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Abstract Background: Established noninvasive pharmacologic means of alleviating pain and anxiety in children undergoing intravenous cannulation are time-consuming, and thus impractical for routine use in the emergency department. Vapocoolant sprays [...]

Steal syndrome is a well-known complication of arteriovenous (AV) access placement. To assess the derangement in hemodynamics of the upper extremity after AV access creation, brachial and digital pressures were [...]

The techniques for inserting and carrying for central vascular access devices are presented. Tips for correct placement, insertion and and aftercare are presented for Nontunneled catheters, tunneled catheters, implanted ports and peripherally inserted central catheters.

Critical pathways define the essential components of care that must occur within a specific time period to achieve a desired outcome. At Vanderbilt University Medical Center, a multidisciplinary critical pathway [...]

Background. Dependable chronic venous access is an important aspect of supportive care for patients requiring chemotherapy or other long-term therapy because it enables such patients to be treated on an outpatient basis. Methods. The authors studied 56 patients with cancer requiring chronic venous access who had an infusion catheter placed into the inferior vena cava (IVC) through open saphenous venotomy, most commonly because superior vena cava (SVC) occlusion, severe chest wall infection, or chest wall malignancy precluded standard subclavian or jugular cannulation. Results. The 56 catheters were in place for 12-550 days. The overall complication rate was 0.30 complications per 100 catheter-days. Thirty-six patients (64%) had no complications. Among the remaining 20 patients, 8 (14.3%) had a local infection, 2 (3.6%) had systemic bacteremia, and 10 had lower extremity edema, including 9 patients (16.1%) in whom the IVC was thrombosed. Twelve of the 20 complications were treated successfully without catheter removal. Thus, in 86% (48 of 56) of patients, the catheter was effective for as long as infusion therapy was required. Conclusion. Venous cannulation through the saphenous vein is a useful method of achieving and maintaining chronic venous access in patients in whom the subclavian or jugular veins are unavailable.

Patients with chronic kidney failure may require dialysis. This treatment replaces kidney function by removing impurities or wastes from the blood. Access to the circulation is gained by the creation of an arteriovenous fistula (abnormal connection of the two vascular systems) in which two tubes are placed through the skin; one is positioned inside a large vein and the other inside a large artery. The blood is then circulated through semipermeable tubes that are bathed by solutions that remove unwanted materials. Complications of dialysis access can be life-threatening, and an examination of complications occurring over a six-year period was undertaken. There were 158 access procedures performed on 77 patients. The most common complications of patients undergoing chronic dialysis were infection (10 percent) and thrombosis, clot formation, (32 percent). These findings are similar to the rate of complications found in patients who undergo vascular surgery. Because of the need for repeated needle sticks, patients with kidney failure seem to be at increased risk for infection; this may be a result of compromise of the immune system. Infection can be eliminated only by removal of the entire graft. Thrombosis is not caused by the stagnation of blood as a result of poor vascular run off, or progression of atherosclerotic disease (cholesterol plaque formation on the inner layer of the artery wall), which characterizes vascular surgery patients. Thrombosis in dialysis patients may be due to the hemodynamics of the arteriovenous fistula with its high flow pressures. (Consumer Summary produced by Reliance Medical Information, Inc.)

CAVF has been proposed as a superior access conduit in the problem access population. The potential advantage is the reported 80% endothelial cell viability that theoretically leads to fewer thromboses and greater patency. The authors reviewed a series of 20 consecutive patients who received CAVY as access. At 3.1 months postgraft placement, mean panel reactive antibody (PRA) for this group was 77.8%. Retrospective pregraft PRA values were found on seven patients who were on the transplant waiting list, and six of these were found to have been unsensitized ([is less than] 0.05%) prior to CAVF. Mean PRA in these patients post CAVF was 92.3%. The authors concluded that CAVF use can broadly allosensitize recipients, precluding transplantation in the vast majority. Therefore, CAVF should not be used in potential transplant recipients., Use of Cryopreserved Cadaver Vein Allograft (CAVF) Precludes Renal Transplantation Due to Allosensitization. G. Lipkowitz, B. Benedetto, R. Madden, A. Kurbanov, D. Hull, M. Germain, L. Bow, & M. Miller. [...]

