Journal of Vascular Access最新文献

A foreign body was inadvertently retained in the patient's radial artery during a previous endovascular procedure, leading to early recurrent thrombosis of his hemodialysis arteriovenous fistula. Through the strategic use of ultrasound, a through-and-through wire, as well as sequential balloon inflation to "push" the foreign body, it was successfully retrieved endovascularly, leading to effective salvage of the patient's hemodialysis access.

Tip location of central venous access devices is considered highly relevant for the purpose of reducing catheter-related complications and prolong the duration of the access. Though, the choice of the method of tip location currently relies upon the operator's experience, preference, and training, on the local availability of specific resources and technologies, and on local policies. On the contrary, considering the relevance of tip location, such clinical choice should preferably be based on the best available evidence. Though current guidelines recommend intra-procedural rather than post-procedural methods of tip location, many clinicians still adopt the strategy of assessing the position of the tip by radiological methods after the completion of the procedure. Also, though current guidelines and evidence-based documents recommend the intra-cavitary electrocardiography and/or trans-thoracic echocardiography as preferred methods of intraprocedural tip location, many clinicians still adopt fluoroscopy. While the pros and cons of each different method of tip location are well known, there is no evidence-based document that offer robust recommendations about the choice of tip location of different central venous access devices in different population of patients (neonates, children, adults). Therefore, the Italian Group of Long-Term Venous Access Devices (GAVeCeLT) and the Italian Vascular Access Society (IVAS) have developed a national consensus on the choice of the most appropriate method of tip location. After a systematic review of the available evidence, the panel of the consensus (which included 22 Italian experts with documented competence in this area) has provided structured recommendations answering six key questions regarding the choice between intra-procedural and post-procedural tip location, as well as the appropriate indication of the four different methods of intra-procedural tip location currently available (trans-esophageal echocardiography, trans-thoracic echocardiography, intracavitary electrocardiography, and fluoroscopy). Only statements reaching a 100% agreement were included in the final recommendations.

Introduction: Percutaneous transluminal angioplasty (PTA) is the global standard for treating dysfunctional arteriovenous fistulas (AVF). However, PTA can cause vessel wall damage and intimal hyperplasia, leading to restenosis and the need for reintervention. The drug-coated balloon (DCB) is a novel approach for managing recurrent dysfunction in AVFs. However, there is limited information on the optimal number of DCB treatments required. Specifically, it is uncertain whether a second DCB should be performed in patients in whom the initial treatment with the first DCB was ineffective.

Methods: This single-center, retrospective observational study aimed to evaluate the effectiveness of a second DCB treatment in 40 patients. A second DCB was performed if PTA was required generally within 90 days after the first DCB, indicating failure of the first DCB treatment.

Results: The results showed a significant difference in patency following the second DCB compared to conventional balloon treatment (χ² = 20.46, p < 0.001) and between the first and second DCB treatments (χ² = 11.41, p = 0.0007). Univariate logistic regression analysis indicated that patients with thinner maximum intimal hyperplasia had significantly longer assisted primary patency periods (p = 0.006). Furthermore, receiver operating characteristic curve analysis to assess the sensitivity-specificity profile of the second DCB's effectiveness showed that the optimal threshold for maximum intimal hyperplasia was 1.2 mm (sensitivity/specificity, 0.80/0.58).

Conclusion: Our findings suggest that a second DCB treatment is effective for patients whose first DCB was unsuccessful, particularly in those with maximum intimal hyperplasia thinner than 1.2 mm.

Background: The intracavitary electrocardiogram (IC-ECG) localization technique has been widely used in peripherally inserted central catheter (PICC) placement. However, the accuracy of IC-ECG on PICC tip localization and complications remains controversial. The purpose of this work is to evaluate the clinical efficacy and safety of IC-ECG on PICC placement.

Materials and method: We retrieved randomized control trials from PubMed, Web of Science, Cochrane Library, EMBASE, and CNKI databases published before October 30, 2024. Patients guided by IC-ECG technology or landmark, and then used radiography to confirm the tip position, regardless of age, race, nationality, and region. Interventions other than IC-ECG or landmark were excluded. We used the Cochrane Bias Risk Assessment tools version 2 to evaluate the quality of enrolled trials. The Grading of Recommendations Assessment, Development, and Evaluation Statements online tool was used to determine the certainty of the evidence. The primary outcome was the success rate on the first attempt.

Results: Sixteen studies involving 6707 PICC patients are included. The results of the meta-analysis indicate that the IC-ECG group has a significantly higher success rate on first attempt of PICC placement (RR = 1.23, 95% CI [1.09-1.37], p < 0.00001). Total complications and phlebitis events decreased in the IC-ECG group compared with the landmark group. The mean procedure time, thrombogenesis, infection, and arrhythmia in the IC-ECG group are not statistically significant compared with the landmark group. Trial-sequential analysis (TSA) of the results indicate that sufficient events had been observed in the outcomes in success rate on first attempt, overall successful rate, total complications, phlebitis events, and infection events.

