Prospective Assessment of Catheter Migration in Implanted Vascular Access Devices for Adjuvant Colorectal Cancer Chemotherapy

Background: Chemotherapy in colorectal cancer is usually administered as continuous infusion of 5-fluorouracil, often in combination with oxaliplatin or irinotecan. Targeted drugs are most efficient and tolerable in conjunction with continuous infusion dosing. Implanted venous access devices (VAD) are the prerequisite for continuous infusion administration. The reported catheter migration frequency with VAD is 0% - 3.5%. The purpose of this case-control study was to evaluate the predisposing factors of catheter migration. Methods: We inserted VADs in 88 radically operated colorectal cancer patients randomized to adjuvant 48-hour-infusion chemotherapy repeated every 14 days, altogether 12 times over 24 weeks. Three out of 88 patients (3.4%) had a symptomatic catheter migration from the superior caval vein into the internal jugular vein. The fourth case had chemotherapy for osteosarcoma. These 4 cases were compared with 12 controls from the same 88 patient study population, matched for age, sex, body mass index (BMI), physical activity level and right subclavian insertion site. Tip position, port model, complications, catheter length and material was studied. The post insertion catheter tip position in the chest X-ray was numbered from 1 (in subclavia) to 8 (in atrium). Results: The four cases, all male, had a median position of 3 (range 3 - 4) and controls 6 (range 4 - 8), P = 0.004, median difference 3 (CI95% 1 - 5). At notification of migration the patients had experienced discomfort in the neck region starting 5 to15 days before at strenuous upper extremities activity with Valsalva maneuvers. Conclusion: Optimal catheter tip position when sitting is in the right atrium or low in the superior vena cava to avoid migration. Patients with VADs should avoid strenuous activity with Valsalva maneuvers.

Effect of Infrared Irradiation Combined with External Application Nursing on Maintenance of Vascular Access in Hemodialysis Patients

Objective:This paper mainly analyzes the effect of infrared radiation combined with external application nursing on maintenance of vascular access in hemodialysis patients.Methods:A total of 150 hemodialysis patients in our hospital from December 2019 to September 2020 were divided into the conventional group and the study group,75 cases in each group.The conventional group was given external application nursing alone,and the study group was given infrared radiation combined with external application nursing,and the effect on the maintenance of vascular access was counted.Results:After the intervention,the indexes of URR,kt/V and human albumin in the study group were higher than those in the routine group,and the indexes of β2-mg and MIS in the study group were lower than those in the routine group,P<0.05;The improvement of vascular elasticity and quality of life in the study group was higher than that in the conventional group,and the incidence of complications was lower than that in the conventional group,P<0.05.Conclusion:Infrared radiation combined with external application of nursing care in hemodialysis patients with vascular access maintenance effect is significant,can effectively improve vascular elasticity.

A novel role of chitosan in reducing vascular access bleeding complications after transradial angiography

To investigate the safety and efficacy of chitosan ( Anscare,Daxon) in reducing vascular ac cess complications compared to a kind of radial compression device( TR-BAND,Terumo) . Method: We studied 128 patients who had undergone transradial angiography in our center from December 2009 to April 2010. Among them,64 patients were randomly treated with radial compression device ( TR-BAND,Terumo) when the procedure was over ( CD group) . The other 64 patients were dealt with chitosan ( CS group) . The compression time,the major and minor access site bleeding complications and the errhysis were observed. Results: There were no statistical differences in the baseline clinical characteristics of the patients between two groups. The compression time in CS group was significantly shorter than that of CD group ( P < 0. 001) . There were 12 patients suffering from minor access site bleeding while only 3 patients experienced these minor complications in CS group( 19% vs 4% ,P < 0. 05) . At the same time 20 patients had er- rhysis in CD group and 4 patients in CS group ( 31% vs 6% ,P < 0. 001) . Conclusion: Chitosan,compared to radial compression device ( TR-BAND,Terumo) ,can not only shorten the compression time,but also significantly reduce the rate of minor access site bleeding and puncture-site errhyis.

