MO783CENTRAL VEIN STENOSIS IN HEMODIALYSIS PATIENTS WITH PAST CENTRAL VEIN MANIPULATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Pedro Reis Pereira ◽  
Círia Sousa ◽  
Natalia Silva ◽  
Jose Francisco ◽  
Mónica Fructuoso ◽  
...  
Keyword(s):  
Vascular Access ◽  
Significant Proportion ◽  
Previous History ◽  
Hemodialysis Patients ◽  
Brachiocephalic Vein ◽  
Central Vein ◽  
Central Venous ◽  
Short Term ◽  
History Of

Abstract Background and Aims Central vein stenosis (CVS) is frequently observed in hemodialysis patients. Risk factors for CVS include prior ipsilateral central venous catheterization (CVC) and cardiac rhythm device (CRD) insertions. Though it may have clinical manifestations, CVS is often asymptomatic and, therefore, not diagnosed. The aim of this work was to evaluate the prevalence of CVS in a population of hemodialysis patients, as well as underlying risk factors, clinical manifestations and impact in patients’ vascular access. Method We retrospectively evaluated all venous angiographies of prevalent patients in our hemodialysis units from 2013 to 2018. In patients with proved CVS, we evaluated history of prior short term and long term upper ipsilateral CVC and CRD insertions. We also analyzed symptoms associated CVS as well as the rate of loss of vascular access for hemodialysis related to the presence of CVS. Results The prevalence of CVS in prevalent patients in hemodialysis during the period of our study (n=209) was 14%. We identified 31 upper CVS in 29 patients undergoing venous angiography. Left brachiocephalic vein was the most commonly affected site (45.1% of cases), followed by the right brachiocephalic vein (19.3%), left subclavian vein (16.1%), right subclavian vein (12.9%) and superior vena cava (6.4%). The majority of patients with CVS (95%) had previous history of ipsilateral CVC (previous short-term CVC in 40%, pervious short term and long-term CVC in 27% and previous long-term CVC in 33%). Loss of vascular access for hemodialysis due do CVS was observed in 26% of patients with CVS. Conclusion A significant proportion of patients in hemodialysis presents CVS. The majority of patients with CVS had a previous history of ipsilateral central venous catherization. A significant proportion of patients with CVS had a previous history central venous catherization uniquely with short term CVC, highlighting the importance of the risk of vascular lesion, even during short periods of catherization. The presence of CVS is associated with a significant rate of loss hemodialysis vascular access.

Advanced vascular access

2019 ◽  
pp. 177-190
Author(s):  
Richard Craig
Keyword(s):  
Vascular Access ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous ◽  
Short Term ◽  
Central Lines ◽  
Venous Access Devices

In this chapter, the use of ultrasound to facilitate cannulation of a vessel is described in detail, including commentaries on equipment, preparation, scanning, and needling technique. Equipment and techniques for the insertion of short-term non-tunnelled central lines, long-term central venous access devices, arterial lines, and intraosseous needles are presented.

Long-Term Vascular Access Devices

1997 ◽  
Vol 15 (1) ◽  
pp. 237-262 ◽  
Author(s):  
JANET S. FULTON
Keyword(s):  
Vascular Access ◽  
Interrater Reliability ◽  
Future Research ◽  
Central Venous ◽  
Short Term ◽  
Laboratory Methods ◽  
Vascular Access Devices ◽  
Adults And Children ◽  
Patient Subgroups

Introduced in the 1970s, long-term vascular access devices are used in both adults and children, with about 500,000 devices placed annually. This integrative review of research on dressings to minimize infectious catheter-related complications showed that current practices were adapted from knowledge derived from short-term central venous and peripheral catheters without thorough investigation. Summary and critique of recent, as well as older significant studies, provide guidance for future research. Specifically, future research should demonstrate greater confidence in outcome measures with attention to reliability of laboratory methods, diagnostic criteria, and interrater reliability. Continuing research efforts are needed to capture unique design features of various devices, qualify device performance across prolonged time, examine nuances within patient subgroups, and address underrepresented patients and settings. Confounding and interacting variables require greater attention in study design and analysis.

scholarly journals Predictors and Management of Antiplatelet-Related Bleeding Complications for Acute Coronary Syndrome in Chinese Elderly Patients

