It is possible to create a vascular access team in a middle resource country? Experience of Hevi Paediatric Teaching Hospital at DUHOK – IRAQ

2021 ◽  
pp. 112972982110554
Author(s):  
Buzzi Federica ◽  
Bakir Nizar Yahya ◽  
Adel Hevan Al-Atroushy ◽  
Abdullah Wahida Ibraheem ◽  
Haji Bayar Saleem ◽  
...  
Keyword(s):  
Teaching Hospital ◽  
Vascular Access ◽  
Healthcare Professionals ◽  
Clinical Skill ◽  
Fundamental Importance ◽  
Success Rates ◽  
Vascular Access Devices ◽  
Paediatric Patients ◽  
The Mean ◽  
The Creation

Background: Vascular access devices are critically important for the treatment of neonates and paediatric patients. Vascular cannulation is a key clinical skill for healthcare professionals working in the neonatal and paediatric wards. The creation of specialised Teams dedicated to the positioning of Vascular Venous Accesses is increasingly used and of fundamental importance for good patients care. The aim of the study is to evaluate the effectiveness of a training intervention for the staff of the Intensive Care Units for the insertion of the short/long peripheral catheter and to create a NuVa Team (Nurse-led Vascular Access Team). Methods: At the Hevi Paediatric Teaching Hospital, a course and an on-the-job training programme were carried out for two doctors and six nurses on the insertion of the in long peripheral catheters newborns and paediatric patients admitted at the hospital. The data collected were analysed from April 2017 to December 2020. A pre and post-procedure study was designed to determine whether establishing the Nurses Vascular Accesses Team (NuVa) is associated with higher success rates and a reduced risk of catheter-related complications. Results: A total of 271 Leader-cath™ catheters were placed during the study period. The mean age at catheters insertion was 2.9 years, the mean residence time was 11.7 days. Most catheters were inserted by five nurses ( n = 216 (80%)); the remainder was entered by two paediatricians ( n = 55 (20%)), p = 0.001. General reasons for removal were home discharge ( n = 103 (38%)), deceases ( n = 81 (30%)), accidental causes ( n = 43 (16%)), leg/arm oedema ( n = 21 (8%)), mechanical problems ( n = 10 (3.5%)), physician’s indication ( n = 9 (3%)) and skin infection ( n = 4 (1.5%)), p = 0.001. Conclusions: The standardisation of the procedure for inserting the catheters placement and the creation of a NuVa Team has been of fundamental importance in gaining awareness of the procedure and allows healthcare professionals to insert the catheter without complications.

Endovascular bypass for salvage of vascular access in hemodialysis catheter-consigned patients

2018 ◽  
Vol 19 (6) ◽  
pp. 585-592 ◽  
Author(s):  
Matt Chiung-Yu Chen ◽  
Mei-Jui Weng ◽  
Huei-Lung Liang
Keyword(s):  
Vascular Access ◽  
Clinical Success ◽  
Primary Patency ◽  
Secondary Patency ◽  
Success Rates ◽  
Access Site ◽  
Hemodialysis Catheter ◽  
Kaplan Meier ◽  
The Mean

Purpose: This study was performed to retrospectively assess the efficacy of percutaneous creation of an intervascular bypass with or without stent graft deployment (endovascular bypass) for salvage of abandoned vascular access sites in hemodialysis catheter-consigned patients. Methods: Salvage of abandoned vascular access sites was attempted in 16 patients with hemodialysis catheters. These vascular access sites were salvaged using endovascular bypass techniques to redirect the access flow to a nonarterialized vein as a new outflow conduit or cannulation segment. The postintervention primary, assisted primary, and secondary patency rates of the access site and bypass were calculated using the Kaplan–Meier method. Results: The procedural and clinical success rates were both 100%. The postintervention primary patency rate of the bypass and access site at 360 days was 75.7 ± 12.5% and 56.8 ± 14.9%, respectively. The mean follow-up period was 461.9 days (range: 121–900 days). No major complications were observed. One bare bypass tunnel rupture and one pseudoaneurysm were noted during the procedure. Conclusion: Salvage of abandoned vascular access sites for hemodialysis catheter-consigned patients can be technically feasible and clinically successful using endovascular bypass techniques in selected patients when surgical revision is not considered or is not possible.

