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Abstract Aims Patients with high‐flow arteriovenous (AV) access are at risk of developing high‐output cardiac failure (HOCF) and subsequent hospitalization. However, diagnosing HOCF is challenging and often requires invasive procedures. The role of systemic vascular resistance (SVR) in diagnosing HOCF is underestimated, and its predictive value is limited. Our study aims to identify non‐invasive risk factors for HOCF to facilitate early diagnosis and timely surgical interventions. Methods and results We included 109 patients with high‐flow AV access who underwent serial echocardiography. The retrospective cohort was divided into two groups based on their hospitalization due to HOCF. The two groups were matched for age and gender. After a mean follow‐up of 25.1 months, 19 patients (17.4%) were hospitalized due to HOCF. The two groups had similar baseline characteristics. However, the HOCF group had a higher value of vascular access blood flow (Qa) (2168 ± 856 vs. 1828 ± 617 mL/min; P = 0.045). Echocardiographic analysis revealed that the HOCF group had more pronounced left ventricular diastolic dysfunction (E/e′: 21.1 ± 7.3 vs. 16.2 ± 5.9; P = 0.002), more severe pulmonary hypertension (right ventricular systolic pressure: 41.4 ± 16.7 vs. 32.2 ± 12.8; P = 0.009), a higher Doppler‐derived cardiac index (CI) (4.3 ± 0.8 vs. 3.7 ± 1.1; P = 0.031), and a lower Doppler‐derived estimated SVR (eSVR) value (5.5 ± 0.3 vs. 6.9 ± 0.2; P = 0.002) than the non‐HOCF group. Using multivariable Cox regression analysis, a low eSVR value (

Abstract Background Patient reported experience measures are contemporary quality indicators that focus on evaluation of healthcare delivery processes. While surgical arteriovenous fistulas (otherAVF) are preferred for haemodialysis vascular access, fears about surgery and complications often result in refusal/delays. A new technique of endovascular arteriovenous fistula creation (EndoAVF) has been developed and as part of it’s ongoing introduction into our unit, the patient perspective was felt critical to its evaluation. The Vascular Access Questionnaire (VAQ) provides a mechanism for identifying and scoring perceptions in this setting. Method Patients who had previously undergone EndoAVF formation were approached to undertake the VAQ as part of a service evaluation of their experience. In addition to the components of the VAQ, data questions relating to the patient’s perception of their access were gathered. Results were compared with a matched historical cohort of surgically created fistulas (otherAVF) patients. Results Patient satisfaction and self-reported ease of use with EndoAVF were high. Overall VAQ scores were similar between the EndoAVF and the surgically created cohort. Functionally, there was no significant difference in perception of their fistula by patients, irrespective of them being created surgically or radiologically. Conclusion Although numbers in this report are small limiting exploration of preserved inherent heterogeneity, we provide a useful initial patient reported experience and perspectives on comparative functional use of radiologically and surgically created AVFs. As real world experience gathers, future larger cohorts with adequate sampling may allow exploration of patient reported experiences and outcome measures.

Objective: This study was carried out to determine the effect of cartoon watching with virtual reality (VR) glasses and kaleidoscope used during blood draw on the pain and fear of children. Methods: The universe of this randomized controlled study was composed of 7-12-year-old children who were admitted to blood draw unit of a hospital between January-April 2020. Data of the study were collected by using “Participant Information Form”, “Visual Analog Scale”, “Wong-Baker FACES Pain Rating Scale” and “The Children’s Fear Scale (CFS).” Results: Mean pain scores of the children in kaleidoscope and VR groups were found to be significantly lower than the ones in the control group in the study (p

Background: We have developed a new approach for peripherally inserted central catheter (PICC) insertion that we think has several advantages, including ease of insertion, access to a larger vein and patient comfort. Methods: In this case series report, the first 19 cases were audited. Results: All PICCs were inserted without complications; 17 on the first attempt. Conclusion: We conclude that the novel approach to the axillary vein for PICC insertion is feasible and appears to be safe when performed by an experienced operator. [ABSTRACT FROM AUTHOR]

Purpose. The arterio-venous anastomosis (AVA) continues to be the "gold standard" for vascular access in patients undergoing haemodialysis. This retrospective study aims to analyze the causes that led to End Stage Renal Disease (ESRD), the type of native AVA, their localization, and their patency. Material and Methods. The study included the last 100 consecutive and random AVAs constructed in our clinic. 68 men of average age 62.3 (+/-10.8) years and 32 women of average age 59.9 (+/-15.8) years were operated. The main causes that led to ESRD were: Glomerulonephritis - 33%, Hypertension- 24% and Diabetes- 20%. The overweight patients were 33% and the smokers - 30%. Results. AVA has been successfully constructed in 82% of the patients on the left hand and in 18% on the right hand. A distal latero-terminal radio-cephalic fistula (DLTRC) was constructed on only 8% of the patients. The most common type of anastomosis was an L.T. radio-cephalic in the forearm - 58%, followed by an L.T. brachio-cephalic fistula - 19% and latero-lateral, radio-cephalic in the forearm - 14% of the patients. The early fistula patency was - 80%, one-year cumulative patency was 94%. Conclusion. The analysis of our results shows that the relative share of the overweight and diabetes population is increasing today. In practice, solutions for the construction of primary forearm anastomosis are increasingly common.

Introduction: Needle-related distress is common among people receiving hemodialysis and affects quality of life and treatment decisions, yet little evidence exists to guide management. This study explored patients’ experiences of needle-related distress to inform the development of prevention, identification, and management strategies. Methods: Semistructured interviews concerning dialysis cannulation, needle-related distress, and potential solutions were conducted with people with current or recent experience of hemodialysis (N = 15) from a tertiary hospital-based service. Interviews ceased at thematic saturation. Transcripts were analyzed thematically. Results: There were 4 themes and 11 subthemes generated: (i) uncovering a hidden source of distress (dismissal and minimization by others; suffering in silence to stay alive; preparation, assessment, and education); (ii) coping with cannulation pain and trauma (interaction between physical damage, pain, and distress; operator dependency—the importance of nurse skill and technique); (iii) the environment created by dialysis nurses (emotional transference; communication during cannulation; valuing empathy and person-centered care; a psychosocially supportive dialysis unit); and (iv) supporting patient self-management of distress (accessing tools to help themselves; distraction to reduce distress). Conclusion: Needle-related distress is an often-hidden element of the hemodialysis experience. Patients learn to tolerate it as an inevitable part of dialysis for survival. Nurses’ technical skills and the dialysis environment they create are key determinants of the patient cannulation experience. Proposed solutions include psychological screening, education for patients to self-manage distress, and training for nurses in communication and providing relevant psychological support.

