JAVA - Journal of the Association for Vascular Access最新文献_第5页

Delayed Diagnosis and Treatment of an Occult Hemothorax Following Complicated Central Line Insertion Leads to Cardiac Arrest 复杂中心线插入导致心脏骤停的隐性血胸的延迟诊断和治疗

JAVA - Journal of the Association for Vascular Access Pub Date : 2022-01-26 DOI: 10.2309/1557-1289-27.1.44

G. Raff, B. Goudy

引用次数: 0

American Society for Diagnostic and Interventional Nephrology (ASDIN) 17th Annual Scientific Meeting (VIRTUAL) Abstracts 美国诊断与介入肾脏病学会(ASDIN)第17届年度科学会议(VIRTUAL)摘要

JAVA - Journal of the Association for Vascular Access Pub Date : 2022-01-01 DOI: 10.1177/11297298221074835

C. Santos-Alonso, ME RiveroGorrín, H. SosaBarrios, Burguera Vion, Qureshi, DA Derylo

{"title":"American Society for Diagnostic and Interventional Nephrology (ASDIN) 17th Annual Scientific Meeting (VIRTUAL) Abstracts","authors":"C. Santos-Alonso, ME RiveroGorrín, H. SosaBarrios, Burguera Vion, Qureshi, DA Derylo","doi":"10.1177/11297298221074835","DOIUrl":"https://doi.org/10.1177/11297298221074835","url":null,"abstract":"We report the results of a retrospective review of 155 successfully created endovascular arteriovenous fistulas at the Dallas Nephrology Plano Vascular Access Center between May 2019 through October 2020 using 2 devices (Ellipsys and WavelinQ). Outcomes reported include brachial artery flow, number of secondary procedures, time to physiologic maturity and failure rate. These outcomes are reported for the whole group as well as for each of the Ellipsys, radial WavelinQ and ulnar WavelinQ fistulas. During the follow up period of the study, 33 (21.3%) fistulas failed and 101 (65.2%) reached physiologic maturity. Of those which reached physiologic maturity, 43 (42.6%) did so with zero secondary procedures, 40 (39.6%) with 1 secondary procedure, and 18 (17.8%) with 2 or more. The mean and median durations to physiologic maturity were 100.5 and 86 days, respectively. The mean and median number of secondary procedures to physiologic maturity were 0.8 and 1, respectively. Male gender and a higher immediate postoperative brachial artery flow were predictors of","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":"65 3 1","pages":"NP1 - NP9"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80878378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Routine Chest Radiography Following Tunneled Hemodialysis Catheter: Use and Clinical Outcomes 隧道式血液透析导管后的常规胸部X线摄影：应用和临床结果

JAVA - Journal of the Association for Vascular Access Pub Date : 2021-12-17 DOI: 10.2309/java-d-21-00011

Mouafak Homsi, I. Hashim, C. Hmedeh, B. Karam, J. Hoballah, F. Haddad

{"title":"Routine Chest Radiography Following Tunneled Hemodialysis Catheter: Use and Clinical Outcomes","authors":"Mouafak Homsi, I. Hashim, C. Hmedeh, B. Karam, J. Hoballah, F. Haddad","doi":"10.2309/java-d-21-00011","DOIUrl":"https://doi.org/10.2309/java-d-21-00011","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000 Background: A postoperative chest x-ray (CXR) remains part of some hospital protocols following tunneled hemodialysis catheter placement despite the use of operative imaging-guided techniques. The aim is to assess the usefulness of this practice and its impact on clinical outcomes and resource use.\u0000 Methods: A review of medical records and postoperative CXR was done for 78 adult patients who had tunneled hemodialysis catheters placed in the operating room under fluoroscopy guidance. Catheters were inserted by ultrasound-guided puncture (51.3%) or exchanged from an existing catheter over a guide wire (48.7%). The postoperative CXRs were also examined by an independent reviewer to assess the catheter tip position and the need for repositioning to mimic a real-life postoperative setting. Procedural, nursing, and billing records were also reviewed.\u0000 Results: No patients had a pneumothorax or major complications. On postoperative CXRs, 29 (37.2%) patients had the catheter tips in the right atrium, 23 (29.5%) in the cavoatrial junction, 25 (23.1%) in the superior vena cava, and 1 (1.3%) in the brachiocephalic vein. The independent reviewer found the catheter tips in acceptable anatomical positions in 75 of 78 patients. Only 3 (3.9%) patients had catheter malfunctions during dialysis and exchanged their catheters (2 had high catheters in the superior vena cava and brachiocephalic vein, 1 had a kinked catheter). Postoperative CXRs also caused delays in patient discharge from postanesthesia care units and significant increases in medical expenses (around $199 per patient).\u0000 Conclusion: Routine CXR after tunneled hemodialysis central venous catheter insertion is unnecessary and does not add to the procedure's safety or to the patient's outcome.\u0000","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45358609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Impact of Seasonality on Prosthetic Arteriovenous Vascular Access Graft Thrombosis 季节性对人工动静脉血管通路移植血栓形成的影响