2018 ◽  
Vol 50 (3) ◽  
pp. 1164-1177 ◽  
Author(s):  
Jindong Wan ◽  
Peijian Wang ◽  
Peng Zhou ◽  
Sen Liu ◽  
Dan Wang ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Antiplatelet Therapy ◽  
Chronic Total Occlusion ◽  
Previous History ◽  
Bleeding Complications ◽  
Short Term ◽  
Total Occlusion ◽  
Coronary Syndrome ◽  
History Of

Background/Aims: Bleeding complications after percutaneous coronary intervention (PCI) are strongly associated with adverse patient outcomes. However, there are no specific guidelines for the predictors and management of antiplatelet-related bleeding complications in Chinese elderly patients with acute coronary syndrome (ACS). Methods: A retrospective analysis of 237 consecutive patients (aged ≥ 75 years) with ACS who had undergone successful PCI from January 2010 to December 2016 was performed to identify predictors and management of antiplatelet-related bleeding complications. Multivariate logistic regression analysis was conducted to investigate independent predictors of antiplatelet-related bleeding complications. We defined antiplatelet-related bleeding complications as first hospitalization received long-term oral antiplatelet therapy and required hospitalization, including gastrointestinal and intracranial bleedings. Results: After multivariable adjustment, independent risk predictors of antiplatelet-related bleeding complications included female gender (odds ratio [OR]: 2.96; 95% confidence interval [CI]: 1.98 to 4.15; P = 0.011), body mass index (OR: 1.54; 95% CI: 1.06 to 1.94; P = 0.034), previous history of bleeding (OR: 4.03; 95% CI: 1.84 to 6.12; P = 0.004), fasting blood glucose (OR: 2.79; 95% CI: 1.23 to 4.46; P = 0.025), and chronic total occlusion lesion (OR: 4.69; 95% CI: 2.19 to 7.93; P = 0.007). Of 46 patients with antiplatelet-related bleeding complications, 54.3% were treated short-term dual antiplatelet therapy (DAPT) cessation (0–7 days) and 45.7% underwent long-term DAPT cessation (> 7 days). Among these, 14 patients presented major adverse cardiac and cerebrovascular events (MACCE), whereas no re-bleeding happened over all available follow-up. The incidence of MACCE was not significantly different between the two groups one year after PCI (36.0% for short-term DAPT cessation versus 23.8% for long-term DAPT cessation, P = 0.522). Conclusion: For elderly patients with ACS, multiple factors were likely to contribute to antiplatelet-related bleeding complications, especially previous history of bleeding and chronic total occlusion lesion. Better individualized, tailored and risk-adjusted antiplatelet therapy after PCI is urgently needed in this high-risk population.

Ultrasound-guided percutaneous right brachiocephalic vein cannulation in a 5-year-old patient with bilaterally occluded internal jugular veins due to previous access by venous cut-down: A case report

2021 ◽  
pp. 112972982110118
Author(s):  
Filiz Uzumcugil
Keyword(s):  
Venous Access ◽  
Term Treatment ◽  
Brachiocephalic Vein ◽  
Central Vein ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Jugular Veins ◽  
Assessment Protocol ◽  
Long Term Treatment

The open surgical venous cut-down technique is widely performed in cases of long-term treatment including administration of chemotherapy, parenteral nutrition, or replacement therapies. However, it has been recommended to avoid this technique considering the resultant unpredictable alterations in the veins draining the relevant site, especially in patients who may need central venous cannulation (CVC) during disease progression. We aimed to report on CVC in a 5-year-old child who had previously undergone bilateral internal jugular venous access by the open venous cut-down technique, in order to highlight the importance of performing the Rapid Central Vein Assessment protocol prior to any intervention and considering to abandon the use of the open surgical venous cut-down technique by gaining experience with ultrasound-guided percutaneous techniques.

Aneurysms in Vascular Access: State of the Art and Future Developments

2017 ◽  
Vol 18 (6) ◽  
pp. 464-472 ◽  
Author(s):  
Nicholas Inston ◽  
Hiren Mistry ◽  
James Gilbert ◽  
David Kingsmore ◽  
Zahid Raza ◽  
...  
Keyword(s):  
Vascular Access ◽  
Audience Participation ◽  
Short Term ◽  
Cross Sectional ◽  
Av Fistula ◽  
Active Audience ◽  
Cross Sectional Imaging ◽  
History Of ◽  
Definition Of