Vascular access today

The number of patients with chronic kidney disease requiring renal replacement therapy has increased worldwide. The most common replacement therapy is hemodialysis(HD). Vascular access(VA) has a key role for successful treatment. Despite the advances that have taken place in the field of the HD procedure, few things have changed with regards to VA in recent years. Arteriovenous fistula(AVF), polytetrafluoroethylene graft and the cuffed double lumen silicone catheter are the most common used for VA. In the long term, a number of complications may present and more than one VA is needed during the HD life. The most common complications for all of VA types are thrombosis, bleeding and infection, the most common cause of morbidity in these patients. It has been estimated that VA dysfunction is responsible for 20% of all hospitalizations. The annual cost of placing and looking after dialysis VA in the United States exceeds 1 billion dollars per year. A good functional access is also vital in order to deliver adequate HD therapy. It seems that the native AVF that Brescia and Cimino described in 1966 still remains the first choice for VA. The native forearm AVFs have the longest survival and require the fewest interventions. For this reason, the forearm AVF is the first choice, followed by the upper-arm AVF, the arteriovenous graft and the cuffed central venous catheter is the final choice. In conclusion, VA remains the most importantissue for patients on HD and despite the technical improvements, a number of problems and complications have to be resolved.

Percutaneous management of vascular access in transfemoral transcatheter aortic valve implantation

Transcatheter aortic valve implantation(TAVI) using stent-based bioprostheses has recently emerged as a promising alternative to surgical valve replacement in selected patients. The main route for TAVI is retrograde access from the femoral artery using large sheaths(16-24 F). Vascular access complications are a clinically relevant issue in TAVI procedures since they are reported to occur in up to one fourth of patients and are strongly associated with adverse outcomes. In the present paper, we review the different types of vascular access site complications associated with transfemoral TAVI. Moreover, we discuss the possible optimal management strategies with particular attention to the relevance of early diagnosis and prompt treatment using endovascular techniques.

Impact of central venous port implantation method and access choice on outcomes

BACKGROUND Although the number of patients who need central venous ports for permanent vascular access is increasing,there is still no“gold standard”for the implantation technique.AIM To identify the implantation technique that should be favored.METHODS Two hundred central venous port-implanted patients in a tertiary hospital were retrospectively evaluated.Patients were assigned into two groups according to the access method.The first group comprised patients whose jugular veins were used,and the second group comprised patients whose subclavian veins were used.Groups were evaluated regarding age,sex,application side,primary diagnosis,active follow-up period in the hospital,chemotherapy agents administered,number of complications,and the Clavien-Dindo severity score.The distribution of the variables was tested with the Kolmogorov-Smirnov test and the Mann-Whitney U test.Theχ^(2) test was used to analyze the variables.RESULTS There was no statistically significant difference between the groups regarding age,sex,side,number of chemotherapy drugs,and duration of port usage(P>0.05).Only 2 patients in group 1 had complications,whereas in group 2 we observed 19 patients with complications(P<0.05).No port occlusion was found in group 1,but the catheters of 4 patients were occluded in group 2.One port was infected in group 1 compared to three infected ports in group 2.Two port ruptures,two pneumothorax,one revision due to a mechanical problem,one tachyarrhythmia during implantation,and four suture line problems were also recorded in group 2 patients.We also showed that it would be sufficient to evaluate and wash ports once every 2 mo.CONCLUSION Our results robustly confirm that the jugular vein route is safer than the subclavian vein approach for central venous port implantation.

即穿型人工血管在血管通路中的应用效果及并发症分析

目的 研究即穿型人工血管在血管通路中的应用效果及并发症。方法 选取从2019年2月—2022年2月于资阳市人民医院接受人工血管内瘘手术的83例患者为研究对象。将流出道静脉直径>4mm分为即穿型人工血管组(n=41),流出道静脉直径3~4 mm分为膨体聚四氟乙烯(expanded polytetrafluoroethylen,ePTFE)人工血管组(n=42),分别选用即穿型人工血管、ePTFE人工血管进行造瘘手术。对所有患者均实施为期18个月的随访,比较2组手术后通畅率,治疗效果,手术后并发症,手术后生存率。结果 即穿型人工血管组与e PTFE人工血管组手术后6、12、18个月初级通畅率(t=1.437、0.609、0.595,P=0.231、0.435、0.441)及次级通畅率(t=2.108、0.149、0.310,P=0.147、0.699、0.578)对比无统计学差异。即穿型人工血管组首次穿刺时间、手术后透析导管移除时间均短于ePTFE人工血管组(t=78.386、21.491,均P<0.001);2组手术后透析血流量及人工血管使用率对比均不明显(t/χ^(2)=0.214、0.988,P=0.831、0.320)。即穿型人工血管组手术后肿胀、血栓形成发生率均低于ePTFE人工血管组(χ^(2)=24.418、7.540,P<0.001、0.006)。2组手术后6、12、18个月患者生存率对比均不明显(χ^(2)=1.037、0.239、0.183,P=0.309、0.625、0.668)。结论 即穿型人工血管应用于血管通路中可实现早期穿刺,通畅率高,且并发症发生风险较低,值得推广应用。