This research examines the application of non-invasive acoustic analysis for detecting obstructions in vascular access (fistulas) used by kidney dialysis patients. Obstructions in these fistulas can interrupt essential dialysis treatment. In this study, we utilized a condenser microphone to capture the blood flow sounds before and after angioplasty surgery, analyzing 3819 sound samples from 119 dialysis patients. These sound signals were transformed into spectrogram images to classify obstructed and unobstructed vascular accesses, that is fistula conditions before and after the angioplasty procedure. A novel lightweight two-dimension convolutional neural network (CNN) was developed and benchmarked against pretrained CNN models such as ResNet50 and VGG16. The proposed model achieved a prediction accuracy of 100%, surpassing the ResNet50 and VGG16 models, which recorded 99% and 95% accuracy, respectively. Additionally, the study highlighted the significantly smaller memory size of the proposed model (2.37 MB) compared to ResNet50 (91.3 MB) and VGG16 (57.9 MB), suggesting its suitability for edge computing environments. This study underscores the efficacy of diverse deep-learning approaches in the obstructed detection of dialysis fistulas, presenting a scalable solution that combines high accuracy with reduced computational demands.

Rationale & objectiveDespite the high prevalence of frailty among dialysis patients, it is unknown whether frailty is associated with dialysis vascular access failure. This study examined the association between frailty and functional use of vascular access.Study designRetrospective observational study.Setting & participantsPatients who initiated hemodialysis through a tunneled catheter in the US Renal Data System database from 2012 through 2017 and underwent subsequent creation of an arteriovenous fistula or graft.PredictorsThe "claims-based frailty indicator" (CFI) was calculated using a validated claims-based disability status model anchored to a well-described frailty phenotype.OutcomesTime to functional use for fistulas and grafts defined as the time from initiation of hemodialysis to treatments using the index vascular access with 2 needles.Analytical approachFine and Gray competing risk models separately examining fistula and graft outcomes. Patient survival was modeled for the entire cohort using Cox proportional hazards regression.ResultsA total of 41,471 patients met inclusion criteria, including 33,212 who underwent fistula creation and 8,259 who underwent graft placement. Higher CFI quartiles were associated with a greater rate of mortality. Patients in the highest CFI quartile had more than 2 times the rate of mortality compared with patients in the lowest CFI quartile (hazard ratio [HR], 2.49 [95% CI, 2.41-2.58]). In multivariable analyses, the highest CFI quartile was significantly associated with longer time to functional use of fistulas (HR, 0.65 [95% CI, 0.62-0.69]) and grafts (HR, 0.88 [95% CI, 0.79-0.98]).LimitationsGeneralizability may be limited by the requirement of 12 months of Medicare claims availability before initiation of dialysis. There were no data on patient anatomic characteristics or surgeon characteristics and limited patient-specific sociodemographic data.ConclusionsHigher degrees of frailty are associated with longer times to vascular access functional use. Frailty may be useful for informing clinical decision-making regarding choice of vascular access.

Background: Chronic kidney disease is a prevalent global health issue, particularly in advanced stages requiring dialysis. Vascular access (VA) quality is crucial for the well-being of hemodialysis (HD) patients, ensuring optimal blood transfer through a dialyzer machine. The ultrasound dilution technique (UDT) is used as the gold standard for assessing VA quality; however, its limited availability due to high costs impedes its widespread adoption. We aimed to develop a novel deep learning model specifically designed to predict VA quality from Photoplethysmography (PPG) sensors. Methods: Clinical data were retrospectively gathered from 398 HD patients, spanning from February 2021 to February 2022. The DeepVAQ model leverages a convolutional neural network (CNN) to process PPG sensor data, pinpointing specific frequencies and patterns that are indicative of VA quality. Meticulous training and fine-tuning were applied to ensure the model's accuracy and reliability. Validation of the DeepVAQ model was carried out against established diagnostic standards using key performance metrics, including accuracy, specificity, precision, F-score, and area under the receiver operating characteristic curve (AUC). Result: DeepVAQ demonstrated superior performance, achieving an accuracy of 0.9213 and a specificity of 0.9614. Its precision and F-score stood at 0.8762 and 0.8364, respectively, with an AUC of 0.8605. In contrast, traditional models like Decision Tree, Naive Bayes, and kNN demonstrated significantly lower performance across these metrics. This comparison underscores DeepVAQ's enhanced capability in accurately predicting VA quality compared to existing methodologies. Conclusion: Exemplifying the potential of artificial intelligence in healthcare, particularly in the realm of deep learning, DeepVAQ represents a significant advancement in non-invasive diagnostics. Its precise multi-class classification ability for VA quality in hemodialysis patients holds substantial promise for improving patient outcomes, potentially leading to a reduction in mortality rates. [ABSTRACT FROM AUTHOR]

Vascular access (VA) flow suppression surgery augments VA flow resistance and can increase other circulation flows hindered by high-flow VA. However, whether VA flow suppression surgery affects cervical circulation has rarely been reported. We aimed to determine the effect of VA flow suppression surgery on the cervical circulation in patients with high-flow VA. This single-center, retrospective, observational study included 85 hemodialysis patients who underwent VA flow suppression surgery at the Kanno Dialysis and Access Clinic between 2009 and 2018. Blood flow in the VA, bilateral vertebral arteries, and common carotid artery was measured before and after VA flow suppression surgery. The VA flow decreased from 1548 mL/min to 693 mL/min postoperatively. The flow of the vertebral artery on the VA side increased from 55 mL/min to 81 mL/min. The flow in the bilateral common carotid arteries also increased. Patients whose symptoms improved postoperatively showed better improvement in the vertebral artery on the VA side. VA flow suppression surgery in patients with high-flow VA increases the flow of the vertebral artery on the VA side and of the bilateral common carotid arteries. High-flow VA can hinder the vertebral and common carotid circulation. [ABSTRACT FROM AUTHOR]

Background The Kidney Failure Risk Equation (KFRE) can play a better role in vascular access (VA) planning in patients with chronic kidney disease (CKD) requiring hemodialysis (HD). We described the VA creation and utilization pattern under existing estimated glomerular filtration rate (eGFR)-based referral, and investigated the utility of KFRE score as an adjunct variable in VA planning. Methods Patients with CKD aged ≥18 years with eGFR <20 mL/min/1.73 m2 who chose HD as dialysis modality from January 2010 to August 2020 were included from a population-based database in British Columbia, Canada. Modality selection date was the index date. Exposures were categorized as (i) current eGFR-based referral, (ii) eGFR-based referral plus KRFE 2-year risk score on index date (KFRE-2) >40% and (iii) eGFR-based referral plus KFRE-2 ≤40%. We estimated the proportion of patients who started HD on arteriovenous fistula/graft (AVF/G) within 2 years, indicating timely pre-emptive creation, and the proportion of patients in whom AVF/G was created but did not start HD within 2 years, indicating too-early creation. Results Study included 2581 patients, median age 71 years, 60% male. Overall, 1562(61%) started HD and 276 (11%) experienced death before HD initiation within 2 years. Compared with current referral, the proportion of patients who started HD on AVF/G was significantly higher when KFRE-2 was considered in addition to current referral (49% vs 58%, P -value <.001). Adjunct KFRE-2 significantly reduced too-early creation (31% vs 18%, P -value <.001). Conclusions KFRE in addition to existing eGFR-based referral for VA creation has the potential to improve VA resource utilization by ensuring more patients start HD on AVF/G and may minimize too-early/unnecessary creation. Prospective research is necessary to validate these findings. [ABSTRACT FROM AUTHOR]