scholarly journals International recommendations for a vascular access minimum dataset: a Delphi consensus-building study

2020 ◽  
pp. bmjqs-2020-011274
Author(s):  
Jessica Schults ◽  
Tricia Kleidon ◽  
Vineet Chopra ◽  
Marie Cooke ◽  
Rebecca Paterson ◽  
...  
Keyword(s):  
Vascular Access ◽  
Delphi Study ◽  
Healthcare Professionals ◽  
International Consensus ◽  
Vascular Access Devices ◽  
Response Options ◽  
Access Device ◽  
Vascular Access Device ◽  
Device Use ◽  
Minimum Dataset

BackgroundData regarding vascular access device use and outcomes are limited. In part, this gap reflects the absence of guidance on what variables should be collected to assess patient outcomes. We sought to derive international consensus on a vascular access minimum dataset.MethodsA modified Delphi study with three rounds (two electronic surveys and a face-to-face consensus panel) was conducted involving international vascular access specialists. In Rounds 1 and 2, electronic surveys were distributed to healthcare professionals specialising in vascular access. Survey respondents were asked to rate the importance of variables, feasibility of data collection and acceptability of items, definitions and response options. In Round 3, a purposive expert panel met to review Round 1 and 2 ratings and reach consensus (defined as ≥70% agreement) on the final items to be included in a minimum dataset for vascular access devices.ResultsA total of 64 of 225 interdisciplinary healthcare professionals from 11 countries responded to Round 1 and 2 surveys (response rate of 34% and 29%, respectively). From the original 52 items, 50 items across five domains emerged from the Delphi procedure.Items related to demographic and clinical characteristics (n=5; eg, age), device characteristics (n=5; eg, device type), insertion (n=16; eg, indication), management (n=9; eg, dressing and securement), and complication and removal (n=15, eg, occlusion) were identified as requirements for a minimum dataset to track and evaluate vascular access device use and outcomes.ConclusionWe developed and internally validated a minimum dataset for vascular access device research. This study generated new knowledge to enable healthcare systems to collect relevant, useful and meaningful vascular access data. Use of this standardised approach can help benchmark clinical practice and target improvements worldwide.

scholarly journals Study protocol: In the preparation and administration of intravenous medicines, what are the best practice standards that healthcare professionals need to follow to ensure patient safety?

2020 ◽  
Vol 3 ◽  
pp. 19
Author(s):  
Peter J. Carr ◽  
Laura O'Connor ◽  
Georgina Gethin ◽  
John D. Ivory ◽  
Paul O'Hara ◽  
...  
Keyword(s):  
Systematic Review ◽  
Vascular Access ◽  
Best Practice ◽  
Healthcare Professionals ◽  
Meta Analysis ◽  
Review Literature ◽  
Intravenous Therapy ◽  
Vascular Access Devices ◽  
Ensure Patient Safety ◽  
Practice Standards

Introduction: Intravenous therapy and medicines (IVTM) are the most common invasive interventions in use in healthcare. Prescribed IVTM play an essential role in the treatment of illness, management of chronic conditions and in maintaining health and wellbeing. The intravenous (IV) route is the administration of concentrated medications (diluted or undiluted) directly into peripherally or centrally inserted vascular access devices. Medication safety is a key priority and best practice standards are required to guide the safe preparation and administration of IVTM. Methods: We will conduct a systematic review of the literature pertaining to the preparation and administration of intravenous therapy and medicines. Our search will include studies concerned with the preparation and/or administration of IVTM via peripheral or central vascular access devices. We will be guided by the preferred reporting items for systematic review and meta-analysis (PRISMA) in this review. Literature will include all trial designs, national/international guidelines, and expert consensus opinion made available in English from 2009 to present day. Conclusions: We will synthesise the evidence concerning safe and effective preparation and administration of intravenous therapy and medicines to inform the development of a national guideline for healthcare professionals in Ireland. The availability of up-to-date, contemporaneous evidence-based practice standards will ensure quality and safety for service-users. Registration:  This study has been submitted to PROSPERO and we are awaiting confirmation of registration.

