Pub Date : 2021-03-01DOI: 10.2309/JAVA-2021-26-01-08
Cate Brennan
{"title":"CEO’S Message","authors":"Cate Brennan","doi":"10.2309/JAVA-2021-26-01-08","DOIUrl":"https://doi.org/10.2309/JAVA-2021-26-01-08","url":null,"abstract":"","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43758665","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}
Pub Date : 2021-03-01DOI: 10.1177/11297298211000649
{"title":"Thanks to reviewers","authors":"","doi":"10.1177/11297298211000649","DOIUrl":"https://doi.org/10.1177/11297298211000649","url":null,"abstract":"","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":"1 1","pages":"328 - 330"},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75680550","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}
M. Fukuda, Masakazu Nabeta, Toshio Morita, O. Takasu
Intermittent pneumatic compression (IPC) is an effective method for preventing deep vein thrombosis (DVT) and is comparatively low risk for hemorrhaging compared with anticoagulant therapy. IPC is easily administered, and severe complications are rare. The patient was a 69-year-old male with no underlying diseases related to hemorrhaging of hemostasis. He was hospitalized for treatment of a third-degree burn injury to the upper body. Because the treatment included surgical debridement and skin grafting, there was substantial concern regarding the potential of hemorrhagic complications; hence, IPC was initiated to prevent DVT rather than standard anticoagulant therapy. On the ninth day of hospitalization, a femoral venous catheter initially placed to manage hydration was removed. Manual compression was performed for 15 minutes, and after confirming hemostasis at the insertion site, a hemostasis band was applied for an additional hour. At 90 minutes after confirming hemostasis, there was a secondary hemorrhage at the site of catheter removal. The secondary hemorrhage was stopped with manual compression, and IPC was discontinued. It was concluded that IPC might result in increased blood flow in the femoral vein. This may have contributed to the secondary hemorrhage after the removal of the catheter. Clinicians need to be aware of the fact that IPC may promote secondary hemorrhage after removal of a femoral venous catheter.
{"title":"Recurrent Hemorrhage from Intermittent Pneumatic Compression Device Use After the Removal of a Femoral Venous Catheter—A Case Review","authors":"M. Fukuda, Masakazu Nabeta, Toshio Morita, O. Takasu","doi":"10.2309/JAVA-D-20-00018","DOIUrl":"https://doi.org/10.2309/JAVA-D-20-00018","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000 Intermittent pneumatic compression (IPC) is an effective method for preventing deep vein thrombosis (DVT) and is comparatively low risk for hemorrhaging compared with anticoagulant therapy. IPC is easily administered, and severe complications are rare. The patient was a 69-year-old male with no underlying diseases related to hemorrhaging of hemostasis. He was hospitalized for treatment of a third-degree burn injury to the upper body. Because the treatment included surgical debridement and skin grafting, there was substantial concern regarding the potential of hemorrhagic complications; hence, IPC was initiated to prevent DVT rather than standard anticoagulant therapy. On the ninth day of hospitalization, a femoral venous catheter initially placed to manage hydration was removed. Manual compression was performed for 15 minutes, and after confirming hemostasis at the insertion site, a hemostasis band was applied for an additional hour. At 90 minutes after confirming hemostasis, there was a secondary hemorrhage at the site of catheter removal. The secondary hemorrhage was stopped with manual compression, and IPC was discontinued. It was concluded that IPC might result in increased blood flow in the femoral vein. This may have contributed to the secondary hemorrhage after the removal of the catheter. Clinicians need to be aware of the fact that IPC may promote secondary hemorrhage after removal of a femoral venous catheter.\u0000","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":"23 1","pages":"54-56"},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82739519","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}
Introduction: Achieving and maintaining optimal peripherally inserted central catheter (PICC) tip position can be challenging. At any time during therapies, the final catheter position can be altered due to changes in patient condition and intrathoracic pressure. Aim: To determine if the use of a standardized protocol with power flush option for repositioning the PICC tips will reduce the number of withdrawal interventions or exchange procedures. Methods: Johns Hopkins evidence-based practice (EBP) methodology was used to evaluate literature published in the past 5 years. A standardized protocol was developed and implemented in patients with malpositioned PICCs. The outcome measures were the successful repositioning of the catheter and costs for the procedure. Results: In 4 months, 43 (93%) of 46 (14 adult/32 pediatric) catheters were successfully repositioned. The withdrawal method was used to reposition 34 (73.9%). In 12 patients where a power flush was used, 9 (75%) were successfully repositioned. These changes resulted in decreased delays in treatment and financial savings of $235,210 in personnel time and supplies. Discussion: The standardized protocol provided an alternative to previous practices, extending dwell time, decreasing treatment delay, and unnecessary procedures, showing significant savings for the institution. Conclusions: The Vascular Access Team use of an evidence-based protocol was successful in reducing catheter exchange and withdrawals in malpositioned catheters among adult and pediatric populations. Relevance to Clinical Practice: The implementation of a standardized EBP to address malpositioned catheters resulted in the decreased need for catheter exchange, reduced delays in treatment, and cost savings.