Vascular access devices form an essential component in the management of acute and chronic medical conditions. Introduction and ongoing management of these devices are linked with bundles of care aimed at reducing associated risks including bleeding and infection. To evaluate the antimicrobial potential of the potassium ferrate haemostatic disc on Gram-positive (Staphylococcus aureus) and Gram-negative (Klebsiella pneumonia e, Pseudomonas aeruginosa) bacteria and on Candida albicans. The impact of the potassium ferrate disc was compared with the often-used chlorhexidine gluconate (CHG) impregnated disc to evaluate the potential efficacy of the potassium ferrate disc as an alternative to CHG in cases with an increased risk of active bleeding. In the presence of anticoagulated blood, we observed an inhibitory effect of the haemostatic disc on microbial growth for microbial strains commonly associated with vascular access device related infections. Our results indicate that the potassium ferrate disc may provide dual clinical benefits with both haemostatic and antimicrobial action observed during in-vitro testing. [ABSTRACT FROM AUTHOR]

Aims: Patients with high‐flow arteriovenous (AV) access are at risk of developing high‐output cardiac failure (HOCF) and subsequent hospitalization. However, diagnosing HOCF is challenging and often requires invasive procedures. The role of systemic vascular resistance (SVR) in diagnosing HOCF is underestimated, and its predictive value is limited. Our study aims to identify non‐invasive risk factors for HOCF to facilitate early diagnosis and timely surgical interventions. Methods and results: We included 109 patients with high‐flow AV access who underwent serial echocardiography. The retrospective cohort was divided into two groups based on their hospitalization due to HOCF. The two groups were matched for age and gender. After a mean follow‐up of 25.1 months, 19 patients (17.4%) were hospitalized due to HOCF. The two groups had similar baseline characteristics. However, the HOCF group had a higher value of vascular access blood flow (Qa) (2168 ± 856 vs. 1828 ± 617 mL/min; P = 0.045). Echocardiographic analysis revealed that the HOCF group had more pronounced left ventricular diastolic dysfunction (E/e′: 21.1 ± 7.3 vs. 16.2 ± 5.9; P = 0.002), more severe pulmonary hypertension (right ventricular systolic pressure: 41.4 ± 16.7 vs. 32.2 ± 12.8; P = 0.009), a higher Doppler‐derived cardiac index (CI) (4.3 ± 0.8 vs. 3.7 ± 1.1; P = 0.031), and a lower Doppler‐derived estimated SVR (eSVR) value (5.5 ± 0.3 vs. 6.9 ± 0.2; P = 0.002) than the non‐HOCF group. Using multivariable Cox regression analysis, a low eSVR value (<6) emerged as an independent predictor of HOCF hospitalization with a hazard ratio of 9.084 (95% confidence interval, 2.33–35.39; P = 0.001). Receiver operating characteristic curve analysis indicated that CI/eSVR values more accurately predicted HOCF hospitalization [sensitivity: 94.7%, specificity: 51.0%, area under the curve (AUC): 0.75, P < 0.001] than the Qa/cardiac output ratio (AUC: 0.50, P = 0.955), Qa values ≥ 2000 mL/min (AUC: 0.60, P = 0.181), and Qa values indexed for height in metres (AUC: 0.65, P = 0.040). Conclusions: In patients with high‐flow AV access, low eSVR values obtained through non‐invasive Doppler echocardiography were associated with a high rate of HOCF hospitalizations. Therefore, routine eSVR screening in these patients might expedite the diagnosis of HOCF. [ABSTRACT FROM AUTHOR]

Background: End-stage kidney disease (ESKD) is associated with a tremendous financial burden. Data in Indonesia shows an increasing number of patients with ESKD taking hemodialysis as a routine procedure every year. Establishment and maintenance of vascular access are important in the management of ESKD. Vascular complications that often arise due to hemodialysis are common and one of the main reasons for hospitalization. Cannulation complications ranged from minor hematomas to acute bleeding from pseudoaneurysms that required emergency surgical procedures. This study aims to assess the different clinicopathological characteristics of ESKD patients with vascular access cannulation complications and the surgical management related to the complications. Materials and Methods: This research is a retrospective observational study. The research subjects in this study were ESKD patients in the vascular and endovascular surgery division of the tertiary hospital in West Java, Indonesia. There were 121 study subjects. Clinicopathological characteristics of vascular cannulation complications and surgical management are extracted from the medical record. Results: Three major vascular complications were ruptured pseudoaneurysms 64/121 (52.9%), impending rupture pseudoaneurysms 28/121 (23.1%), and pseudoaneurysms 21/121 (17.4%). Common surgical procedures were ligation of the draining vein 47/121 (38.8%), arterial primary repair 28/121 (23.1%), and arterial patch repair 18/121 (14.9%). There was a significant relationship between symptoms of bleeding in ruptured pseudoaneurysms and bulging masses in pseudoaneurysms (p = 0.001). There was a significant relationship between the diameter of the vascular mass, vascular defect size, and hematoma and the type of surgical procedure taken (p < 0.010). Conclusion: Ruptured, impending rupture, and pseudoaneurysms are major complications of vascular access in ESKD patients, and there was a significant relationship between the carried-out surgical procedure and the size of the vascular mass, defect, and hematoma. Plain Language Summary: Chronic kidney failure is a particular challenge in terms of health problems in Indonesia. With the increase in kidney failure patients, the number of dialysis patients in this country has also sharply increased because blood dialysis is the main management for end-stage kidney failure. Dialysis treatment does not mean it is 100% safe; various complications can arise from the blood dialysis procedure. Many of the complications that arise are caused by problems with the blood vessels that serve as access to the dialysis machine. In this research, we aim to study the characteristics of blood dialysis complications related to blood vessel access. This study was conducted at one of the largest national hospitals in Indonesia, precisely in West Java province, which is the most populated province in Indonesia. In this study, we involved 121 end-stage kidney failure patients. This study is very important to carry out considering that around 30% of chronic kidney failure patients that were hospitalized have complications from blood vessels. We hope that this research can be used further in determining the best procedure for providing venous access for dialysis with all the limitations faced by developing countries. [ABSTRACT FROM AUTHOR]