基层医院维持性血液透析患者血管通路使用现状调查

目的 调查基层医院维持性血管透析患者血管通路的使用现状。方法 采用多中心横断面研究,收集2023年3月—8月盐城市大丰人民医院、安徽省明光人民医院和常州市溧阳人民医院等15家基层医院血液透析中心维持性血液透析患者的临床资料。结果 共筛查符合标准的维持性血液透析患者650例,其中男性342例(52.62%),女性308例(47.38%),中位透析龄5.48(2.00,8.00)年。首次血液透析治疗血管通路类型主要为无隧道和涤纶套的透析导管291例(48.10%)和自体动静脉内瘘271例(44.79%),目前使用的血管通路类型主要为自体动静脉内瘘518例(85.62%),在自体动静脉内瘘维持性血液透析患者中绳梯穿刺执行率为19.30%(100例),区域穿刺412例(79.54%),在移植物动静脉内瘘绳梯穿刺29例(90.63%),血管狭窄是血管通路的主要并发症,在自体动静脉内瘘和移植物动静脉内瘘中分别为177例(34.17%)和10例(31.25%)。结论 基层医院血液透析中心维持性血液透析患者的血管通路的临床使用现状符合临床预期,但需加强相关操作规范的落实及人员培训管理工作,以早期发现血管通路功能障碍以采取积极有效干预措施。

基于血管重构的纤细动脉自体动静脉内瘘成熟影响因素分析

目的探讨纤细动脉建立自体动静脉内瘘(arteriovenous fistula,AVF)后成熟率及通畅率,并基于血管重构理论分析影响AVF成熟的相关因素。方法选择手术前桡动脉内径≤1.5 mm的AVF患者,超声测量手术前桡动脉及头静脉血管内径,手术后1月测量头静脉内径、肱动脉内径及血流量,评估成熟并随访12个月,分析纤细血管建立AVF的预后。结果56例患者纳入研究,手术前平均桡动脉内径(1.26±0.28)mm,束臂后平均头静脉内径(2.72±0.53)mm,最细桡动脉内径0.5 mm。40例(71.43%)患者AVF未经干预自然发育成熟,其余16例患者中,13例(23.21%)经腔内手术或外科重建干预后成熟。回归模型显示:手术前桡动脉内径是AVF成熟预测的独立相关因素,预测AVF成熟的最佳临界值为桡动脉内径>1.35 mm。56例患者平均随访(11.39±5.81)月,手术后3月,6月,12月初级通畅率分别为73.08%,68.75%,65.71%;3月,6月,12月次级通畅率分别为100%,97.92%,100%。结论手术前桡动脉内径≤1.5mm的纤细桡动脉构建的AVF可具有较高的成熟率及远期通畅率,桡动脉内径1.35 mm以上有较大概率自然发育成熟。

血液透析病人血管通路决策过程的质性研究

目的:探讨血液透析病人的血管通路决策过程,了解医护人员如何鼓励病人参与共享决策。方法:于2022年4月—8月对10例血液透析病人和11名医护人员进行半结构访谈,借助Nvivo软件整理访谈资料,采用科宾和施特劳斯扎根理论的分析方法。结果:血液透析病人在确定接受血液透析治疗后,经历了接受多方面信息阶段、形成初步感知阶段和淡化信息阶段或逐步深入感知阶段的不断反思的过程,病人在血液透析治疗前和治疗后会对血管通路的选择重新审视,医护人员鼓励病人早期参与血管通路共享决策,将血管通路的最终决策权交给病人。结论:血液透析病人的血管通路决策过程是一个不断反思的过程,医护人员可针对病人的不同阶段的特点提供血管通路相关信息,从而促进病人更好地参与血管通路共享决策。