{"title":"CE Article: Use of an Evidence-Based Protocol for Repositioning Peripherally Inserted Central Catheters (PICCs) in Children and AdultsCE","authors":"J. Mesa, Amalyn Mejia, Gareth Tiu","doi":"10.2309/JAVA-D-19-00016","DOIUrl":"https://doi.org/10.2309/JAVA-D-19-00016","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000 Introduction: Achieving and maintaining optimal peripherally inserted central catheter (PICC) tip position can be challenging. At any time during therapies, the final catheter position can be altered due to changes in patient condition and intrathoracic pressure.\u0000 Aim: To determine if the use of a standardized protocol with power flush option for repositioning the PICC tips will reduce the number of withdrawal interventions or exchange procedures.\u0000 Methods: Johns Hopkins evidence-based practice (EBP) methodology was used to evaluate literature published in the past 5 years. A standardized protocol was developed and implemented in patients with malpositioned PICCs. The outcome measures were the successful repositioning of the catheter and costs for the procedure.\u0000 Results: In 4 months, 43 (93%) of 46 (14 adult/32 pediatric) catheters were successfully repositioned. The withdrawal method was used to reposition 34 (73.9%). In 12 patients where a power flush was used, 9 (75%) were successfully repositioned. These changes resulted in decreased delays in treatment and financial savings of $235,210 in personnel time and supplies.\u0000 Discussion: The standardized protocol provided an alternative to previous practices, extending dwell time, decreasing treatment delay, and unnecessary procedures, showing significant savings for the institution.\u0000 Conclusions: The Vascular Access Team use of an evidence-based protocol was successful in reducing catheter exchange and withdrawals in malpositioned catheters among adult and pediatric populations.\u0000 Relevance to Clinical Practice: The implementation of a standardized EBP to address malpositioned catheters resulted in the decreased need for catheter exchange, reduced delays in treatment, and cost savings.\u0000","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":"8 1","pages":"6-14"},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89322298","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}
M. Nicholas, Emily N. Larsen, C. Rickard, G. Mihala, P. Groom, N. Marsh
Background: Peripherally inserted central catheters (PICCs) are commonly placed with the assistance of fluoroscopy or medical imaging, ultrasound, electrocardiogram guidance, or all the above. Innovative ultrasound technologies continue to emerge; however, the impact upon clinical outcomes is not well understood. In this study, we aimed to compare outcomes of an existing ultrasound system with SHERLOCK 3CG™ Tip Confirmation (preintervention) to an updated SHERLOCK 3CG Diamond Tip Confirmation system, incorporating catheter-to-vein ratio measurement capabilities and an advanced magnetic-based tip navigation system (postintervention). Methods: In this prospective pre-post cohort study, we recruited adult patients requiring a new PICC. The study was conducted at a quaternary hospital in Queensland, Australia. Data were collected between May 2017 (4 months before equipment introduction) and January 2018 (4 months after equipment introduction), with a 1-month exclusion (education or learning) period in between. Patient, PICC, and device removal details were collected. The primary outcome was first-time insertion success, defined as successful PICC insertion after a single attempt (skin puncture), with the tip confirmed in an optimal location by the navigation system and a subsequent chest x-ray (as per hospital policy). Results: There were 503 participants with patient demographics and PICC characteristics balanced between the preintervention (n = 266) and postintervention (n = 237) groups. First-time insertion success was higher in the preintervention group (203/255, 80%) than the postintervention group (166/226, 73%), but this was not statistically significant (risk ratio = 0.92, 95% confidence interval = 0.83–1.02). Conclusions: There was no change in clinical outcomes with the use of next-generation ultrasound technology. These results justify future large studies and subsequent review into the efficacy of tip-confirmation systems and processes to maintain patient safety.