Introduction: Peripheral blood stem cell (PBSC) harvesting requires reliable and safe vascular access. In our institution, a change of practice was implemented and the central venous catheter (CVC) placement for all autologous PBSC collections was abandoned in favor of a careful evaluation of peripheral venous access (PVA) for each individual patient. The aim of this prospective study was to evaluate the rate of patients with adequate peripheral veins for autologous PBSC collection and compare patient characteristics, collection efficacy, and complication rate between patients with PVA and CVC. Method: Peripheral veins were assessed by the apheresis nurse team in all patients referred between January 2020 and July 2021 to autologous PBSC collection. Only in case of difficult venous access, CVC was inserted. Large volume leukapheresis (LVL) procedures, which processed ≥3 total blood volumes, were performed. Results: In 65 (57%) patients PVA was used, while 49 (43%) patients required placement of short‐term CVC. Peripheral venous access was successfully used significantly more often in males (69.8%) (P = 0.010), and patients with multiple myeloma (71.0%) than in patients with non‐Hodgkin's lymphoma (35.9%) and Hodgkin's lymphoma patients (33.3%) (P < 0.001). There was a significant difference in the type of prior administered chemotherapy; in the patients who received cytostatics free chemotherapy, PVA was used more often (75.0%) (P = 0.007). In terms of the efficacy and safety of LVLs, there were no differences between procedures performed using PVA and CVCs. Conclusion: Peripheral venous access is feasible for autologous PBSC collection in more than a half of patients, in particular in those with multiple myeloma. Changes in the treatment of multiple myeloma, using new proteasome inhibitors‐based and immunomodulatory agents that do not adversely affect peripheral veins, have enabled the use of PVA even at the high blood flow rates required by LVL. Peripheral venous access is not associated with safety issues or with a lesser collection efficiency, and it is cost‐effective as well. Each patient referred to autologous PBSC collection needs to be evaluated individually by the experienced apheresis team for the most appropriate venous access. [ABSTRACT FROM AUTHOR]

Purpose: Controversy exists regarding the treatment of recurrent stenosis in vascular access at cannulation sites with a covered stent as repeated cannulation may damage the stent. The purpose of this study was to review covered stent placement at cannulation sites to salvage failing vascular access. Materials and methods: A total of 11 patients were included for the purpose of this study. Eight patients (72.7%) received a covered stent due to recurrent stenosis, 2 (18.2%) due to an acute occlusion, and in 1 case (9.1%), the covered stent was used to repair a damaged polytetrafluoroethylene arteriovenous graft (PTFE AVG). Results: Primary patency after stent placement was 40.9% at 6 months, primary-assisted patency was 79.5% at 12 months, and secondary patency was 80% at 24 months. No significant problems were observed during the dialysis sessions after stent placement. The intervention rate per patient-year was not significantly different before or after covered stent placement, at 3.8 (IQR=9.5) interventions per year versus 2.5 (IQR=3.0) interventions per year (p=0.280). Conclusion: In conclusion, treating failing vascular access with problems at cannulation sites with covered stents can be considered. Clinical Impact: Treating vascular access stenosis at cannulation sites with covered stents can successfully prolong vascular access life. [ABSTRACT FROM AUTHOR]

Background: Peripheral intravenous catheter placement is one of the most common invasive procedures that nurses will perform, especially in emergency departments. Aims: This early analysis aimed to quantify the economic burden associated with intravenous therapy in patients presenting in emergency departments with difficult intravenous access, receiving traditional peripheral intravenous catheters. This may inform the opportunity for improvement for investment in nursing tools and services regarding difficult venous access burden reduction. Methods: Model parameter data were obtained from published literature where possible via a targeted literature review for the terms including relative variations of 'Difficult Venous Access', 'burden', and 'costs', or elicited from expert clinical opinion. A simple decision tree model was developed in Microsoft® Excel 2016. Results included number of insertion attempts, number of patients requiring escalation, catheter failures due to complications, healthcare professional (e.g. nurse) time, and total costs (including/excluding health care professional time). Sensitivity analyses were performed. Results: The model considers 64,000 individuals presenting in the emergency department annually, of which 75% (48,000) require a peripheral intravenous catheter; of these 22% (10,560) are estimated to have difficult venous access. The total cost burden of difficult venous access is estimated to be $890,095 per year/$84.29 per patient with difficult venous access, including the cost of clinician time. Key total cost drivers include the population size treated in the emergency department annually, the proportion of midlines placed by a specialist IV (intravenous access) nurse and the percentage of patients with difficult venous access. Conclusion: This is the first formal analysis estimating the significant economic burden of difficult venous access in emergency departments via peripheral intravenous catheter placement, a task frequently performed by nurses. Further studies are needed to evaluate nursing-centric strategies for reducing this burden. Additionally, adoption of a concise definition is needed, as is routine use of reliable assessment tools so that future cost analyses can be better contextualised. [ABSTRACT FROM AUTHOR]

Background: Patient reported experience measures are contemporary quality indicators that focus on evaluation of healthcare delivery processes. While surgical arteriovenous fistulas (otherAVF) are preferred for haemodialysis vascular access, fears about surgery and complications often result in refusal/delays. A new technique of endovascular arteriovenous fistula creation (EndoAVF) has been developed and as part of it's ongoing introduction into our unit, the patient perspective was felt critical to its evaluation. The Vascular Access Questionnaire (VAQ) provides a mechanism for identifying and scoring perceptions in this setting. Method: Patients who had previously undergone EndoAVF formation were approached to undertake the VAQ as part of a service evaluation of their experience. In addition to the components of the VAQ, data questions relating to the patient's perception of their access were gathered. Results were compared with a matched historical cohort of surgically created fistulas (otherAVF) patients. Results: Patient satisfaction and self-reported ease of use with EndoAVF were high. Overall VAQ scores were similar between the EndoAVF and the surgically created cohort. Functionally, there was no significant difference in perception of their fistula by patients, irrespective of them being created surgically or radiologically. Conclusion: Although numbers in this report are small limiting exploration of preserved inherent heterogeneity, we provide a useful initial patient reported experience and perspectives on comparative functional use of radiologically and surgically created AVFs. As real world experience gathers, future larger cohorts with adequate sampling may allow exploration of patient reported experiences and outcome measures. [ABSTRACT FROM AUTHOR]

Peripherally inserted central catheters (PICCs) ensure safe and long-lasting venous access. Using validated instruments to assess nurses' knowledge of PICC use will allow educational measures to improve this area of care to be developed. Objective: This study aimed to build an instrument for analysing nurses' knowledge about PICCs and assess its content validity. Methods: A psychometric study was used with the construction of a knowledge analysis instrument. This was developed in two stages: instrument construction; and content validation by expert judges using the content validity ratio. Results: The panel of experts comprised nine nurses. Nineteen changes related to content and semantics were suggested for the instrument. Conclusion: The research allowed for the construction and validation of a tool for knowledge analysis; this is relevant to practice as no such knowledge instrument exists. It is proposed to use this assessment instrument to identify gaps in knowledge and implement focused training interventions. [ABSTRACT FROM AUTHOR]