In today's world of super-networking communication, there are many ways to find out the latest in one's field of interest. Using the Internet for informal information exchanges, accessing and searching [...]

Failure to create an access prior to initiation of dialysis has been blamed on late referral. The authors found there are other reasons why those patients with early referral and who were provided with specific education about the rationale for and the benefits of early access creation (n = 38) did not have an access placed. Uninsured patients were notified of their eligibility for Emergency Medicaid. As these patients began dialysis they were grouped according to whether or not a surgical access had been created. Groups were compared by age, gender, immigration status, income, insurance, and scores of rankings for FOD, FOS, and belief in alternative medicine. Though not significant, there was a trend for the uninsured and female gender toward the no access creation group. No difference between groups was found in the alternative medicine beliefs. The group with early access construction had lower scores in both FOS and FOD rankings. The authors concluded that FOS and FOD correlated clearly with late access construction in spite of the fact that the patients were referred early for pre-ESRD care., Fear of Dialysis (FOD) and Fear of Surgery (FOS) Negates Early Vascular Access Creation in Urban ESRD Patients. A.J. Joseph, B.G. Delano, E. Gray, J. Feldman, J. Hong, & E.A. [...]

These surgeons, on seven of their patients who did not have any more conventional vascular access sites left, created a tunnel from the skin into the right atrium and placed a percutaneous catheter through this tunnel to serve as a vascular access. Mean age of patients was 25 (range 1.5-46). The 6-month actuarial survival was 85.7%., The Atriocutaneous Fistula: A New Surgical Technique for Hemodialysis Access. F.L. Joglar & E. Marquez. San Juan, PR [...]

This intriguing abstract showed that analysis of routine intradialytic data recorded on a Fresenius FDS08 dialysis machine could provide access monitoring without employing extra equipment or personnel. The abstract contained the algorithm and regression formula that the authors used to analyze venous drip chamber pressures and corresponding mean arterial pressures to determine the estimated access pressure ratio (EARP). A positive access pressure ratio test (APRT) was defined as an EARP [is greater than] 0.55 for any three consecutive treatments during the eighth to twelfth treatment of the month. Approximately 377 patients with arteriovenous (AV) grafts were tested for 3 months. The ability of the APRT to predict a graft event (clotting or need for angioplasty) within the next 3 to 6 months was determined by statistical analyses of 1,131 access evaluations. The authors concluded that this is a useful, noninvasive screening test to monitor AV grafts with a high specificity (96% in 0-6 months) and acceptable sensitivity (75% in the 0-6 months)., Computerized Vascular Access Monitoring for Hemodialysis. S. Frinak, G. Zasuwa, T. Dunfee, A. Besarab, & A. Shetty. Detroit, MI [...]

Patient scenarios and nursing considerations related to the selection of a vascular access device for infusion therapy are discussed. The available devices include the short peripheral catheter device, the midline catheter, the peripherally inserted central catheter, the nontunneled percutaneous central venous catheter, the tunneled central venous catheter, and the implanted port.

Nurses who site intravenous catheters must prevent the unnecessary withdrawal of vascular access devices by learning the management and diagnosis of frequently-occurring problems. Persistent withdrawal occlusion can result from an anatomical obstruction or the incorrect positioning of the catheter tip. The majority of catheters will develop a fibrin sheath if left in place for over one week, with the fibrin sheath becoming a one-way valve. The lumen must be patent prior to the administration of intravenous fluids or drugs in order to facilitate free passage.

CHICAGO -- An increased use of fistulas and less reliance on catheters to provide vascular access for dialysis patients would improve patient outcomes and lower treatment costs, according to a [...]

Q: We have a patient who has had surgically placed accesses in both arms and legs and who has been dialyzing through catheters for the past 2 years. His most [...]