JAVA - Journal of the Association for Vascular Access Pub Date : 2021-12-17 DOI: 10.2309/java-d-21-00022

S. Zammit, K. Cassar

{"title":"The Impact of Seasonality on Prosthetic Arteriovenous Vascular Access Graft Thrombosis","authors":"S. Zammit, K. Cassar","doi":"10.2309/java-d-21-00022","DOIUrl":"https://doi.org/10.2309/java-d-21-00022","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000 Introduction: Arteriovenous prosthetic grafts are susceptible to recurrent thrombotic occlusions mainly due to venous outflow disease secondary to neointimal hyperplasia. Maintenance of vascular access for dialysis is a perpetual challenge for both patients and health care systems. In regions with hotter climates, there is a clinical impression that episodes of prosthetic arteriovenous vascular access graft thrombosis are more frequent during hot dry summers secondary to dehydration and increased blood viscosity. Seasonality of thrombotic events has been observed in multiple vascular beds. However, a seasonal pattern or any association of arteriovenous graft thrombosis with temperature and relative humidity levels has never been fully demonstrated.\u0000 Methods: Data were collected prospectively from January 2014 until December 2020 but analyzed retrospectively. In this 7-year timeframe, 289 episodes of arteriovenous graft thrombosis were identified from 142 grafts fashioned.\u0000 Results: No monthly variation (P = 0.35) or seasonal variation (P = 0.91) was identified. No statistically significant correlation between episodes of thrombosis and mean monthly temperature and mean relative humidity was noted.\u0000 Conclusion: No evidence was identified to support this theory. However, multiple issues with assessments of events must be conceded. Graft thrombosis is multifactorial in nature, and venous outflow disease contributes toward a significant number of these events. Within our local cohort, a low primary patency rate was identified, which further contributes to graft interventions. Relatively small numbers were recruited, and therefore, potential correlations could have been missed.\u0000","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49422770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Establishing a Contingency Plan to Improve Patient Comfort During Peripherally Inserted Central Catheter Insertions: A Quality Improvement Effort 建立一个应急计划，以提高患者舒适度在周围插入中心导管插入:质量改进的努力

JAVA - Journal of the Association for Vascular Access Pub Date : 2021-11-19 DOI: 10.2309/java-d-21-00024

Scott T. Wagoner, Jamie M Lorenc, Elizabeth Edmunson, J. Schurman

{"title":"Establishing a Contingency Plan to Improve Patient Comfort During Peripherally Inserted Central Catheter Insertions: A Quality Improvement Effort","authors":"Scott T. Wagoner, Jamie M Lorenc, Elizabeth Edmunson, J. Schurman","doi":"10.2309/java-d-21-00024","DOIUrl":"https://doi.org/10.2309/java-d-21-00024","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000 Background: Negative outcomes can occur when painful experiences related to needle procedures are not addressed. Patients at the institution in this study were not demonstrating sufficient levels of comfort during peripherally inserted central catheters (PICC) placements, so formal assessment of discomfort or distress began via the Pediatric Sedation State Scale (PSSS), and an enhanced approach to comfort planning, built around the Comfort Promise, was implemented. Over 1 year, we aimed to increase the percent of patients meeting sufficient comfort during PICC insertions by our Vascular Access Team (VAT) from 54% to 65%.\u0000 Methods: Initially, VAT staff were educated on use of the PSSS and began routinely charting the highest score obtained during each PICC placement. Interventions were delivered concurrently and included (1) changing the VAT culture, (2) process development, (3) consensus building and scale up, and (4) information system modifications.\u0000 Results: During the project period, 421 PICC insertions were completed. From baseline to the last 8 months, the percent of patients rated as experiencing sufficient comfort (PSSS = 2–3) during PICC placement increased from 54% to 74%, with the percent of patients experiencing significant discomfort or distress (PSSS = 4–5) decreasing from 45% to under 7%.\u0000 Conclusions: Success in this project required a culture change. Building consensus by engaging others and integrating with the processes, preferences, and priorities of each area was key. Future work will focus on increasing use of all Comfort Promise bundle elements, identifying patients at risk for escalation, and taking a long-term view to comfort planning, as well as applying lessons learned to other needle procedures.\u0000","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44587684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Managing Central Venous Catheter Dressings: A Short Gut Syndrome Case Study 管理中心静脉导管敷料:短肠综合征病例研究