Vascular access continues to be a key factor for the reliable and safe delivery of intravenous (IV) therapy to patients in any healthcare setting. Clinical guidelines advocate for the right vascular access device selection, in order to reduce avoidable complications, eg multiple stabs, phlebitis, thrombophlebitis, insertion site infection, and blood stream infection, while improving efficiency and reducing costs. Peripheral intravenous catheters or cannulas (PIVCs) remain widely used for gaining vascular access in all clinical settings, with both adults and children, because they provide a relatively cheap and simple way to provide blood sampling and the prompt administration of IV medications. Although safe and easy to insert, PIVCs present with associated risks that can be costly to the organisation. The case studies included with this article introduce Nipro's Safetouch Cath Winged with Injection Port as a new cost-effective choice of PIVC, which is now available from NHS Supply Chain. [ABSTRACT FROM AUTHOR]

Objective: This study was carried out to determine the effect of cartoon watching with virtual reality (VR) glasses and kaleidoscope used during blood draw on the pain and fear of children. Methods: The universe of this randomized controlled study was composed of 7-12-year-old children who were admitted to blood draw unit of a hospital between January-April 2020. Data of the study were collected by using “Participant Information Form”, “Visual Analog Scale”, “Wong-Baker FACES Pain Rating Scale” and “The Children’s Fear Scale (CFS).” Results: Mean pain scores of the children in kaleidoscope and VR groups were found to be significantly lower than the ones in the control group in the study (p<0.05). Mean fear scores of the children in kaleidoscope and VR groups were significantly lower than the control group based on CFS (p<0.05). Conclusion: It was concluded that kaleidoscope and VR methods were found to be effective in alleviating pain and fear among 7-12-year-old children during blood draw. [ABSTRACT FROM AUTHOR]

This is part of a series of articles on vascular access in emergencies. The other two articles were on intra osseous lines and central venous lines. These are critical lifesaving emergency skills for the primary care professional. In this article, we will provide an overview of umbilical vein catheterisation highlighting its importance, the indications, contraindications, techniques, complications and nursing considerations. By familiarising healthcare providers with this procedure, we hope to enhance their knowledge and skills, ultimately leading to improved outcomes in the neonatal population. [ABSTRACT FROM AUTHOR]

Pulmonary hypertension (PH) is often present in patients presenting for kidney transplant listing. While PH can complicate kidney transplantation (KTx), it can be managed with multidisciplinary management that includes both the transplant center and pulmonary hypertension center, or with experts both pre- and post-transplant. This review summarizes the approach and management of PH in KTx candidates and recipients, along with expected outcomes and controversies surrounding arteriovenous fistula and graft management. [ABSTRACT FROM AUTHOR]

Patients with end‐stage kidney disease may require creation of an arteriovenous fistula in order to receive hemodialysis treatment. The creation may result in several complications, including carpal tunnel syndrome. Early diagnosis and treatment are essential to relieve symptoms, prevent permanent nerve damage, and improve quality of life. However, the sensory and motor disturbances resembling carpal tunnel syndrome could be related to other etiologies than external compression of the median nerve underneath the transverse ligament. This case report presents eight patients with a radiocephalic arteriovenous fistula, who all had symptoms of carpal tunnel syndrome. Ultrasonographic examination showed a segmental intraneural hypervascularization of a large vessel inside the median nerve proximal to the wrist and arteriovenous fistula anastomosis with garland‐like course as well as multiple flow velocities. The neurophysiological findings showed a significant decreased velocity in the ipsilateral forearm to the arteriovenous fistula. [ABSTRACT FROM AUTHOR]

Late primary care provider (PCP) or nephrologist evaluation of patients with progressive kidney disease may be associated with increased morbidity and mortality. Among patients undergoing initial arteriovenous (AV) access creation, we aimed to study the relationship of recent PCP and nephrologist evaluations with perioperative morbidity and mortality. We performed a retrospective review of patients from 2014 to 2022 who underwent initial AV access creation at an urban, safety-net hospital. Univariable and multivariable analyses identified associations of PCP and nephrologist evaluations <1 year and <3 months before surgery, respectively, with hemodialysis initiation via tunneled dialysis catheters (TDCs), 90-day readmission, and 90-day mortality. Among 558 patients receiving initial AV access, mean age was 59.7 ± 14 years, 59% were female gender, and 60.6% were Black race. Recent PCP and nephrology evaluations occurred in 386 (69%) and 362 (65%) patients, respectively. On multivariable analysis, unemployed and uninsured statuses were associated with decreased likelihood of PCP evaluation (unemployment: odds ratio [OR], 0.51; 95% confidence interval [CI], 0.34-0.77; uninsured status: OR, 0.05; 95% CI, 0.01-0.45) and nephrologist evaluation (unemployment: OR, 0.63; 95% CI, 0.43-0.91; uninsured status: OR, 0.22; 95% CI, 0.06-0.83) (all P <.05). Social support was associated with increased likelihood of PCP evaluation (OR, 1.81; 95% CI, 1.07-3.08) (all P <.05). Hemodialysis was initiated with TDCs in 304 patients (55%). Older age (OR, 0.98; 95% CI, 0.96-0.99), obesity (OR, 0.38; 95% CI, 0.25-0.58), and nephrologist evaluation (OR, 0.12; 95% CI, 0.08-0.19) were independently associated with decreased hemodialysis initiation with TDCs in patients receiving an initial AV access (all P <.05). Ninety-day readmission occurred in 270 cases (48%). Cirrhosis (OR, 2.5; 95% CI, 1.03-6.03; P =.04), coronary artery disease (OR, 2.31; 95% CI, 1.5-3.57), prosthetic AV access (OR, 1.84; 95% CI, 1.04-3.26), and impaired ambulation (OR, 1.75; 95% CI, 1.15-2.66) were independently associated with increased readmission (all P <.05). Older age (OR, 0.98; 95% CI, 0.97-0.99), prior TDC (OR, 0.65; 95% CI, 0.45-0.94), and unemployment (OR, 0.58; 95% CI, 0.39-0.86) were associated with decreased readmission (all P <.05). Ninety-day mortality occurred in 1.6% of patients. Neither PCP nor nephrologist evaluation was associated with readmission or mortality. Recent nephrology evaluation was associated with reduced hemodialysis initiation with TDCs among patients undergoing initial AV access creation. Unemployed and uninsured statuses posed barriers to accessing nephrology care. [ABSTRACT FROM AUTHOR]

