Plastic cannulae versus metal needle cannulation in haemodialysis: Results of an international survey from the nurse perspective

Background: In haemodialysis is key to successfully obtaining cannulation of the arteriovenous fistula (AVF). The literature agrees that cannulation, failing in the initial maturation period, can lead to delayed dialysis, haematoma, scarring, needle phobia and loss of confidence in the cannulator. The introduction of plastic cannulae for haemodialysis has changed cannulation practice positively, preventing frequent complications such as infiltration or trauma. Despite that, most countries have continued to use metal cannulation, in particular in Europe. This study investigates the common use of plastic cannulae versus metal needles for cannulation in dialysis units and explores the implications of focusing on the side effects of cannulation. Methods: The study is a cross-sectional survey. A questionnaire was created by a team of experts from the European Dialysis Transplant Nurse Association/European Renal Care Association (EDTNA/ERCA) to address the study's aims and sent online to nurse members. Results: Data collected suggested a strong resistance towards using plastic cannulae, with few respondents claiming to use these cannulas. Most of the respondents were female (74%), Europeans, working in nephrology for more than 10 years and most worked in the public sector. There was a strong correlation between the use of plastic cannulae and fewer adverse events in elbow located AVF and newly created or fragile AVF. Conclusions: The results are in line with the current literature. Possible resistance to the use of the plastic device includes the difference in cost between the two devices in favour of metal needles. However, it should be considered that the lower number of adverse events, in particular infiltration and haematoma caused by the metal needle, involves a considerable saving both in money and in terms of time and distress for the patient.

Efficacy and Safety of Plastic Cannulae Compared with Metal Needles in the Initial Use of an Arteriovenous Fistulae in Incident Hemodialysis Patients: A Randomized Controlled Study

<b><i>Introduction:</i></b> Successful cannulation of an arteriovenous fistula (AVF) is important in patients starting hemodialysis (HD). Metal needles have been used for decades, but the usefulness of plastic cannulae has recently been demonstrated as a new technique. <b><i>Methods:</i></b> This was a prospective, randomized, open-label study of incident HD patients. Eligible patients were randomized into 2 groups in a 1:1 ratio (<i>n</i> = 45/group). Maturation of the AVF was confirmed using Doppler ultrasound prior to first needling, and 2 well-trained nurses implemented the AVF cannulation. The primary endpoint was the initial cannulation failure rate, defined as the failure of successful completion of 3 consecutive dialysis sessions. The secondary endpoints were time for hemostasis at the end of HD, degree of patients’ pain, degree of cannulation difficulty felt by the nursing staffs, and achieving optimal HD adequacy. <b><i>Results:</i></b> The mean elapsed time from AVF creation to the first cannulation was 48.1 ± 16.7 days. A total of 17 cases of cannulation failure occurred, and the failure risk tended to be higher in the metal needle group than the plastic cannula group (hazard ratio 2.6, 95% confidence interval 0.95–7.41) after adjusting for age, gender, comorbidities, and AVF location. The overall incidence of vessel injury was higher and time for hemostasis was significantly longer in the metal group than the plastic group. The use of plastic cannula was associated with a better HD adequacy compared to a metal needle. However, the patients’ pain score (<i>p</i> = 0.004) and nursing staff’s cannulation difficulty score (<i>p</i> = 0.084) were higher in the plastic group, emphasizing the great importance of practice using plastic cannulae. <b><i>Conclusion:</i></b> The vascular outcomes of plastic cannulae were much favorable compared to metal needles in incident HD patients. The use of plastic cannulae could be a new and innovative way to improve the quality of dialysis.

Direct bare metal needle puncture and balloon angioplasty in calcified plaques of the common femoral artery guided by angiography (“BAMBOO SPEAR”)

Background Surgical endarterectomy for common femoral artery (CFA) disease is still considered the gold standard for treatment. Development of various techniques and devices has improved the clinical results of endovascular therapy (EVT) for CFA. However, severe conditions remain, especially for occlusive lesions owing to calcified plaque. We developed a useful technique for passing a lesion by directly penetrating the calcified plaque of the CFA using a bare metal needle and then passing through a balloon or dilating it. We named this technique “direct bare metal needle puncture and balloon angioplasty in calcified plaques of the common femoral artery guided by angiography” or “BAMBOO SPEAR.” Main text This report describes our technique for crossing a lesion by directly penetrating the calcified plaque of the CFA using a needle. We report a case of a 73-year-old male with hemodialysis who presented with cyanosis and ischemic rest pain of both lower limbs. Control angiography showed total occlusion of the left CFA with a calcified plaque. We advanced a 21-G metal needle that was slightly curved into the blood vessel from where the lumen of the distal CFA was located. The needle was advanced into the center of the calcified plaque, while observing from multiple directions with a fluoroscopic guide. We succeeded in advancing the needle into the lumen of the distal external iliac artery. After guidewire crossing, intravascular ultrasound (IVUS) showed that guidewire was able to completely pass through the center of the calcified plaque. We could dilate the lesion by scoring balloon and drug-coated balloon. The final angiography showed sufficient results. We named this technique “direct BAre Metal needle puncture and BallOOn angioplaSty in calcified PlaquEs of the common femoral ARtery guided by angiography” (BAMBOO SPEAR). Conclusions The BAMBOO SPEAR technique may be considered a useful option in EVT for occlusive CFA with calcified plaques.