一种新型氧合器的设计、数值仿真与实验研究

目的:设计一种新型氧合器,以解决目前体外膜肺氧合设备存在的跨膜压差大、血氧交换效率低、易发血栓等问题。方法:首先,将氧合器血液通路流场主体设置为扁平圆柱体。其次,对血液通路拓扑结构进行三维建模,并将整个流场切分为血液入口段及入口缓冲区、热交换区、血氧交换区、出口缓冲区及血液出口段。最后,采用ANSYS FLUENT软件进行仿真分析和样机制作实验,对比设计的氧合器和Quadrox氧合器的性能。结果:仿真计算表明,设计的氧合器整体性能与临床常用氧合器处于同等水平,且在跨膜压差、血氧交换和流量均匀性方面更优。实验结果表明,设计的氧合器跨膜压差和血氧交换率优于Quadrox氧合器。结论:设计的氧合器跨膜压差小、变温效果好、血氧交换效率高、血栓发生概率低,具有一定的优越性。

Donabedian质量理论干预模式对血液透析患者血管通路并发症的影响

目的探讨Donabedian质量理论干预模式对行血管通路术的血液透析患者血管通路并发症发生率的影响。方法选取福建医科大学附属第二医院2021年12月—2022年12月收治的160例血液透析患者作为研究对象,按照随机数字表法分为对照组(n=80,予以常规护理干预)与观察组(n=80,在对照组的基础上予以Donabedian质量理论干预)。比较2组血液透析患者的日常生活能力评定量表(activity of daily living scale,ADL)及血管通路并发症的发生率。结果在对行血管通路术的血液透析患者进行质量理论干预后,观察组ADL评分[(40.48±3.97)分]明显低于对照组[(44.07±2.51)分](P<0.05);观察组血管通路并发症的总发生率(2.50%)明显低于对照组(11.25%),差异有统计学意义(P<0.05)。结论行血管通路术的血液透析患者使用Donabedian质量理论的干预模式可改善日常生活能力,减少血管通路并发症。

贵州省124所医疗机构维持性血液透析相关感染现况调查

目的了解贵州省维持性血液透析(MHD)患者感染现状,为血液透析相关感染的防控提供依据。方法调查2022年7—12月贵州省124所二级及以上医疗机构血液透析中心MHD患者。调查内容包括患者一般情况、血液透析相关情况、经血传播病原体感染情况及其他感染相关情况。结果共调查MHD患者15114例,年龄以36~<60岁年龄段为主(55.83%)。血液透析龄以1~<5年为主(59.37%),血液透析频率主要是3次/周(73.91%)。透析血管通路以自体动静脉内瘘(AVF)为主,共12948例(85.77%)。原发疾病以慢性肾衰竭为主(99.89%)。血液透析患者乙型肝炎病毒(HBV)感染率5.29%,丙型肝炎病毒(HCV)感染率0.64%,人类免疫缺陷病毒(HIV)感染率0.24%,梅毒螺旋体(TP)感染率1.70%。不同年龄、透析医院数、透析机构规模的MHD患者HBV感染率比较,差异均有统计学意义(均P<0.05)。不同年龄、不同透析时间、透析机构规模的MHD患者HCV感染率比较,差异均有统计学意义(均P<0.05)。不同年龄、不同透析医院数MHD患者TP感染率比较,差异均有统计学意义(均P<0.05)。年龄为36~<60岁MHD患者HBV、HCV感染率较高,分别为6.10%、0.84%。透析时间≥10年的患者HCV感染率(1.64%)较高。透析床位数≥90张的医疗机构患者HCV、HIV和TP感染率均较高,分别为0.74%、0.28%、1.94%。HBV感染率最高的是透析床位数<30张的医疗机构,为18.64%。发生血管穿刺部位感染9例(0.06%),血流感染12例(0.08%),血管通路相关血流感染7例(0.05%),肺部感染30例(0.20%)。不同血管通路类型MHD患者的血管通路相关血流感染发病率、肺部感染发病率比较,差异均有统计学意义(均P<0.05)。血管通路类型为无隧道无涤纶套导管患者的血管通路相关血流感染发病率(0.37%)和肺部感染发病率(1.10%)均较其他类型高。结论贵州省MHD患者以中青年为主,男性多于女性,透析频率多为3次/周,以AVF为主要血管通路。MHD患者容易合并HBV、HCV、HIV、TP、血流感染和肺部感染。