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The goal of this study is to understand the design needs and preferences of patients and care partners for a needleless vascular connection device called the Ambulatory Kidney to Improve Vitality (AKTIV) Connection. One of the greatest barriers to patients' self-management of home-based hemodialysis treatments is connecting the dialysis device to their own blood supply. We gathered detailed data on patients' and care partners' design needs and preferences with the goal of mitigating this barrier to usage with the AKTIV Connection. In particular, we interviewed 16 hemodialysis patients and 7 care partners using a mixed-method approach of rating and semi-structured questions. Participants indicated they would prefer carrying the AKTIV Connection on or around the waist or in a belt bag. Inductive content analysis showed that the participants considered the ideal AKTIV Connection to connect to a patient's bloodstream in the chest area, be rectangularly shaped with rounded corners, and have upper size and weight limits in reference to a modern-day smartphone. We also identified 10 categories of ideal features of the AKTIV Connection and 12 categories of concerns related to connecting the AKTIV Connection to a patient's bloodstream. The findings from this study will help guide the design and development of the AKTIV Connection so that it meets patients' and care partners' needs and preferences, ultimately helping improve the quality of life of patients with end-stage renal disease. [ABSTRACT FROM AUTHOR]

Aim: To explore nurses' perceptions of using point‐of‐care ultrasound for assessment and guided cannulation in the haemodialysis setting. Background: Cannulation of arteriovenous fistulae is necessary to perform haemodialysis. Damage to the arteriovenous fistula is a frequent complication, resulting in poor patient outcomes and increased healthcare costs. Point‐of‐care ultrasound‐guided cannulation can reduce the risk of such damage and mitigate further vessel deterioration. Understanding nurses' perceptions of using this adjunct tool will inform its future implementation into haemodialysis practice. Design: Descriptive qualitative study. Methods: Registered nurses were recruited from one 16‐chair regional Australian haemodialysis clinic. Eligible nurses were drawn from a larger study investigating the feasibility of implementing point‐of‐care ultrasound in haemodialysis. Participants attended a semistructured one‐on‐one interview where they were asked about their experiences with, and perceptions of, point‐of‐care ultrasound use in haemodialysis cannulation. Audio‐recorded data were transcribed and inductively analysed. Findings: Seven of nine nurses who completed the larger study participated in a semistructured interview. All participants were female with a median age of 54 years (and had postgraduate renal qualifications. Themes identified were as follows: (1) barriers to use of ultrasound; (2) deficit and benefit recognition; (3) cognitive and psychomotor development; and (4) practice makes perfect. Information identified within these themes were that nurses perceived that their experience with point‐of‐care ultrasound was beneficial but recommended against its use for every cannulation. The more practice nurses had with point‐of‐care ultrasound, the more their confidence, dexterity and time management improved. Conclusions: Nurses perceived that using point‐of‐care ultrasound was a positive adjunct to their cannulation practice and provided beneficial outcomes for patients. Implications for the Profession and/or Patient Care: Haemodialysis clinics seeking to implement point‐of‐care ultrasound to help improve cannulation outcomes may draw on these findings when embarking on this practice change. Reporting Method: This study is reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ). Patient or Public Contribution: Patients were not directly involved in this part of the study; however, they were involved in the implementation study. Trial and Protocol Registration: The larger study was registered with Australian New Zealand Clinical Trials Registry: ACTRN12617001569392 (21/11/2017) https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373963&isReview=true [ABSTRACT FROM AUTHOR]

The insertion of peripheral intravenous (PIV) catheters is one of the most performed invasive procedures in acute healthcare settings. However, peripheral difficult vascular access (PDVA) is not uncommon and can lead to delays in administering essential medications. Ultrasound (US) has emerged as a valuable tool for facilitating PIV cannulation. Advancements in technology have introduced a technique known as bi-plane imaging, allowing the simultaneous display of both longitudinal and transverse views of vessels. We aimed to investigate whether the utilization of bi-plane imaging, as opposed to the single-plane approach, would yield superior results for PDVA in the emergency department (ED). This study was a single-center randomized controlled trial. We included adult patients admitted to the ED who required PIV cannulation. Patients were randomly assigned to undergo cannulation using either the mono-plane or bi-plane approach, both performed by skilled providers. The primary outcome of the study was to compare the first attempt success rates between the two techniques. A total of 442 patients were enrolled, with 221 undergoing cannulation attempts using the mono-plane approach. Successful placement of a functioning PIV catheter was achieved in a single attempt for 313 out of 442 patients (70.8%). There was no significant difference in the success rates between the two study groups: 68.3% in the mono-plane group and 73.3% in the bi-plane group (p = 0.395). The median time required for a successful attempt differed between the groups, with 45 s (range 18–600) in the mono-plane group and 35 s (range 20–600) in the bi-plane group (p = 0.03). Our study confirms that US is a highly effective tool for facilitating PIV cannulation in patients with PDVA presenting to the ED. However, our investigation into the use of bi-plane imaging did not reveal a significant improvement when compared to mono-plane imaging. [ABSTRACT FROM AUTHOR]

French guidelines for the prevention of vascular access infections in a haemodialysis setting were released in 2005. Compliance with these guidelines is currently unknown. The aim of this study was to assess compliance with the guidelines for vascular access infection prevention in French haemodialysis units, and to describe the difficulties reported. A cross-sectional survey was conducted between March and December 2019 in 200 haemodialysis units in France, selected at random. Data were collected via questionnaire, completed by telephone interview with an infection control practitioner. A practice was deemed compliant when >85% of units declared that they always complied with the guidelines. In total, 103 units (51.5%) agreed to participate. Most practices complied with the guidelines; however, some practices did not reach the 85% compliance threshold for working in pairs when connecting central venous catheter (CVC) lines, performing hand hygiene before disconnecting lines, rinsing antiseptic soap before painting CVC exit site or arteriovenous fistula (AVF) puncture site, allowing antiseptic paint to dry, handling CVC branches with antiseptic impregnated gauze, performing hand hygiene after AVF compression with gloves, wearing protective eyewear when connecting/disconnecting CVC or when puncturing AVF, and wearing a gown when puncturing AVF. The most frequently reported difficulties were understaffing, difficulties with skin preparation because of exit site skin damage, and lack of buttonhole technical expertise. Despite good overall compliance, this survey highlights some shortcomings in compliance with infection prevention guidelines, which could be associated with either higher risk of vascular access infection or increased blood-borne virus transmission. [ABSTRACT FROM AUTHOR]

