Paraplegia - Possible sequelae of infected venous access site

Objectives To assess the effect of topically applied nitroglycerin (NTG) ointment (2%) on preoperative targeted venous access site great saphenous vein (GSV) diameter in patients undergoing endovenous laser treatment (ELT). Methods In this double-blinded randomized study design, 75 patients received either (A) treadmill ambulation only, (B) topically applied NTG ointment only, or (C) topically applied NTG ointment + treadmill ambulation. Targeted venous access vein diameters were measured before therapeutic intervention and then repeated after approximately 30 min following pretreatment intervention. Presence of venospasm and the number of ultrasound-guided venous access attempts during each ELT procedure were assessed during the study. Results The mean pretreatment vein diameter was 2.6 mm (range 0.9–4.9 mm). The post-treatment percentage change in vein diameter for group A (treadmill ambulation only) was +2.7% ( P = 0.403), whereas group B (NTG only) and group C (NTG + treadmill ambulation) demonstrated significant venodilatation of +69.0% ( P < 0.0001) and +51.7% ( P < 0.0001), respectively. Statistical analysis of variances and multivariate linear regression model revealed topically applied NTG ointment and ‘C’ classification of clinical, aetiological, anatomical and pathological elements (CEAP) were each significant predictors for venodilatation percentage change ( P < 0.001 and = 0.028, respectively). Conclusion Pretreatment with topically applied NTG ointment (2%) produced a statistically significant, as well as subjective clinically significant venodilatation change in the targeted venous access site diameter of patients undergoing ELT of the GSV in this study.

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Comparison of HemoFoam® and Conventional Gauze Dressing on Hemostasis of Vascular Access Site in Hemodialysis Patients

10.31661/gmj.v8i0.1395 ◽

2019 ◽

Vol 8 ◽

pp. 1395

Author(s):

Davood Bizari ◽

Hadi Khoshmohabat ◽

Soheila Salahshour Kordestani ◽

Rouhollah Zarepur

Keyword(s):

Vascular Access ◽

Venous Access ◽

Hemodialysis Patients ◽

Dialysis Access ◽

Access Site ◽

Puncture Wound ◽

Arterial Access ◽

Gauze Dressing ◽

The Mean ◽

Venous Access Site

Background: Dialysis access puncture wound bleeding after needle extraction at the end of each hemodialysis session is a very important problem. This study evaluated the effect of HemoFoam® compared to conventional gauze dressing on hemostasis of dialysis access puncture wound bleeding in hemodialysis patients. Materials and Methods: This one-group, before-after, clinical-trial was conducted on 60 hemodialysis patients selected by convenience sampling who underwent hemodialysis through arteriovenous fistula in Shahid Rahnemoon Hospital, Yazd, Iran in 2017. After reviewing the eligibility criteria, the study was performed in two separate sessions. In the first session, only HemoFoam® was used while in the second session; the only conventional dressing was used. Time of hemostasis in each puncture wound was evaluated. Data were analyzed by SPSS 22 (IBM SPSS Statistics for Windows, Armonk, NY: IBM Corp, United States) using paired T-test and Chi-square tests. Results: The mean age of the patients was 55.20±14.25 years. Hemostasis was achieved in 76.6% of cases at the arterial access site in the first two minutes in the HemoFoam® group. The mean homeostasis time in the HemoFoam® group was 2.86±1.87 min at the venous access site and 3.15±1.97 min at the arterial access site (P<0.001). The mean homeostasis time in the conventional dressing group was 10.54±6.65 min at venous access site and 12.74±9.28 min at the arterial access site, which was significantly different between the two groups (P<0.001). Conclusion: HemoFoam® is effective in reducing the time of homeostasis in the vascular access site of hemodialysis patients. Therefore, its use in hemodialysis wards is recommended for hemostasis in the dialysis access puncture wound bleeding. [GMJ.2019;8:e1395]

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Venous access-site closure with vascular closure device vs. manual compression in patients undergoing catheter ablation or left atrial appendage occlusion under uninterrupted anticoagulation: a multicentre experience on efficacy and complications

EP Europace ◽

10.1093/europace/euz004 ◽

2019 ◽

Vol 21 (7) ◽

pp. 1048-1054 ◽

Cited By ~ 9

Author(s):

Sanghamitra Mohanty ◽

Chintan Trivedi ◽

Salwa Beheiry ◽

Amin Al-Ahmad ◽

Rodney Horton ◽

...

Keyword(s):

Catheter Ablation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Venous Access ◽

Atrial Appendage ◽

Manual Compression ◽

Access Site ◽

Vascular Closure Devices ◽

Prolonged Immobilization ◽

Venous Access Site

Aims Manual compression (MC), widely used to achieve venous access haemostasis, needs prolonged immobilization and extended time-to-haemostasis. Vascular closure devices (VCD) have been reported to have significantly shorter time to haemostasis and ambulation in arterial access-site management. The current study aimed to evaluate the safety and efficacy as well as rate of urinary tract complications in patients receiving MC vs. VCD for venous access-site closure. Methods and results A total of 803 consecutive patients undergoing catheter ablation or left atrial appendage closure were classified into the VCD (n = 304) and the MC (n = 499) group, based on the methods used for haemostasis at the venous access site. Foley catheter was used for bladder-emptying in all MC cases and 15 VCD patients. At one site, VCD group patients with experience of MC in prior ablations were asked to describe their overall satisfaction level after comparing the past experience with the present. Haemostasis was achieved effectively in both populations. No VCD cases required >2 h bed rest, whereas 7 (1.4%) patients in the MC group needed prolonged immobilization (P = 0.04). Significantly higher incidence of access-site haematoma (P = 0.004) and urinary complications (P < 0.05) were observed in the MC group. Majority of VCD patients (68%) with prior experience of MC for haemostasis expressed satisfaction over the early ambulation and ability to void urine without bladder catheterization. Conclusion Vascular closure devices provided effective haemostasis, while reducing the access-site complications, ambulation time, and urinary complications.

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