A master class was held at the Vascular Access at Charing Cross (VA@CX2017) conference in April 2017 with invited experts and active audience participation to discuss arteriovenous (AV) vascular access aneurysms, a serious and common complication of vascular access (VA). The natural history of aneurysms in VA is poorly defined, and although classifications exist they are not uniformly applied in studies or clinical practice. True and pseudo aneurysms of AV access occur. Whilst an AV fistula by definition is an abnormal dilatation of a blood vessel, an agreed definition of 18 mm, or 3 times accepted maturation diameter, is proposed. The mechanism of aneurysmal dilatation is unknown but appears to be a combination of excessive external remodeling, wall changes due to injury, and obstruction of outflow. Diagnosis of AV aneurysms is based on physical examination and ultrasound. Venography and cross-sectional imaging may assist and be required for the investigation of outflow stenosis. Treatment of pseudo aneurysms and true aneurysms of VA (AVA) is not evidence-based, but relies on clinical experience and available facilities. In many AVA, a conservative approach with surveillance is suitable, although intervals and modalities are unclear. Avoidance of rupture is imperative and preemptive treatment should aim for access preservation, ideally with avoidance of prosthetic materials. Different techniques of aneurysmorrhaphy are described with good results in published series. Although endovascular approaches and stenting are described with good short-term results, issues with cannulation of stented areas occur and, while possible, this is not recommended, and long-term access revision is recommended.

A Stuck Hemodialysis Central venous Catheter

2008 ◽  
Vol 9 (4) ◽  
pp. 301-303 ◽  
Author(s):  
M. Field ◽  
J. Pugh ◽  
J. Asquith ◽  
S. Davies ◽  
A.D. Pherwani
Keyword(s):  
Case Report ◽  
Central Venous Catheter ◽  
Vascular Access ◽  
Insertion Site ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
Central Venous Catheters ◽  
Central Venous

Background A growing number of hemodialysis patients are dependent upon central venous catheters (CVCs) for long-term vascular access. Although many complications of CVCs have been documented, the phenomenon of the stuck catheter is described relatively infrequently. Case report We describe a case where attempts to remove the line by exploration of the jugular insertion site in theater were unsuccessful and the line was internalized. Discussion The case is then discussed with all available cases in the literature to suggest principles of managing and preventing the stuck catheter phenomenon.

The Burden of Tunneled Central Venous Catheters for Hemodialysis in a County Hospital

2017 ◽  
Vol 83 (10) ◽  
pp. 1095-1098 ◽  
Author(s):  
Eric Pillado ◽  
Abraham Korn ◽  
Christian De Virgilio ◽  
Nina Bowens
Keyword(s):  
Vascular Access ◽  
Central Venous Catheters ◽  
Male Gender ◽  
Insurance Status ◽  
Central Venous ◽  
Short Term ◽  
Arteriovenous Fistulas ◽  
Ambulatory Status ◽  
Initiation Of Dialysis ◽  
History Of

Prolonged use of central venous catheters (CVCs) for hemodialysis (HD) is associated with greater morbidity and mortality when compared with autogenous arteriovenous fistulas (AVF). The objective was to assess compliance with CVC guidelines in adults referred for hemoaccess at a county teaching hospital. Out of 256 patients, 172 (67.2%) were male, with a mean age of 50.0 ± 12.4 years. Overall 62.5 per cent initiated dialysis via CVC. Patients were divided into two groups (those with CVC (62.5%) and those without (37.5%)). Male gender was associated with initiation of dialysis via CVC versus no CVC (72.5 vs 58.3%, P = 0.02), as was a history of prior vascular access (P < 0.01). There were no significant differences between the groups regarding age, diabetes, smoking, ambulatory status, or insurance status. There were no differences in gender, age, insurance status, or prior vascular access between prolonged CVC use (≥90 days) and short-term CVC use (<90 days). We conclude that most patients initiated HD with CVC and exceed the recommended CVC duration. Men are more likely to initiate HD via CVC. Insurance status was not associated with CVC use. Multidisciplinary action may address barriers to reducing CVC duration.