Background: Vascular complications are a cause of increased morbidity and mortality when performing percutaneous procedures requiring large-bore arterial access. MANTA vascular closure device (VCD) is currently the only large-bore VCD using an intraluminal foot plate and an extraluminal collagen plug. The traditional depth locator approach might be compromised in; emergent cases without the required measurements, cases of hematoma formation, or other patient, procedure, or operator-specific variables. Furthermore, this technique can be used for postclosure in cases without the required measurement of depth. We describe vascular outcomes using fluoroscopy (fluoroscopic DOT technique) rather than traditional depth locator approach for vascular closure with the MANTA VCD. Methods: Fifty patients who underwent transcatheter aortic valve implantation (TAVI) were retrospectively analyzed using fluoroscopic DOT technique with 18F MANTA VCD between May and August 2021. All patients >18 years of age who qualified for transfemoral TAVI were included. Access was obtained with ultrasound guidance with vessel diameter of at least > 6 mm and free from anterior vessel wall calcification. Patient related factors and primary outcomes of access site bleeding and acute flow-limited limb ischemia requiring intervention were prospectively analyzed. Furthermore, 1 patient who failed hemostasis with suture-mediated VCD had successful hemostasis with fluoroscopic DOT technique as dry postclosure after balloon aortic valvuloplasty. Results: In total, 50 patients were analyzed with a mean age of 81 years and majority were male (56%). Majority had comorbidities of hypertension (88%) and hyperlipidemia (94%), 24% had peripheral arterial disease, 38% coronary artery disease, and 58% were former smokers. Importantly, 40% were obese with an average body mass index (BMI) of 29 kg/m2. There were no bleeding or ischemic limb complications post MANTA VCD deployment using the fluoroscopic DOT technique. Furthermore, none of the patients required peripheral intervention from index procedure to 1 month post verified during their 1-month post TAVR follow-up. Conclusion: Fluoroscopic DOT technique using the MANTA VCD is highly reproducible and allows hemostasis in a predictable manner for procedures requiring large-bore arterial access in the absence of MANTA depth measurement. [ABSTRACT FROM AUTHOR]

BackgroundA patient-centered dialysis treatment option requires an understanding of patient preferences for alternative vascular accesses and nephrologists often face difficulties when recommending vascular access to end-stage kidney disease (ESKD) patients. We aimed to quantify the relative importance of various vascular access characteristics to patients, healthcare providers and general population, and how they affect acceptability for patients and healthcare providers.MethodsIn a discrete choice experiment, patients with maintenance hemodialysis (MHD), healthcare providers, and individuals from the general population were invited to respond to a series of hypothetical vascular access scenarios that differed in five attributes: cumulative patency, infection rate, thrombosis rate, cost, and time to maturation. We estimated the respondents’ preference heterogeneity and relative importance of the attributes with a mixed logit model (MXL) and predicted the willingness to pay (WTP) of respondents via a multinomial logit model (MNL).ResultsHealthcare providers (n = 316) and the general population (n = 268) exhibited a favorable inclination toward longer cumulative patency, lower access infection rate and lower access thrombosis rate. In contrast, the patients (n = 253) showed a preference for a 3-year cumulative patency, 8% access infection rate, 35% access thrombosis rate and 1.5 access maturity time, with only the 3-year cumulative patency reaching statistical significance. Among the three respondent groups, the general population found cumulative patency less important than healthcare providers and patients did. Patients demonstrated the highest WTP for cumulative patency, indicating a willingness to pay an extra RMB$24,720(US$3,708) for each additional year of patency time.ConclusionPatients and healthcare providers had a strong preference for vascular access with superior patency. While the general population preferred vascular access with lower thrombosis rates. These results indicate that most patients prefer autogenous arteriovenous fistula (AVF) as an appropriate choice for vascular access due to its superior patency and lower complications than other vascular access types.

The low 1-year patency rate of mature arteriovenous fistulas (AVFs) remains a significant clinical problem. Although vessel properties and biomechanics have been suggested to affect AVF function, understanding their roles in AVF patency failure is challenging owing to the heterogeneity within the patient population, including demographics and comorbid conditions. In this study, we present a case of a patient with 2 upper-arm AVFs with different 1-year patency outcomes and investigate whether they had different histologic features before the AVF creation surgery and biomechanics at 1 day and 6 weeks after the AVF creation surgery using magnetic resonance imaging–based fluid structure interaction simulations. Despite both AVFs being in the upper arm, created

Abstract Background It may be challenging for practitioners to secure vascular access in animals, especially in a state of shock. Aim This study aimed to evaluate the clinical relevance of commercial 16‐gauge intravenous (IV) catheter stylet vs. 15‐gauge intraosseous (IO) vascular access in emergencies. Methods Six healthy dogs were used in this study. After general anaesthesia, IO catheterisation was performed on both trochanteric fossae of the femurs using a commercial 16‐gauge IV catheter stylet and EZIO 15‐gauge IO needle. The pressures were measured by manual, gravity and mechanical infusion for 5 min each. Additionally, insertion time and success rate were recorded. Results In hand infusion, mean pressure of a 16‐gauge IO (605.06 ± 49.13 mmHg) was statistically lower than that of a 15‐gauge EZIO IO catheterisation (718.84 ± 93.09 mmHg). In gravity infusion, there was no significant difference in pressure during injection between the 16‐gauge IV catheter (52.23 ± 14.48 mmHg) and 15‐gauge EZIO IO catheterisation (50.68 ± 11.89 mmHg). In mechanical infusion, mean pressure of the 15‐gauge EZIO IO catheterisation (128.25 ± 50.16 mmHg) was lower than that of the 16‐gauge IV catheter (152.56 ± 67.23 mmHg). The insertion times of a 16‐gauge IV catheter and 15‐gauge EZIO IO catheterisation were 16.79 ± 0.92 and 11.65 ± 1.70 s, respectively. The success rates of the insertion were similar between both groups. Conclusion This study shows that IO catheterisation with a commercial IV catheter stylet can be an alternative method of IO catheterisation in an emergency, especially for rapid vascular access.

Background: Totally implantable venous central access devices (TIVADs) can be implanted by open surgery or by direct puncture in the subclavian (ScV), internal jugular (IJV) or cephalic (CephV) veins. Methods: A retrospective study was conducted in 201 patients. Thirty-day follow-up data was analyzed to compare the outcomes of different techniques and evaluation of risk factors. Results: Complications were reported in 3.8 % of the patients with no overall differences between different vascular accesses. Direct puncture was associated with more accidental arterial punction (p = 0.01). History of previous catheters was a risk factor for immediate complications (p = 0.01) and patients with history of thoracic disease had more early and late complications (p = 0.03 and p = 0.04, respectively). Late complications were more common in patients over 60 years old (p = 0.04) and with chronic pain (p = 0.03). Conclusion: There was no difference in overall complication rates between the implantation techniques. Further prospective randomized controlled trials would clarify the most effective technique.