JAVA - Journal of the Association for Vascular Access Pub Date : 2021-11-10 DOI: 10.2309/java-d-21-00009

M. Langford, Maria Leal, Lindsey Patton

引用次数: 0

Treatment of a Neonatal Peripheral Intravenous Infiltration/Extravasation (PIVIE) Injury With Hyaluronidase: A Case Report 透明质酸酶治疗新生儿外周静脉浸润/外渗(PIVIE)损伤1例报告

JAVA - Journal of the Association for Vascular Access Pub Date : 2021-10-04 DOI: 10.2309/java-d-21-00010

M. V. van Rens, Kevin Hugill, A. Francia, A. Abdelwahab, Krisha L. P. Garcia

{"title":"Treatment of a Neonatal Peripheral Intravenous Infiltration/Extravasation (PIVIE) Injury With Hyaluronidase: A Case Report","authors":"M. V. van Rens, Kevin Hugill, A. Francia, A. Abdelwahab, Krisha L. P. Garcia","doi":"10.2309/java-d-21-00010","DOIUrl":"https://doi.org/10.2309/java-d-21-00010","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000 Introduction: Intravenous therapy-related injury, its prevention, and treatment are ubiquitous topics of interest among neonatal clinicians and practitioners. This is due to the economic costs, reputational censure, and patents’ wellbeing concerns coupled with the possibility of potentially avoidable serious and life-long harm occurring in this vulnerable patient population.\u0000 Case description: A term infant receiving a hypertonic dextrose infusion for the management of hypoglycemia developed a fulminating extravasation shortly after commencement of the infusion. This complication developed without notification of infusion pump pressure changes pertaining to a change in blood vessel compliance or early warning of infiltration by the optical sensor site monitoring technology (ivWatch®) in use. The injury was extensive and treated with a hyaluronidase/saline mix subcutaneously injected into the extravasation site using established techniques. Over a period of 2 weeks, the initially deep wound healed successfully without further incident, and the infant was discharged home without evident cosmetic scarring or functional effects.\u0000 Conclusion: This article reports on a case of a term baby who postroutine insertion of a peripherally intravenous catheter showed an extreme reaction to extravasation of the administered intravenous fluids. We discuss the condition, our successful management with hyaluronidase, and the need to remain observationally vigilant of intravenous infusions despite the advances in infusion monitoring technology.\u0000","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49254184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

PIVC Best Practices: A Path to Performance Improvement PIVC最佳实践:绩效改进之路

JAVA - Journal of the Association for Vascular Access Pub Date : 2021-09-23 DOI: 10.2309/java-d-21-00012

Erin Davidson, Prachi Arora

{"title":"PIVC Best Practices: A Path to Performance Improvement","authors":"Erin Davidson, Prachi Arora","doi":"10.2309/java-d-21-00012","DOIUrl":"https://doi.org/10.2309/java-d-21-00012","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000 Background: Insertion of peripheral vascular access devices (PIVC) is fundamental to patient care and may affect patient outcomes. Baseline data of PIVC insertions at a large medical center revealed that catheters required multiple insertion attempts, catheter hubs were manipulated to place extension sets, increasing the risk of complications, dwell times did not meet current standards, nurses experienced blood-exposure risk, and overall compliance with the hospital documentation policy was suboptimal. A 3-phase quality improvement project was conducted to address these concerns.\u0000 Methods: In Phase 1, an assessment of the current state of PIVC insertions and care was conducted using a mixed-methods approach consisting of an observational audit of insertion and maintenance practices, and retrospective chart reviews. In Phase 2, PIVC policies and practices were updated to reflect current standards. A new advanced design PIVC device was adopted, and education was provided to all staff. In Phase 3, the impact of these changes on key PIVC measures was assessed 1 year later.\u0000 Results: The analysis of the data found several improvements following implementation of an integrated IV catheter system: first-stick success rate increased from 73% to 84%, staff blood exposure was reduced from 46.67% to 0% (P = .01), improper securement of PIVC catheters was reduced from 11% to 0% (P = .002), and documentation compliance rate increased from 68% to 80%. The median PIVC dwell time doubled (from 2 days to 4 days).\u0000 Conclusion: Changes to policy, practices, and products plus education can improve the PIVC first-stick success, dwell time, documentation, and staff safety.\u0000","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42351485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Clinical Nurse Specialist Role and its Relevance to Vascular Access: A Canadian Perspective 临床专科护士的角色及其与血管通路的相关性:加拿大的观点