{"title":"Peripherally Inserted Central Catheter (PICC) Insertion Success and Optimal Placement with New Technology: A Pre-Post Cohort Study","authors":"M. Nicholas, Emily N. Larsen, C. Rickard, G. Mihala, P. Groom, N. Marsh","doi":"10.2309/JAVA-D-20-00030","DOIUrl":"https://doi.org/10.2309/JAVA-D-20-00030","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000 Background: Peripherally inserted central catheters (PICCs) are commonly placed with the assistance of fluoroscopy or medical imaging, ultrasound, electrocardiogram guidance, or all the above. Innovative ultrasound technologies continue to emerge; however, the impact upon clinical outcomes is not well understood. In this study, we aimed to compare outcomes of an existing ultrasound system with SHERLOCK 3CG™ Tip Confirmation (preintervention) to an updated SHERLOCK 3CG Diamond Tip Confirmation system, incorporating catheter-to-vein ratio measurement capabilities and an advanced magnetic-based tip navigation system (postintervention).\u0000 Methods: In this prospective pre-post cohort study, we recruited adult patients requiring a new PICC. The study was conducted at a quaternary hospital in Queensland, Australia. Data were collected between May 2017 (4 months before equipment introduction) and January 2018 (4 months after equipment introduction), with a 1-month exclusion (education or learning) period in between. Patient, PICC, and device removal details were collected. The primary outcome was first-time insertion success, defined as successful PICC insertion after a single attempt (skin puncture), with the tip confirmed in an optimal location by the navigation system and a subsequent chest x-ray (as per hospital policy).\u0000 Results: There were 503 participants with patient demographics and PICC characteristics balanced between the preintervention (n = 266) and postintervention (n = 237) groups. First-time insertion success was higher in the preintervention group (203/255, 80%) than the postintervention group (166/226, 73%), but this was not statistically significant (risk ratio = 0.92, 95% confidence interval = 0.83–1.02).\u0000 Conclusions: There was no change in clinical outcomes with the use of next-generation ultrasound technology. These results justify future large studies and subsequent review into the efficacy of tip-confirmation systems and processes to maintain patient safety.\u0000","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":"32 1","pages":"39-46"},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73304842","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}
Pub Date : 2021-03-01DOI: 10.2309/JAVA-2021-26-01-06
M. Neusser
{"title":"Reply to: Comments on the Use of Lock Solution to Prevent Hemodialysis Catheter-Related Infection and Dysfunction","authors":"M. Neusser","doi":"10.2309/JAVA-2021-26-01-06","DOIUrl":"https://doi.org/10.2309/JAVA-2021-26-01-06","url":null,"abstract":"","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":"29 1","pages":"23-23"},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78203324","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}
Moataz Fatthy, T. Abdelaziz, M. Marie, Mohamed Abdelkawi, Tamer Abdel Tawab
Background: End-stage renal disease (ESRD) is a growing global health hazard. Most patients are maintained on dialysis rather than transplantation. Adequate vascular access for hemodialysis is crucial to achieve an optimal dialysis dose and to reduce morbidity and mortality. Patients with multiple access failure are in desperate need for lifesaving access, especially in the absence of alternatives (transplantation or peritoneal dialysis).Objective: Patients with multiple vascular access failure and exhausted approachable veins are being referred to an interventional nephrology or radiology centers. The aim of this work is to evaluate a single center’s experience of sophisticated venous approaches to provide access for hemodialysis.Methods: This study was performed at the Interventional Nephrology Center at Kasr Al-Ainy University Hospitals. Epidemiological data of patients, e.g., age, gender, as well as the number of previously cannulated central veins, were documented.Results: Data of 188 patients with multiple dialysis venous access failure (117 females and 71 males, aged 17–56 years) were collected. Successful innominate (brachiocephalic) venous cannulation was achieved in 149 patients (79%). Eighteen patients had successful external iliac venous approach (9%). Successful transhepatic venous approach was placed as permanent access in 7 patients (4%). The rest of the patients (n = 14, 7%) were referred to other centers due to failure.Conclusions: Sophisticated central venous approaches, mainly brachiocephalic, as described in this study, may play as alternatives for placing either temporary or tunneled hemodialysis catheters in patients with multiple vascular access failure and stenosed or thrombosed central veins.
