The FACT : Use of a novel intermittent pneumatic compression device to promote pre-surgery arm vein dilation in patients with chronic renal failure

Background: Arteriovenous fistula (AVF) creation and maturation for hemodialysis is globally a topic of importance given the poor results and high costs associated with renal care. Successful AVF (surgical or endovascular) creation requires appropriate superficial veins and quality arteries. Many procedures fail due to initial small veins with limited blood flow capacity and distensibility. Intermittent pneumatic compression has previously shown success in trials to increase superficial veins in patients with end stage renal disease post AVF. The objective of this study is to investigate the role of an intermittent pneumatic device, the Fist Assist®, to dilate cephalic arm veins in patients with advanced chronic kidney disease (CKD) prior to AVF placement. Methods: Three centers enrolled subjects from June 2019 through July 2021. Baseline Doppler measurements of the cephalic vein in standard locations the forearm and upper arm with and without a blood pressure cuff were recorded. Patients were instructed and used Fist Assist® on their non-dominant arm for up to 4 h daily for 90 days. At approximately 3 months, Doppler measurements were repeated. The primary endpoint was cephalic vein enlargement with secondary endpoints based on percentage of veins approaching 2.5 mm in the forearm and 3.5 mm in the upper arm. Results: Thirty-seven subjects with CKD (mean eGFR 13.8 mL/min) were enrolled and completed the trial. Paired-difference t-tests (one tail) for aggregate data showed significant venous dilation of the cephalic vein in both the forearm and upper arm after use with the Fist Assist® ( p < 0.05). Mean differences in the forearm veins were approximately 0.6 and 1.1 mm in the upper arm cephalic vein after Fist Assist® application. There were no major complications reported by any subject during the trial. Conclusions: Fist Assist® use in patients with CKD is effective to enhance vein dilation. Forearm and upper arm cephalic veins increased on average 0.6 and 1.1 mm respectively after Fist Assist® application. This is the first trial to evaluate the effect of intermittent, focal pneumatic compression on pre-surgery vein diameter in patients with advanced CKD before AVF creation.

Health Informatics Study of Related Complications Relating to Upper Arm Implantable Intravenous Infusion Port in Breast Cancer Patients

Objective: In order to explore the clinical application effect of the upper arm venous infusion port, analyze the prevention and treatment effect of catheter rupture of the upper arm venous infusion port, and conduct a series of studies on postoperative related complications, as well as analyze the prevention and treatment of catheter rupture of the upper arm venous infusion port effect using chest radiography and computed tomography. Methods: We collected clinical data of 98 patients implanted in the upper arm venous infusion port in the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine and Hangzhou Shulan Hospital from January to December 2017, divided the 98 patients into two groups, and gave 49 patients in group A Based on the patient’s basic intervention, 49 patients in group B were given prevention and treatment intervention of catheter rupture, and the intervention effects of the two groups were compared. Consult the nursing records during the hospitalization and maintenance period after the implantation of the upper arm vein infusion port, summarize the complications, analyze the causes, and discuss the formulation of feasible nursing countermea-sures. Results: 98 patients were followed up for 5-16 months, with a median follow-up time of 10 months. Within 2 weeks after implantation of the upper arm vein infusion port and during discharge maintenance, the incidence of complications was 24.49% (24/98), 8.16% (8/98), the difference in the incidence of complications between the two time periods was statistically significant (P < 0.05). Among them, common complications include incision bleeding at the port body, poor healing of the incision, local swelling, obstruction of catheter withdrawal, extravasation of transfusion at the port body, catheter blockage, catheter displacement, and catheter-related thrombosis. There was a difference in the incidence of catheter rupture, catheter rupture time, and patient satisfaction after intervention between the two groups of intravenous implantation patients (P < 0.05), which was statistically significant. Conclusions: Complications within 2 weeks after implantation of the upper arm venous infusion port are significantly higher than the maintenance period. Among them, infusion extravasation, catheter-related thrombosis, catheter blockage, and catheter displacement at the port body are serious complications that directly affect the use of the upper arm infusion port . The prevention and treatment of catheter rupture for patients who have used implanted intravenous infusion ports for a long time has significant effects, which can reduce the occurrence of catheter rupture and ensure the safety of patients’ lives and health.

Forearm loop arteriovenous grafts preserve and may create new upper arm access sites

Introduction: This study evaluated the mid-term patency of forearm loop arteriovenous grafts and the dilation of previously inadequate upper arm basilic and cephalic veins after failed forearm loop arteriovenous graft. Methods: All access procedures from September 2009 to December 2015 were reviewed. Vein mapping measurements were used to determine whether there was “adequate” upper arm cephalic and/or basilic vein, defined as ⩾3 mm by duplex ultrasound, at the time of forearm loop arteriovenous graft creation. Outcomes of forearm loop arteriovenous graft were compared with upper arm arteriovenous fistula, and primary and cumulative patencies were evaluated. Results: Thirty-eight forearm loop arteriovenous grafts and 278 upper arm arteriovenous fistulas were created. In the forearm loop arteriovenous graft cohort, nine were inserted with adequate upper arm vein, group A, and 29 were inserted with inadequate upper arm vein, group B. Cumulative patency was lower for forearm loop arteriovenous graft compared with upper arm arteriovenous fistula at 6 months, 1 year, and 2 years (67% vs 91%, 61% vs 85%, and 49% vs 80%, respectively, P < .01). Comparison of group A forearm loop arteriovenous graft and upper arm arteriovenous fistula did not show a statistical difference in cumulative patency at 6 months, 1 year, and 2 years (P = .80, .62, and .70, respectively). Of group B with failed forearm loop arteriovenous graft, 36% became candidates for upper arm arteriovenous fistula with dilation of ipsilateral upper arm cephalic or basilic vein to ⩾3 mm. Conclusion: In this study, forearm loop arteriovenous graft with adequate upper arm vein did not show a statistical difference in mid-term patencies compared with upper arm arteriovenous fistula. For those forearm loop arteriovenous grafts with inadequate upper arm vein, approximately one-third of patients became candidates for upper arm arteriovenous fistula demonstrating the benefits forearm loop arteriovenous graft.