scholarly journals First experience with percutaneous arteriovenous fistula creation using the Ellipsys® vascular access system

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
A Isaak ◽  
A Mallios ◽  
L Gürke ◽  
T Wolff
Keyword(s):  
Radial Artery ◽  
Vascular Access ◽  
Success Rates ◽  
Basilic Vein ◽  
Technical Success ◽  
Upper Arm ◽  
Promising Alternative ◽  
Access System ◽  
The Creation ◽  
Vein Stenosis

Abstract Objective Percutaneous creation of arteriovenous fistulae (pAVF) has been developed as an alternative to the creation of an upper arm cephalic or basilic vein fistula. Several studies have shown high technical success rates and comparable time of maturation. To our knowledge, the technique has not been used in Switzerland before. Methods Prospective data collection of the first consecutive patients undergoing the creation of pAVF between April and July 2020 at two vascular surgery centres. Results Seven patients underwent pAVF creation with the Ellipsys® vascular access system under regional anaesthesia for maximum vasodilation. The procedures were performed entirely under sonographic control without the use of fluoroscopy. The cephalic or basilic vein was punctured and the puncture needle advanced under sonographic control through the cubital perforator vein into the proximal radial artery. The Ellipsys® catheter was advanced over a guidewire and activated to create the fistula between the proximal radial artery and the perforator vein. The fistula was further dilated with a 5mm PTA balloon. We achieved technical success in 6 patients. In one patient with small and spastic vessels, the needle could not be advanced into the radial artery. A conventional upper arm cephalic fistula was created during the same procedure. In three patients primary maturation was achieved and the cephalic vein or distal basilic vein could be punctured for dialysis without any adjunct procedures. One patient required three additional procedures before the fistula could be used successfully (additional angioplasty of the fistula, superficialisation of the basilic vein and correction of a cubital vein stenosis by excision and end-to-end anastomosis). One patient required superficialisation of the basilic vein and one patient transposition of the arterialised brachial vein. Maturation was achieved in six pAVF after a mean of 158 days with a mean fistula flow of 920 ml/ min. Conclusion We achieved high technical success and maturation rates in our first patients undergoing pAVF creation with the Ellipsys® system. Prerequisites are suitable anatomy of the cubital perforator vein and good skills in sonography and endovascular techniques. We believe that pAVF is a promising alternative to the creation of a conventional upper arm fistula in patients unsuitable for a distal radio-cephalic fistula.

scholarly journals In the preparation and administration of intravenous medicines, what are the best practice standards that healthcare professionals need to follow to ensure patient safety? Protocol for a systematic review.

2021 ◽  
Vol 3 ◽  
pp. 19
Author(s):  
Peter J. Carr ◽  
Laura O'Connor ◽  
Georgina Gethin ◽  
John D. Ivory ◽  
Paul O'Hara ◽  
...  
Keyword(s):  
Systematic Review ◽  
Vascular Access ◽  
Best Practice ◽  
Healthcare Professionals ◽  
Meta Analysis ◽  
Review Literature ◽  
Intravenous Therapy ◽  
Vascular Access Devices ◽  
Ensure Patient Safety ◽  
Practice Standards