{"title":"Placing a Hemodialysis Catheter in Patients With Multiple Access Failure and Exhausted Usual Approachable Veins: Egyptian Single Center Experience","authors":"Moataz Fatthy, T. Abdelaziz, M. Marie, Mohamed Abdelkawi, Tamer Abdel Tawab","doi":"10.2309/JAVA-D-20-00029","DOIUrl":"https://doi.org/10.2309/JAVA-D-20-00029","url":null,"abstract":"Background: End-stage renal disease (ESRD) is a growing global health hazard. Most patients are maintained on dialysis rather than transplantation. Adequate vascular access for hemodialysis is crucial to achieve an optimal dialysis dose and to reduce morbidity and mortality. Patients with multiple access failure are in desperate need for lifesaving access, especially in the absence of alternatives (transplantation or peritoneal dialysis).Objective: Patients with multiple vascular access failure and exhausted approachable veins are being referred to an interventional nephrology or radiology centers. The aim of this work is to evaluate a single center’s experience of sophisticated venous approaches to provide access for hemodialysis.Methods: This study was performed at the Interventional Nephrology Center at Kasr Al-Ainy University Hospitals. Epidemiological data of patients, e.g., age, gender, as well as the number of previously cannulated central veins, were documented.Results: Data of 188 patients with multiple dialysis venous access failure (117 females and 71 males, aged 17–56 years) were collected. Successful innominate (brachiocephalic) venous cannulation was achieved in 149 patients (79%). Eighteen patients had successful external iliac venous approach (9%). Successful transhepatic venous approach was placed as permanent access in 7 patients (4%). The rest of the patients (n = 14, 7%) were referred to other centers due to failure.Conclusions: Sophisticated central venous approaches, mainly brachiocephalic, as described in this study, may play as alternatives for placing either temporary or tunneled hemodialysis catheters in patients with multiple vascular access failure and stenosed or thrombosed central veins.","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":"34 1","pages":"47-53"},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86105903","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}
Pub Date : 2021-03-01DOI: 10.2309/JAVA-2021-26-01-07
Mary Beth Hovda Davis, Darcy Doellman, Stephanie Pitts
{"title":"Minimum Education and Training for Pediatric and Neonatal IV Insertion for all Clinicians","authors":"Mary Beth Hovda Davis, Darcy Doellman, Stephanie Pitts","doi":"10.2309/JAVA-2021-26-01-07","DOIUrl":"https://doi.org/10.2309/JAVA-2021-26-01-07","url":null,"abstract":"","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":"19 1","pages":"15-20"},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82549776","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}
Pub Date : 2021-03-01DOI: 10.2309/JAVA-2021-26-01-05
J. Hong
{"title":"Comments on the Use of Lock Solution to Prevent Hemodialysis Catheter-Related Infection and Dysfunction","authors":"J. Hong","doi":"10.2309/JAVA-2021-26-01-05","DOIUrl":"https://doi.org/10.2309/JAVA-2021-26-01-05","url":null,"abstract":"<jats:sec>\u0000 \u0000 </jats:sec>","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":"41 1","pages":"21-22"},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83032413","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}
NC labeling does not appear to correspond with manufacturer claims. Two of 13 NCs passed the test for bidirectional flow control. All NCs reflux either on connection or disconnection. Neutral displacement does not appear to be present in the NCs tested in this observational study. Accurate bidirectional flow control, reflux cycle, and volume of reflux beyond the manufacturer’s performance claims will assist in the proper use of NCs.
{"title":"Do Needleless Connector Manufacturer Claims on Bidirectional Flow and Reflux Equate to In Vitro Quantification of Fluid Movement?","authors":"S. Matthew Gibson, Jonathan Primeaux","doi":"10.2309/java-d-20-00031","DOIUrl":"https://doi.org/10.2309/java-d-20-00031","url":null,"abstract":"\u0000 NC labeling does not appear to correspond with manufacturer claims. Two of 13 NCs passed the test for bidirectional flow control. All NCs reflux either on connection or disconnection. Neutral displacement does not appear to be present in the NCs tested in this observational study. Accurate bidirectional flow control, reflux cycle, and volume of reflux beyond the manufacturer’s performance claims will assist in the proper use of NCs.","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49405596","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}
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