Safety and Efficacy of Vacuum Bottle Plus Catheter for Drainage of Iatrogenic Pneumothorax

Iatrogenic pneumothorax is common after thoracic procedures. For pneumothorax larger than 15%, simple aspiration is suggested. This clinical trial (NCT03724721) assessed the safety and efficacy of vacuum bottle plus non-tunneled catheter air drainage, which has long been performed in many institutions. From August 2018 to February 2020, patients older than 20 years of age who developed iatrogenic pneumothorax were prospectively enrolled. Totally 21 patients underwent vacuum bottle plus catheter drainage. The median size of pneumothorax was 19.6%, as measured by Rhea’s method. Of the 21 patients, 15 had successful air drainage, and the remaining 6 patients required subsequent pigtail placement. The end-expiratory intrapleural pressure of all patients remained less than -20 cmH2O during drainage. The median duration of hospitalization was 2 (interquartile range [IQR], 1-4) days. No procedure-related complication was observed. A retrospective analysis of patients who received conservative treatment showed that the median duration of hospitalization was longer in patients with larger pneumothorax (1 day vs. 5 days [IQR, 1-1 day vs. 3-7 days]). This study showed that vacuum bottle plus catheter drainage of iatrogenic pneumothorax is a safe and efficient procedure. It is recommended as initial management of stable iatrogenic pneumothorax with size larger than 15%.

Vascular Access Use Among Hemodialysis Patients and Competency of Nurses at National Kidney Centre, Nepal

Introduction: Vascular access are a prerequisite for hemodialysis and good care by nurses is key to their longevity. A pattern of vascular access use has not been assessed previously nor the competency of nurses to identify the gaps in knowledge and skills. This study aims to describe vascular access use and nursing competency at National Kidney Centre. Materials and Methods: A cross-sectional study was done to obtain demographic information and history of vascular access of patients. Vascular access was examined. Demographic and professional information of nurses were collected. A quiz based on KDOQI Clinical Practice Guidelines and a visual analogue scale to indicate confidence in managing vascular access were administered to the nurses. Results: Four-hundred seventy-two patients and 70 nurses were recruited. The proportion of patients with an arteriovenous fistula, arteriovenous graft, tunneled catheter, and non-tunneled catheter at the time of initiation of hemodialysis were 24.36%, 0.64%, 1.27%, and 73.73%, respectively, and after conversion was 67.23%, 5.08%, 1.98%, and 19.77%, respectively. The cost at initiation was lower for catheters and the arteriovenous access in long run. Nurses had received vascular access training during their hemodialysis course (95.71%), but a few received further training (38.57%). They did well in sections related to preparation for permanent access and treatment of complications. Conclusions: Most of the patients initiated hemodialysis via a non-tunneled catheter. The prevalence of arteriovenous fistula was high. Continued training of nurses was lacking. Nurses were confident in managing arteriovenous fistula and non-tunneled catheters.

Persistence of left superior vena cava: a rare cause of hemodialysis tunneled catheter malposition

Hemodialysis central venous catheter (CVC) insertion can be complicated in patients with anomalous vessel anatomy. In such cases detailed knowledge of thoracic vessel anatomy is necessary to identify the exact location of the catheter. Central venous placement under ultrasound control has significantly reduced the complications associated with blind puncture and allows an appropriate puncture of the desired vessel, but the CVC can still get misplaced if it follows an anomalous route. Herein, we report a case of dialysis catheter placed into a left sided superior vena cava, only diagnosed after CT scan study.

The efficacy of single suture for exit site wound closure and stabilization of hemodialysis central tunneled catheter

Introduction: The majority of the end-stage renal disease patients begin hemodialysis with the central tunneled catheter as a permanent or bridge vascular access. The procedure of central tunneled catheter insertion can be complicated by exit site bleeding, prolonged tunnel healing, and infection. The study aimed at evaluating whether the catheter exit site wound closing with a single-suture method is equally effective as the double suture method, which is most frequently applied. The assumption was that the single-suture method, which is less traumatizing for the skin, could offer an advantage for the patients with “paper” skin, that is, elderly, after long-term immunosuppressive treatment. Methods: Insertion of central tunneled catheter with antegrade tunnel formation was performed in 140 patients divided randomly into two groups of 70 patients using either single-suture method or double suture method. Results: Follow-up observations revealed a comparable number of early complications, that is, bleeding or exit site infection, in about 26% of the patients from both groups. No difference appeared in the catheter displacement, either. The percentage of patients with a prolonged central tunneled catheter exit site wound healing was not significantly lower in the single-suture method group: 5.8% versus 11.3%, p = 0.367. There was no impact of single-suture method versus double suture method on the central tunneled catheter long-term function and survival. Conclusion: The single-suture method of the central tunneled catheter exit closure is equal in efficacy to the double suture method. Its potential benefit for the patients with an increased risk of poor wound healing should be tested in further study.

Infective endocarditis in hemodialysis patients: A 10-year observational single center study

Background: The incidence of infective endocarditis (IE) in chronic hemodialysis (CHD) patients remains high, despite the preventive measures implemented by nephrologists, especially the rigorous respect of hygiene, the use of antibiotic locks for catheters and the use of tunneled catheters instead of non-tunneled. Objective: The objective of this study was to determine the clinical, biological, and echocardiographic characteristics, and the prognosis of IE in CHD. Patients and methods: It was a retrospective study, conducted from December 2010 to March 2020, at the Nephrology and Cardiology units of University Hospital in Oujda, Morocco. Results: We compiled a series of 31 CHD patients having developed IE. Eleven cases (35.4%) were collected between 2010 and 2015, and 20 cases (64.6%) between 2016 and 2020. The mean age was 47 ± 19 years, 58% were male, and 25.8% of patients had diabetes. Vascular access for hemodialysis was by arteriovenous fistula, non-tunneled catheter, and tunneled catheter in 22.5%, 32.2%, and 45.2%, of the cases, respectively. About 25.8% of patients had benefited from more than two catheters (tunneled or non-tunneled) during the 3 months preceding the occurrence of IE. The mitral, tricuspid, and aortic valves were the site of IE in 41.9%, 41.9%, and 13% of the cases, respectively. Right heart IE and left heart IE were observed in 42% (13 cases) and 58% (18 cases) of cases, respectively. Blood cultures were negative in 58.1% of the cases at the time of diagnosis of IE. Staphylococcus aureus was identified in 69.2% of the cases. Mortality occurred in 54.8% of the cases. Conclusion: IE remains a severe condition in CHD patients with an increasing incidence. Rigorous prevention and screening strategies should be implemented at the hemodialysis centers.