Introduction: Intravenous therapy and medicines (IVTM) are the most common invasive interventions in use in healthcare. Prescribed IVTM play an essential role in the treatment of illness, management of chronic conditions and in maintaining health and wellbeing. The intravenous (IV) route is the administration of concentrated medications (diluted or undiluted) directly into peripherally or centrally inserted vascular access devices. Medication safety is a key priority and best practice standards are required to guide the safe preparation and administration of IVTM. Methods: We will conduct a systematic review of the literature pertaining to the preparation and administration of intravenous therapy and medicines. Our search will include studies concerned with the preparation and/or administration of IVTM via peripheral or central vascular access devices. We will be guided by the preferred reporting items for systematic review and meta-analysis (PRISMA) in this review. Literature will include all trial designs, national/international guidelines, and expert consensus opinion made available in English from 2009 to present day. Conclusions: We will synthesise the evidence concerning safe and effective preparation and administration of intravenous therapy and medicines to inform the development of a national guideline for healthcare professionals in Ireland. The availability of up-to-date, contemporaneous evidence-based practice standards will ensure quality and safety for service-users. Registration:  This study has been submitted to PROSPERO and we are awaiting confirmation of registration.

scholarly journals In the preparation and administration of intravenous medicines, what are the best practice standards that healthcare professionals need to follow to ensure patient safety? Protocol for a systematic review.

2020 ◽  
Vol 3 ◽  
pp. 19
Author(s):  
Peter J. Carr ◽  
Laura O'Connor ◽  
Georgina Gethin ◽  
John D. Ivory ◽  
Paul O'Hara ◽  
...  
Keyword(s):  
Systematic Review ◽  
Vascular Access ◽  
Best Practice ◽  
Healthcare Professionals ◽  
Meta Analysis ◽  
Review Literature ◽  
Intravenous Therapy ◽  
Vascular Access Devices ◽  
Ensure Patient Safety ◽  
Practice Standards

Introduction: Intravenous therapy and medicines (IVTM) are the most common invasive interventions in use in healthcare. Prescribed IVTM play an essential role in the treatment of illness, management of chronic conditions and in maintaining health and wellbeing. The intravenous (IV) route is the administration of concentrated medications (diluted or undiluted) directly into peripherally or centrally inserted vascular access devices. Medication safety is a key priority and best practice standards are required to guide the safe preparation and administration of IVTM. Methods: We will conduct a systematic review of the literature pertaining to the preparation and administration of intravenous therapy and medicines. Our search will include studies concerned with the preparation and/or administration of IVTM via peripheral or central vascular access devices. We will be guided by the preferred reporting items for systematic review and meta-analysis (PRISMA) in this review. Literature will include all trial designs, national/international guidelines, and expert consensus opinion made available in English from 2009 to present day. Conclusions: We will synthesise the evidence concerning safe and effective preparation and administration of intravenous therapy and medicines to inform the development of a national guideline for healthcare professionals in Ireland. The availability of up-to-date, contemporaneous evidence-based practice standards will ensure quality and safety for service-users. Registration:  This study has been submitted to PROSPERO and we are awaiting confirmation of registration.

Effectiveness of adenotonsillectomy in improving of nocturnal enuresis in children with adenotonsillar hypertrophy

2018 ◽  
Vol 9 (SPL1) ◽  
Author(s):  
Kassim R Dekhil ◽  
Ali abd-almer Jwad ◽  
Abbas Alyasiry
Keyword(s):  
Teaching Hospital ◽  
Nocturnal Enuresis ◽  
Adenotonsillar Hypertrophy ◽  
Number Of Children ◽  
The Mean ◽  
Childhood Condition ◽  
Rule Out