JAVA - Journal of the Association for Vascular Access Pub Date : 2021-09-01 DOI: 10.2309/java-d-21-00014

Andrea Raynak, B. Wood

{"title":"The Clinical Nurse Specialist Role and its Relevance to Vascular Access: A Canadian Perspective","authors":"Andrea Raynak, B. Wood","doi":"10.2309/java-d-21-00014","DOIUrl":"https://doi.org/10.2309/java-d-21-00014","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000 Purpose: The purpose of this quality improvement study was to examine the impact of a Vascular Access Clinical Nurse Specialist (VA-CNS) on patient and organizational outcomes.\u0000 Description of the Project/Program: The VA-CNS role was created and implemented at an acute care hospital in Thunder Bay, Ontario, Canada. The VA-CNS collected data on clinical activities and interventions performed from April 1 to March 29, 2019. The dataset and its associated qualitative clinical outcomes were analyzed using deductive content analysis. Furthermore, a cost analysis was performed by the hospital accountant on these clinical outcomes.\u0000 Outcome: Over a 1-year period, there were 547 patients protected from an unwarranted peripherally inserted central catheter (PICC) insertion among 302 patient consultations for the VA-CNS. A total of 322 ultrasound-guided peripheral intravenous catheters were inserted and 45 PICC insertions completed at the bedside. The cost associated with the 547 patients not receiving a PICC line result in an estimated savings of $113,301. The VA-CNS role demonstrated a positive payback of $417,525 to the organization.\u0000 Conclusion: The results of this quality improvement project have demonstrated the positive impacts of the VACNS on patient and organizational outcomes. This role may be of benefit and worth its adoption for other health systems with similar patient populations.\u0000","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45044989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Peripherally Inserted Central Catheters in Children: A Prospective Single-Center Analysis of Associated Complications 儿童外周置入中心导管相关并发症的前瞻性单中心分析

JAVA - Journal of the Association for Vascular Access Pub Date : 2021-09-01 DOI: 10.2309/java-d-20-00036

F. Tavares, Maria AlBandari, J. Donnellan

{"title":"Peripherally Inserted Central Catheters in Children: A Prospective Single-Center Analysis of Associated Complications","authors":"F. Tavares, Maria AlBandari, J. Donnellan","doi":"10.2309/java-d-20-00036","DOIUrl":"https://doi.org/10.2309/java-d-20-00036","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000 Objective: To assess performance of peripherally inserted central catheters (PICCs) in pediatric patients Design: Prospective observational study\u0000 Setting: Academic pediatric tertiary referral center\u0000 Study Population: Children aged less than 18 years with PICCs inserted in Interventional Radiology from January 2019 to June 2019\u0000 Outcome Measures: Number of catheters remaining in situ until completion of intended therapy; and for those removed prematurely, the type and rate of complications\u0000 Results: A total of 88 PICCs (40 uncuffed, 48 cuffed) were inserted in 77 children. Overall, 72% (n = 63) of all catheters remained in situ until intended therapy was completed. Complications resulting in premature removal occurred in 24% of catheters (rate of 3.89/1000 catheter-days). Complications included catheter malfunction (2.04 per 1000 catheter-days), infection (1.67 per 1000 catheter-days), and thrombosis (0.18 per 1000 catheter-days). Complications were further recorded by catheter type. In patients with uncuffed catheters, the overall complication rate was observed to be 6.74 per 1000 catheter-days. In patients with cuffed catheters, the overall complication rate was observed to be 1.10 per 1000 catheter-days.\u0000 Conclusions: Findings suggest that cuffed PICCs may provide additional benefits toward optimizing catheter performance and securement in neonatal and pediatric patients. This can contribute to improved likelihood of complication-free PICC therapy and successful therapy completion. Pediatric patients present unique challenges and considerations for clinicians planning PICC therapy. Additional studies are needed to identify effective strategies to mitigate catheter failure in neonatal and pediatric populations.\u0000","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48462663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1