Conclusion: The IC-ECG guided method has a higher success rate on the first attempt and lower total complication for catheter tip localization in PICC placement. IC-ECG may be considered the preferred method for accurate catheter tip placement. (PROSPERO registration number, CRD42023456651).

Background: Medical adhesive-related skin injury (MARSI) is a significant but underreported complication, particularly in cancer patients with peripherally inserted central catheters (PICC). This systematic review and meta-analysis aimed to estimate the prevalence of MARSI and identify key risk factors in this patient population.

Methods: A systematic search of PubMed, Embase, the Cochrane Library, CNKI, Wanfang, and VIP was conducted to identify studies reporting MARSI prevalence and risk factors in cancer patients with PICC. Pooled prevalence estimates and odds ratios (ORs) for risk factors were calculated using a random-effects model. Heterogeneity was assessed using the I² statistic, and subgroup analyses were performed to explore potential sources of heterogeneity. Publication bias was assessed using funnel plots and Egger's test.

Results: A total of 20 studies met the inclusion criteria, encompassing 8411 patients. The pooled prevalence of MARSI was 22% (95% CI: 18-26), with substantial heterogeneity across studies (I² = 96.3%). Subgroup analysis revealed that retrospective studies reported higher prevalence (25%) compared to prospective studies (16%). Key risk factors included advanced age (OR: 2.593, 95% CI: 1.322-5.089), higher BMI (OR: 2.927, 95% CI: 2.029-4.223), pre-existing skin conditions (OR: 2.487, 95% CI: 1.693-3.650), and the use of transparent film dressings (OR: 3.228, 95% CI: 2.086-5.001). Funnel plot and Egger's test showed no significant publication bias.

Conclusions: MARSI is prevalent in cancer patients with PICC. Modifiable risk factors should guide prevention strategies, including careful adhesive selection and regular skin assessments to improve patient outcomes.

Objective: This study aims to evaluate the satisfaction and health-related quality of life (HRQoL) in cancer patients with chest ports and to understand their experiences and challenges.

Methods: A convergent parallel mixed methods study was conducted. We surveyed 618 cancer patients from 17 hospitals using the Quality of Life Assessment, Venous Device-Port questionnaire from October 2022 to October 2023. Concurrently, 14 patients from a tertiary hospital were interviewed in May 2023.

Results: Cancer patients reported a high level of satisfaction with chest port with an average score of 8.25 out of 10. However, over half had concerns such as concerns about port damage, blockage, and infection, and attempted to cover the port with clothing. The most common practical concern was interference with sports or exercise. Thirteen themes emerged from the interviews, divided into sense of benefit (convenience in daily life, high sense of security, reduction in repeated punctures and related pain, and decreased burden of frequent hospital visits), trust issues and emotional reactions at port implantation (trust and passive decision-making, fear and anxiety about surgical procedures, and resistance and passive acceptance), and negative perceptions after port implantation (safety concerns, cosmetic concerns, interference with daily activities, physical discomfort, inconvenience of accessing medical resources, patient uncertainty and need for port care information).

Conclusion: Combining quantitative and qualitative findings provides a deeper understanding of chest port-related HRQoL in cancer patients. Although they reported a high level of satisfaction, they face significant concerns that negatively impact their HRQOL. By addressing their concerns, we can significantly improve their experiences.

Implications for clinical practice: Enhanced patient education, emotional support, and innovative techniques are essential for improving overall satisfaction and quality of life of cancer patients with chest ports.

Background: Exercise management for cancer patients with arm peripherally inserted central catheter-PORT (PICC-PORT) requires standardization to prevent complications and optimize outcomes. However, evidence-based exercise protocols specifically designed for these patients are lacking.

Objective: To develop a comprehensive exercise management protocol for cancer patients with PICC-PORT through systematic investigation and expert consensus.

Methods: A three-phase approach was employed: (1) semi-structured interviews with 22 oncology nurses to identify practical challenges; (2) systematic evidence synthesis from clinical guidelines and databases; and (3) two-round Delphi consultation with 18 intravenous therapy experts.

Results: The final protocol comprises five key dimensions with 25 evidence-based measures, including exercise assessment, exercise components, exercise timing, exercise dosage, and exercise precautions. Expert consensus was achieved with authority coefficients of 0.894 and 0.897 for two rounds, and variation coefficients ranging from 0 to 0.22 in the final round.

Conclusions: This study established a standardized, evidence-based exercise protocol for cancer patients with PICC-PORT. The protocol integrates with established implantation guidelines and provides comprehensive guidance for clinical practice. Future research should evaluate its effectiveness through randomized controlled trials.