Nocturnal enuresis (NE) is an old & common childhood condition. It has been found that,there is a relationship between adenotonsillar hypertrophy in children & nocturnal enuresis. This study was conducted to see the effects of adenotonsillectomy on nocturnal enuresis in children with adenotonsillar hypertrophy.This study was conducted in Diwaniyah teaching hospital,Diwaniyah city,Iraq from May 2012 to August 2014. The total number of children admitted for adenotonsillectomy or tonsillectomy alone were 287. 76 children out of the total number were included in the study. The children were followed by the same questionnaire for four months postoperatively,including,age,the number of night bed wettings,type of enuresis and the results of urine examinationof total 287 children who were submitted for surgery,76 children were eligible for the study,48 (63.16%) of the total number included in the study were males and 28 (36.84%) were females. The mean age was 7.2 years. Adenotonsillectomy was performed in 64 children,and tonsillectomy in12 children. A complete improvement of nocturnal enuresis (NE) & daytime incontinence was achieved in 32 (42.11%) children. A mild to moderateimprovement was observed in 38 (50%),while no improvement seen in the remaining 6 (7.89%) children postoperatively.Nocturnal enuresis (NE) is an old & common childhood condition & there is a relation between nocturnal enuresis in children & adenotonsillar hypertrophy. Children with nocturnal enuresis should be evaluated by ENT surgeon to rule out any adenotonsillar hypertrophy for possible adenotonsillectomy effect. However,a wide base studies are needed to clarify these results.

Renal Hemodynamic Response to the Creation of Vascular Access in Patients with End-Stage Renal Disease

Renal Failure ◽  
1995 ◽  
Vol 17 (5) ◽  
pp. 589-593 ◽  
Author(s):  
Susan Crowley ◽  
Richard Morrissey ◽  
Eugene Silverman ◽  
William Yudt ◽  
Przemyslaw Hirszel
Keyword(s):  
Renal Disease ◽  
Vascular Access ◽  
End Stage Renal Disease ◽  
Hemodynamic Response ◽  
Renal Hemodynamic ◽  
The Creation ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Comparison of Efficacy between 120° and 180° Schlemm’s Canal Incision Microhook Ab Interno Trabeculotomy

2021 ◽  
Vol 10 (14) ◽  
pp. 3181
Author(s):  
Naoki Okada ◽  
Kazuyuki Hirooka ◽  
Hiromitsu Onoe ◽  
Yumiko Murakami ◽  
Hideaki Okumichi ◽  
...  
Keyword(s):  
Surgical Outcomes ◽  
Open Angle Glaucoma ◽  
Case Series ◽  
Glaucoma Surgery ◽  
Success Rates ◽  
Schlemm’S Canal ◽  
Schlemm's Canal ◽  
Kaplan Meier ◽  
The Mean ◽  
Ab Interno

We compared surgical outcomes in patients with either primary open-angle glaucoma or exfoliation glaucoma after undergoing combined phacoemulsification with either a 120° or 180° incision during a Schlemm’s canal microhook ab interno trabeculotomy (μLOT-Phaco). This retrospective comparative case series examined 52 μLOT-Phaco eyes that underwent surgery between September 2017 and December 2020. Surgical qualified success was defined as an intraocular pressure (IOP) of ≤20 mmHg, ≥20% IOP reduction with IOP-lowering medications, and no additional glaucoma surgery. Success rates were evaluated by Kaplan-Meier survival analysis. The number of postoperative IOP-lowering medications and occurrence of complications were also assessed. Mean preoperative IOP in the 120° group was 16.9 ± 7.6 mmHg, which significantly decreased to 10.9 ± 2.7 mmHg (p < 0.01) and 11.1 ± 3.1 mmHg (p = 0.01) at 12 and 24 months, respectively. The mean number of preoperative IOP-lowering medications significantly decreased from 2.8 ± 1.4 to 1.4 ± 1.4 (p < 0.01) at 24 months. Mean preoperative IOP in the 180° group was 17.1 ± 7.0 mmHg, which significantly decreased to 12.1 ± 3.2 mmHg (p = 0.02) and 12.9 ± 1.4 mmHg (p = 0.01) at 12 and 24 months, respectively. The mean number of preoperative IOP-lowering medications significantly decreased from 2.9 ± 1.2 to 1.4 ± 1.5 (p < 0.01) at 24 months. The probability of qualified success at 24 months in the 120° and 180° groups was 50.4% and 54.6%, respectively (p = 0.58). There was no difference observed for hyphema formation or IOP spikes. Surgical outcomes were not significantly different between the 120° and 180° incisions in Schlemm’s canal.

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