中等长度导管在儿童静脉输液治疗中的应用进展

目前中等长度导管(midline catheters,MC)日益成为临床血管通路研究的热点,并在成人静脉输液治疗中得到了很好的应用,但在儿童静脉输液治疗中的应用尚处于探索阶段,本文从MC在儿童静脉输液治疗中的起源与发展、置管与维护、并发症及在儿童特殊领域的应用4个方面进行综述,以期为MC在我国儿科领域的发展提供参考。

经桡动脉入路在外周血管疾病中的应用展望

经桡动脉入路(transradial access,TRA)已成为冠脉介入手术中的标准入路方式,TRA与经股动脉入路相比有创伤小、舒适度高等优点。近年来,TRA在外周血管疾病的介入治疗中的应用正逐步得到重视,然而其在临床推广方面仍存在一些挑战。本文总结了TRA在外周介入治疗中的优势与挑战,并结合最新的临床研究结果深入探讨了其在外周介入中的应用价值。同时,本文对TRA在外周介入领域未来的发展进行展望,旨在为该领域的进一步研究和实践提供启示。

Korean single-center experience with femoral access closure using the ExoSeal device

AIM To report 17-mo experience of femoral artery puncture site closure during angiographic procedures using Exo Seal vascular closure devices(VCDs).METHODS Between November 2015 and April 2017, we performed 179 diagnostic and interventional angiographic procedures via a common femoral arterial access.The Exo Seal VCD was used at the puncture site to achieve hemostasis in 125 patients.We evaluated the technical and procedural success rates, the complications, and the factors affecting the hemostasis time of the ExoSeal VCDs.RESULTS Technical and procedural successes were achieved in 176 cases(98.0%) and 128 cases(71.5%), respectively.Device failure occurred in 3(1.7%) cases.In 1 case(0.6%) a small hematoma developed, but there were no major complications.Among the hemostasis-relevant variables, a history of drinking alcohol, low platelet(PLT) count, and high prothrombin time-international normalized ratio(commonly known as PT-INR) values were the statistically significant predictors of the need for longer manual compression(MC).There was no difference in the success rates between the repeat and single Exo Seal procedure groups, and repeated use of the ExoSeal did not affect hemostasis time.CONCLUSION The ExoSeal VCD effectively achieves hemostasis, with few complications.Longer light MC may be needed with alcohol drinkers, low PLT count, and high PT-INR values.

维持性血液透析病人血管通路全生命周期管理实践效果研究

目的:探讨维持性血液透析病人血管通路全生命周期管理模式临床实践效果。方法:选取2019年10月—2021年9月在血液净化中心行维持性血液透析的病人为研究对象。2019年10月—2020年9月收治的187例病人为对照组,实施血管通路常规护理模式,2020年10月—2021年9月收治的199例病人为观察组,实施血管通路全生命周期管理模式。比较两组病人血管通路并发症发生率及再循环发生率。结果:观察组血管通路并发症及再循环的发生率分别为13.06%、4.52%,对照组血管通路并发症及再循环的发生率分别为的25.67%、11.23%,两组比较差异均有统计学意义(P<0.05)。结论:全生命周期管理模式的应用有助于降低维持性血液透析病人血管通路并发症,提高血管通路的通畅率,延长使用寿命。