Direct Bare Metal Needle Puncture and Balloon Angioplasty in Calcified Plaques of the Common Femoral Artery Guided by Angiography (“BAMBOO SPEAR”)

BackgroundSurgical endarterectomy for common femoral artery (CFA) disease is still considered the gold standard for treatment. Development of various techniques and devices has improved the clinical results of endovascular therapy (EVT) for CFA. However, severe conditions remain, especially for occlusive lesions owing to calcified plaque. We developed a useful technique for passing a lesion by directly penetrating the calcified plaque of the CFA using a bare metal needle and then passing through a balloon or dilating it. We named this technique “direct bare metal needle puncture and balloon angioplasty in calcified plaques of the common femoral artery guided by angiography” or “BAMBOO SPEAR.” Main textThis report describes our technique for crossing a lesion by directly penetrating the calcified plaque of the CFA using a needle. We report a case of a 73-year-old male with hemodialysis who presented with cyanosis and ischemic rest pain of both lower limbs. Control angiography showed total occlusion of the left CFA with a calcified plaque. We advanced a 21-G metal needle that was slightly curved into the blood vessel from where the lumen of the distal CFA was located. The needle was advanced into the center of the calcified plaque, while observing from multiple directions with a fluoroscopic guide. We succeeded in advancing the needle into the lumen of the distal external iliac artery. After guidewire crossing, intravascular ultrasound (IVUS) showed that guidewire was able to completely pass through the center of the calcified plaque. We could dilate the lesion by scoring balloon and drug-coated balloon. The final angiography showed sufficient results. We named this technique ‘‘direct BAre Metal needle puncture and BallOOn angioplaSty in calcified PlaquEs of the common femoral ARtery guided by angiography” (BAMBOO SPEAR).ConclusionsThe BAMBOO SPEAR technique may be considered a useful option in EVT for occlusive CFA with calcified plaques.

Embroidering the New Science

An unruly object of seventeenth-century experimental science is the metal needle, an instrument that begins Robert Hooke’s Micrographia (1665) but also was the essential tool used in women’s embroidery work. This article follows traces of the needle through the historical record and florilegia – a genre that bridged botanical and artistic studies – to argue that needlework provided a way of seeing that facilitated the development of empiricism. Using evidence from the works of Isabella Parasole, Elizabeth Isham, and Maria Sibylla Merian, I show how the needle surfaces in scenes of scientific illustration, thereby resituating natural histories and the scientific process of ordering minute organisms.

Comparison of dynamic arterial and venous pressure between metal needles and plastic cannulas in incident hemodialysis patients with arteriovenous graft

Background and objects: We hypothesized that plastic cannulae with 17-gauge inner needle compared to 16-gauge metal needles can have stable dynamic venous and arterial pressure maintaining prescribed blood flow safely during a hemodialysis treatment. Design, setting, participants, and measurements: A single-center, prospective, randomized, open-label clinical trial was conducted involving 16 incident hemodialysis patients who had arteriovenous graft placed as their first arteriovenous access. Subjects were randomized to metal needle group (n = 8) versus plastic cannula group (n = 8). We measured serial dynamic pre-pump arterial and venous pressure under five different blood pump flow rates (150, 200, 250, 300, and 350 mL/min). Results: The mean age of patients was 67.6 ± 8.5 (range: 51–81) years, and six patients (37.5%) were male. Patients with plastic cannula showed less negative arterial pre-pump pressures and lower venous pressures than those with metal needles at all prescribed blood flow rates, and the difference was statistically significant (P < 0.001). Conclusion: The plastic cannula had more stable arterial and venous pressures at prescribed blood pump flow rates than those pressures of the metal needle in incident patients with arteriovenous graft during hemodialysis.

Rapid analysis of chemical warfare agents by metal needle-enhanced low-temperature plasma mass spectrometry

A copper needle was coupled with LTP-MS for rapid analysis of chemical warfare agents.

Bubble Melt Electrospinning for Production of Polymer Microfibers

In this paper, we report an interesting bubble melt electrospinning (e-spinning) to produce polymer microfibers. Usually, melt e-spinning for fabricating ultrafine fibers needs “Taylor cone”, which is formed on the tip of the spinneret. The spinneret is also the bottleneck for mass production in melt e-spinning. In this work, a metal needle-free method was tried in the melt e-spinning process. The “Taylor cone” was formed on the surface of the broken polymer melt bubble, which was produced by an airflow. With the applied voltage ranging from 18 to 25 kV, the heating temperature was about 210–250 °C, and polyurethane (TPU) and polylactic acid (PLA) microfibers were successfully fabricated by this new melt e-spinning technique. During the melt e-spinning process, polymer melt jets ejected from the burst bubbles could be observed with a high-speed camera. Then, polymer microfibers could be obtained on the grounded collector. The fiber diameter ranged from 45 down to 5 μm. The results indicate that bubble melt e-spinning may be a promising method for needleless production in melt e-spinning.

The Progress of Advanced Engineering Materials in Acupuncture Needle

In order to promote the development of acupuncture technique and improve the effect of acupuncture, acupuncturists have innovated and produced many new acupuncture needles using suitable engineering materials. This article aims to show the progress of advance engineering materials in acupuncture needles. We searched the international database PubMed, EI, and the Chinese database CNKI, Wangfang. The MESH and Key words were: acupuncture needle, needle implement, acupuncture implement, float needle, new nine needles, fire needle, laser acupuncture. And we classified the new needles into 5 related parts: name, inventor, function, materials and application. In this study, we had summarized common used 13 needles and 15 materials. The mainly used needles were Stone Needle, Metal needle, Stainless steel needle, New nine needles, Magnetic pole needle and Floating-Acupuncture. The mainly used materials were Si Bin floating stone, stainless steel, magnet, molybdenum, tungsten .Stainless steel needle is the most frequently used in clinic. In conclusion, there are not many advance engineering materials applied in acupuncture needles. A few materials help to promote the development of acupuncture but they are not frequently used enough. The development of acupuncture needs more suitable materials to improve the function of needle. An ideal needle may be painless but thicker enough to manipulate, and produce some material effect to produce enough stimulating quantity.