Internal jugular to internal jugular vein bypass of symptomatic central vein obstruction

2022 ◽  
pp. 112972982110707
Author(s):  
Jared Carleton ◽  
Jason Chang ◽  
Qinghua (Richard) Pu ◽  
Robert Rhee
Keyword(s):  
Upper Extremity ◽  
Jugular Vein ◽  
Hemodialysis Patients ◽  
Brachiocephalic Vein ◽  
Central Vein ◽  
Central Venous ◽  
Av Fistula ◽  
Facial Swelling ◽  
Vein Bypass ◽  
The Creation

Introduction: Central venous obstruction (CVO) often arises among hemodialysis patients with upper extremity access due to a varying number of risk factors. While the true incidence of CVO in hemodialysis patients is unknown, it been reported in the range of 20%–40% in dialysis patients undergoing venograms. In the non-hemodialysis population, chronic central vein obstruction has a compensatory mechanism comprised of numerous collaterals along the chest wall, neck, and mediastinum. However, the presence of an AVF or AVG ipsilateral to a central venous stenosis or occlusion can overwhelm the collateral network due to the significantly elevated blood flow. This may result in severe and debilitating upper extremity and fascial swelling. While ligation results in almost instantaneous symptomatic relief, it does not address the patient’s underlying pathologic process and necessitates an additional access. As these patients continue to live longer, our strategies to manage these failing accesses are becoming increasingly complex. The goal of preserving existing access while correcting any symptoms is paramount. Previous case reports have documented various surgical options for preserving an existing access. Case presentation: Our patient is a 49-year-old female with hypertension and end-stage renal disease, on hemodialysis through a right arm arteriovenous (AV) fistula. She had a history of multiple AV fistulae creations in the past, all of which previously thrombosed. Several years after the creation of her most recent fistula, she developed severe throbbing headaches, right arm and facial swelling, right eye lacrimation, and blurry vision. AV fistula angiogram demonstrated right brachiocephalic vein chronic occlusion and endovascular revascularization through both trans-AVF and transfemoral approaches were attempted, but unsuccessful. Discussion: This case illustrates the success of the creation of an internal jugular-jugular vein bypass to maintain a right arm arteriovenous fistula, while at the same time, correcting the symptoms of a right brachiocephalic vein occlusion.

scholarly journals Diagnosis and management of catheter-related bloodstream infections in patients on home parenteral nutrition

2019 ◽  
Vol 11 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Ashley Bond ◽  
Paul Chadwick ◽  
Trevor R Smith ◽  
Jeremy M D Nightingale ◽  
Simon Lal
Keyword(s):  
Parenteral Nutrition ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Nutrition Support ◽  
Central Venous ◽  
Short Term ◽  
Qualitative And Quantitative ◽  
Central Venous Catheter Removal ◽  
Support Team

Catheter-related bloodstream infections (CRBSIs) commonly arise from a parenteral nutrition catheter hub. A target for a Nutrition Support Team is to have a CRBSI rate of less than 1 per 1000. The diagnosis of CRBSI is suspected clinically by a temperature shortly after setting up a feed, general malaise or raised blood inflammatory markers. It is confirmed by qualitative and quantitative blood cultures from the catheter and peripherally. Treatment of inpatients may involve central venous catheter removal and antibiotics for patients needing short-term parenteral nutrition, but catheter salvage is generally recommended for patients needing long-term parenteral nutrition, where appropriate.

scholarly journals Rheumatoid arthritis onset after COVID-19 infection: a case report

2021 ◽  
Vol 9 (12) ◽  
pp. 3713
Author(s):  
Thafar S. A. Safar ◽  
Karmen B. Katay ◽  
Reem H. Khamis
Keyword(s):  
Rheumatoid Arthritis ◽  
Case Report ◽  
Pathological Condition ◽  
Primary Health Care Centre ◽  
Short Term ◽  
Health Care Centre ◽  
Immune Mediated ◽  
Small Hand ◽  
History Of

At the end of 2019, coronavirus disease (COVID-19) outbreak is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). Worldwide researchers and physician try to explore the mechanisms of damage induced by virus, they focus on the short-term and long-term immune-mediated consequences induced by the virus infection. Every day discover a new pathological condition induced by virus and new symptoms and disease may occur after recovery from disease. Our case report is 41 years old, Indian lady who presented to our primary health care centre complaining of multiple small hand joints pain, both elbows and knees pain with swelling of them and prolonged morning stiffness, diagnosed seropositive rheumatoid arthritis (RA) (arthritis, positive rheumatoid factor (RF), and X-ray changes) after 1 month recovery from COVID-19 infection. She did not have any joint pain and she had negative RF before COVID-19 infection with no family history of RA.

Sign in / Sign up

Export Citation Format

Share Document