超声引导下经外周置入中心静脉导管在新生儿血管通路穿刺困难中的临床应用

目的探讨超声引导下经外周置入中心静脉导管(peripherally inserted central catheter,PICC)在新生儿穿刺困难中的临床应用。方法选取2019年1月至2021年4月于昆明市儿童医院新生儿科同一组专业的PICC管理团队小组评估为穿刺困难的104例新生儿为研究对象,将其随机分为观察组和对照组,每组各52例。对照组采取传统盲穿置管,观察组采取超声引导下置管,比较2组患儿在穿刺次数、留置时间、一次性穿刺成功率、一次性置管成功率、留置时间等方面的差异。结果观察组的平均穿刺次数以及置管时间均少于对照组;观察组一次性穿刺成功率、一次性置管成功率均高于对照组;观察组留置时间长于对照组;差异均有统计学意义(P<0.05)。观察组穿刺时周围组织损伤、经皮氧饱和度下降的发生率均低于对照组;观察组穿刺后维护期并发症的总发生率低于对照组;差异有统计学意义(P<0.05)。结论穿刺困难新生儿行PICC时,经超声引导,在穿刺过程中可有效减少穿刺次数及置管时间,提高一次性穿刺成功率及一次性置管成功率,并且增加了留置时间,值得临床推广。

Brachial access technique for aortoiliac stenting revisited

We report a modified technique to perform iliac artery stenting through the brachial artery access. A 6F Brite tip sheath (Cordis, Jonhson & Jonhson Medical, Miami Lakes, FL, USA) is inserted into either brachial artery and a standard 4F Judkins Right diagnostic catheter was inserted over a 260 cm 0.038” Terumo Stiff wire (Terumo Corp, Tokyo, Japan) through the sheath. The catheter is navigated down to the aortic bifurcation, and after selecting the common iliac artery ostium, the wire is navigated through the lesion and advanced to the ipsilateral superficial femoral arteries. The catheter should be then moved forward over the wires beyond the lesion and the Terumo guidewire is replaced by two 0.038” 260 cm Supracor wires (Boston Scientific Corporation, San Jose, CA, USA). In order to facilitate advancement of the stent without risk of dislodgement as well as to check the position with low contrast dose injection, a 6 F (or 7F if large stent is selected) 90cm Shuttle Flexor introducer long sheath (Cook Group, Bloomington, IN, USA) should be advanced over the Supracor wire until it reaches the common iliac artery ostium. A road-map technique can be used to check the ostium position in order to properly deploy the selected stent. This technique promises to be safe and effective offering more support than guiding catheter technique; moreover it reduces the stress on the arterial vessel at the subclavian site and enables a stiff balloon or stent catheter to be advanced even through a very elongated and calcified aorta without the risk of stent dislodgement.

致动脉粥样硬化指数及非高密度脂蛋白胆固醇联合预测血液透析患者血管通路衰竭

目的 探讨致动脉粥样硬化指数(atherogenic index of plasma,AIP)和非高密度脂蛋白胆固醇(non-high density lipoprotein cholesterol,non-HDL-C)与血液透析患者血管通路衰竭(vascular access failure,VAF)的相关性,以及AIP和non-HDL-C对VAF事件的预测价值。方法 纳入2017年1月~2021年12月北京朝阳医院肾内科透析室以自体动静脉内瘘为血管通路的维持性血液透析患者为研究对象(n=277),根据是否发生血管通路功能障碍分为VAF组(n=85)与非VAF组(n=192),比较2组间AIP、non-HDL-C及临床特征的差异。多因素COX回归分析VAF发生的独立危险因素,绘制受试者工作特征曲线,根据AUC评估AIP、non-HDL-C及两者联合模型对血液透析患者VAF发生风险的预测价值。结果VAF组患者AIP(Z=7.331,P<0.001)、non-HDL-C(Z=6.566,P<0.001)较非VAF组高,差异有统计学意义。多因素COX回归矫正性别、年龄、血肌酐、尿酸等因素后提示AIP(HR=8.757,95%CI:4.134~18.548,P<0.001)、non-HDL-C(HR=1.533,95%CI:1.094~2.150,P<0.001)是VAF发生的独立危险因素。AIP预测的AUC为0.776(95%CI:0.722~0.831)、non-HDL-C预测的AUC为0.747(95%CI:0.690~0.805),两者联合模型预测的AUC为0.805(95%CI:0.754~0.855)。结论 AIP、non-HDL-C是维持性血液透析患者VAF事件发生的独立危险因素,两者单独或联合模型对VAF发生风险具有良好的预测价值。