to the reference affect and cooperation scales. This study supports the utility of HRAD± for rapid assessment of pediatric procedural anxiety and cooperation during vascular access procedures. HRAD± can serve as a practical tool for facilitating clinical decisions, and its wider incorporation into healthcare settings would importantly guide targeted interventions to reduce patient anxiety.

This case series describes the endovascular management of three patients with catheter-associated superior vena cava (SVC) syndrome. SVC syndrome can result from malignant (60%) or benign (40%) etiologies. The most common causes of benign SVC syndrome are indwelling central venous catheters (CVCs) with 1%-3% and 0.2%-3.3% of patients being affected. In all cases, a mechanical thrombectomy device was used to evacuate the chronic and acute thrombus, followed by a balloon angioplasty and stenting of the SVC. Anterograde flow and rapid symptom resolution was achieved following the procedure. No peri- or postprocedural complications occurred. These cases demonstrate the feasibility of endovascular management of catheter-associated SVC syndrome.

We present a rare case of port malposition into the anterior mediastinum resulting in chemotherapy extravasation into the pleural cavity. While management of extravasation into soft tissues has been established, the data on treatment of mediastinal and intrapleural extravasation is limited. This case underscores how utilizing state-of-the-art technology like real-time intracavitary electrocardiography(IC-ECG) or transthoracic/subxiphoid ultrasound with the "bubble test", rather than reliance on postoperative chest radiography, can help eliminate catheter malposition and its potential catastrophic consequences.

Tension blisters usually occur in the presence of local swelling or excessive pressure. Tension blisters after puncture injury are relatively rare in uremic patients who use autogenous arteriovenous fistula (AVF) for hemodialysis treatment. In this report, the patient we reported developed tension blisters after the initial puncture injury. Arterial CTA revealed obvious stenosis of the right subclavian vein and the patient was diagnosed with venothoracic outlet syndrome (VTOS). In this case, the occurrence and development of tension blisters after dialysis puncture injury were observed. Furthermore, the etiology, treatment measures, and methods for preventing the occurrence of tension blisters are illuminated to further improve the quality of vascular access.

Phlegmasia cerulea dolens (PCD) is a rare but limb-threatening complication of deep vein thrombosis. A 72-year-old hemodialysis male patient presented with upper limb PCD. The patient underwent hemodialysis via a permanent hemodialysis central venous catheter (HD-CVC) while a new brachial-cephalic AVF was created 1 month ago. Computed tomography revealed extensive thrombosis of right subclavian and brachiocephalic vein. The HD-CVC was removed and patient was treated with anticoagulation therapy. However, his clinical condition was worsening and he was transferred to IR department. The patient underwent successful percutaneous pharmacomechanical thrombectomy (PMT) of the right subclavian and brachiocephalic vein followed by percutaneous angioplasty (PTA) with significant flow restoration and no signs of pulmonary embolization. PCD may also be developed in hemodialysis patients with well-functioned AVF. Effective and rapid revascularization is important to prevent serious complications such as venous gangrene and limb ischemia. Endovascular treatment with PMT and PTA can be a limb-saving procedure for rapid recanalization in patients with PCD.

Background: In patients with cancer, the choice of an appropriate venous access device is crucial for effective treatment, minimizing complications, and reducing healthcare costs. Key management decisions, such as the timing of device removal post-therapy, can impact clinical outcomes. As current international guidelines lack specific directives for these issues, a global consensus of experts, representing different countries, was deemed appropriate.

Methods: A panel of 11 experts from three continents, including oncologists and healthcare professionals, was chosen. After a comprehensive review of clinical trials and guidelines on central venous access devices (CVAD) in oncology published between January 2013 and December 2023, the panel developed and voted on specific recommendations for the selection and management of CVADs in patients with cancer, during a 2-day meeting.

Results: The panel reached consensus on 10 issues concerning (a) indications for a CVAD, (b) available options for CVADs, (c) role of the staff and patients in the choice of CVAD, (d) factors influencing the selection of a port over an external catheter, (e) logistical requirements for port and external catheter insertion, (f) stakeholders responsible for port and external catheter insertion, (g) factors determining the removal of a port after completing the definitive therapy, and (h) recommended frequency of flushing when the CVAD is not in use.

Conclusions: The results of the consensus may offer healthcare professionals a global view of some critical issues concerning CVADs for cancer therapy, helping to establish recommendations for local clinical practice.

Background: There is limited research on the consumption of aspirin and its effects on bleeding during arteriovenous fistula (AVF) placement surgery and associated complications in end-stage renal disease (ESRD) patients. Regarding the potential risks imposed on cardiac patients by discontinuing aspirin, the aim of the study was to determine whether aspirin should be discontinued prior to AVF placement surgery.

Methods: This prospective study was carried out at two referral medical centers from 2023 to 2024. The patients were included as 30 patients who routinely took 80 mg of aspirin daily and 30 patients who did not take aspirin. The primary outcomes included the amount of blood loss, and the secondary outcomes included AVF success and maturation time. The amount of bleeding was assessed by the ΔHb (Hb₁-Hb₂), ΔHCT (HCT₁-HCT₂), and intraoperative hemorrhage volume.

Results: Aspirin consumption did not significantly affect any of the examined parameters, including operation duration, hemoglobin decrease, hematocrit decrease, intraoperative hemorrhage, AVF success rate, maturity time, need for blood transfusion, postoperative bleeding, hematoma and thrombosis, hospitalization, and re-Operation (p > 0.05).

Conclusion: Aspirin did not have any significant or negative effects across any of the parameters examined. Based on the findings of this study, there is no need to discontinue aspirin in patients prior to upper limb AVF placement surgery, but further studies are recommended.