Objective To explore the influencing factors for the risk of autologous arteriovenous fistula (AVF) nonfunction in patients on hemodialysis (HD) for >10 years. Methods A total of 50 patients on HD >10 years were assigned into two groups of nonfunction (n=26) and function (n=24) according to the presence or absence of AVF nonfunction. General profiles and laboratory parameters were compared between two groups for evaluating the effects of various indicators on AVF nonfunction. ResultsInitial cannulation time for AVF was significantly earlier in nonfunction group than that in function group. The levels of cholesterol and retinol-binding protein were significantly higher than those in function group. Inter-group differences also existed in the proportions of different cannulation techniques and blood flow distribution (P

Abstract Background To access the efficacy of percutaneous transluminal angioplasty and arteriovenous fistula reconstruction for immature arteriovenous fistula, compare the long-term patency and post-operative complications between them. Materials and methods The medical records and Hemodialysis record sheets from 44 patients between May 2020 and January 2022 who underwent percutaneous transluminal angioplasty or arteriovenous fistula reconstruction treatment for immature autogenous arteriovenous fistula (AVF) were retrospectively reviewed. The patients were divided into two groups according to the type of surgery they received, including 25 patients in the PTA group and 19 patients in the AVF reconstruction group. Clinical outcomes were included, such as the primary and secondary patency rates following the procedure, maturation time, peak systolic velocity (PSV) of brachial artery, maximum pump-controlled blood flow at initial dialysis, and post-operative complications rates in the two groups. Results Technical and clinical success was achieved in 100% of the 44 cases. For patients who underwent percutaneous transluminal angioplasty, the primary patency rate at 3, 6, and 9 months was 84.0%, 68.0%, 60.0%, and the secondary patency rate was 92.0%, 84.0%, 80.0%, respectively. And for patients who underwent arteriovenous fistula reconstruction, the primary patency rate at 3, 6, and 9 months was 89.5%, 73.7%, 68.4%, and the secondary patency rate was 100.0%, 94.7%, 94.7%, respectively. There were no significant differences between the two groups in terms of patency rates (p > .050). In patients whose maturation was successful, the average maturation time of fistula after the PTA procedure was 19.36 ± 13.94 days, and 58.63 ± 18.95 days for the reconstruction procedure (p .050). The maximum pump-controlled blood flow at initial dialysis was 232.60 ± 16.72 ml/min in PTA group, which was significantly higher than 197.11 ± 10.45 ml/min in reconstruction group (p .050). Conclusion When immature AVFs require reconstruction surgery, the patency outcomes are comparable to AVFs that undergo successful management by PTA. While, when AVFs are successfully managed by PTA, they have significantly less maturation times and higher maximum pump-controlled blood flow rates at initial dialysis AVF use.

Abstract Introduction Ultrasound is the current standard for central venous access due to its advantages in efficiency and safety. In-plane and out-of-plane visualization techniques are commonly used, but there is no clear evidence showing an advantage of one technique over the other. The objective of this study was to compare the success and time required for biplane visualization vs. in-plane and out-of-plane techniques in simulated models. Methodology Ten emergency medicine specialists participated in 60 simulated events, with randomization of the visualization technique for each event. Each event required intravenous cannulation of a simulated model for jugular venous access, with a maximum of three attempts allowed. The number of attempts required for each event, success of puncture and venous cannulation, frequency of redirection and puncture of the posterior wall, time required to obtain an optimal window, visualize the needle inside the vessel, and passage of the guidewire were recorded. The success ratios and times required for each visualization technique (biplane, in-plane, and out-of-plane) were compared. Results Cannulation success rate was 100% for all three techniques. Success on the first attempt was 95% for biplane visualization vs. 100% for in-plane and out-of-plane. The median total time for the procedure was higher for biplane visualization (29.9 s) compared to in-plane (25.2 s) and out-of-plane (29 s), but this difference was not statistically significant (p = 0.999). There were no significant differences in cannulation success, needle redirection, or posterior wall puncture frequency between biplane visualization and in-plane and out-of-plane techniques. Conclusions This study suggests that biplane visualization with the use of pocket ultrasound for internal jugular cannulation in simulated models did not demonstrate significant differences when compared with in-plane and out-of-plane visualization techniques. Further research with larger sample sizes may be needed to confirm these results.

Implanted central vascular access devices for intravenous administration of drugs are widely used in cancer patients who require long-term access, specific chemotherapy and parenteral nutrition. Installation of central vascular access devices solves the problem of venous access, but, unfortunately, it can lead to complications, including serious and irreversible ones. Here is a clinical case of cancer in a 49-year-old female patient who was implanted with a vascular access device for intravenous therapy. The incorrect and undiagnosed insertion of the vascular access device in the subclavian artery and also neoadjuvant polychemotherapy sessions led to myelomalacia with the subsequent development of myeloradiculopathy, the emergence and development of persistent neurological disorders. After radiological diagnosis and verification of this complication, percutaneous transluminal angioplasty with single stenting and removal of the central vascular access device was performed. The article presents complications with the insertion of central vascular access devices and discusses in detail a clinical case of complication and methods for its solution when this device is incorrectly implanted in the artery.

Animals in the veterinary and experimental settings, including nonhuman primates (NHPs), often require repeated and prolonged vascular access for indications including blood sampling or administration of fluids, blood products, medication, or other therapies. A vascular access approach should be tailored to experimental or clinical use meeting the needs of the individual animal such that benefits outweigh risks. The optimal device and placement technique is based on the inherent advantages and disadvantages of specific anatomic sites and planned use. Totally implanted vascular access ports (VAPs) enable reliable central venous access for frequent sample collection and/or intravenous therapies. VAPs minimize discomfort with IV access to facilitate cooperation with handling and minimize stress-induced physiologic changes which can confound biologic data and drug responses. VAPs do not limit species-typical behavior and social group activities and are compatible with animal enrichment programs that include play and swim because there are no externalized components. VAPs are typically used long-term and demonstrate excellent durability with high patency and low complication rates over time, presenting a safe and dependable vascular access approach.

Percutaneous central vein catheterization is commonly performed to access venous circulation for various clinical indications. However, unintentional arterial puncture may occur which can result in catastrophic complications. We report a case of an inadvertent right brachiocephalic artery cannulation in a 77-year-old lady planned for haemodialysis via a percutaneous internal jugular vein vascular access performed under ultrasound guidance. As an intravascular stent is not favourable in view of the close proximity of the right common carotid artery to the site of puncture as well as the risk of massive bleeding upon simple removal of the catheter, an open surgical removal via a median sternotomy was performed. Acquiring the competency in procedural skills, an understanding of the surgical anatomy and anticipating impending complications are of paramount importance in preventing as well as in mitigating the above complication. [ABSTRACT FROM AUTHOR]

David Mantle discusses the various vascular access options for patients undergoing haemodialysis [ABSTRACT FROM AUTHOR]