Objective To explore the vascular access infection (VAI) incidence of hemodialysis patients during the the maximum spread of the COVID-19 epidemic (epidemic period) compared with the corresponding period with no local cases of COVID-19 (control period). Methods A single-center, retrospective study was carried out. Adult patients who underwent hemodialysis at the Department of Blood Purification Center, the Affiliated Hospital of Xuzhou Medical University during the epidemic period between December 7, 2022 and February 23, 2023 and the control period between December 7, 2020 and February 23, 2021 were selected. The incidence of local access site infection (LASI) and access related bloodstream infection (ARBSI) in included patients were observed and compared. ResultsA total of 1 401 patients were included. Among them, there were 737 cases during the epidemic period and 664 cases during the control period. There was no statistically significant difference in the age, gender, and duration of catheterization among patients of different periods and pathway types (P>0.05). There was no statistically significant difference in the occurrence of LASI between the epidemic period and the control period (χ2=1.800, P=1.180). There was a statistically significant difference in the occurrence of ARBSI between the epidemic period and the control period [χ2=4.610, relative risk (RR)=2.575, 95% confidence interval (CI) (1.053, 6.298), P=0.032]. There was no statistically significant difference in the incidence of LASI and ARBSI at different stages in patients with arteriovenous fistula and unnel-cuffed catheters (TCC) (P＞0.05). There were statistically significant differences in the incidence of LASI [χ2=4.898, RR=3.832, 95%CI (1.058, 13.885), P=0.027] and ARBSI [χ2=7.150, RR=4.684, 95%CI (1.333, 16.460), P=0.005] among non cuffed catheters (NCC) patients at different stages. TCC patients might experience LASI (P<0.05) during the epidemic period and ARBSI (P<0.05) during the control period compared with the arteriovenous fistula patients; both central venous catheterization and NCC patients might experience LASI and ARBSI during the control period (P<0.05). Conclusion Targeting COVID-19 prevention may be associated with the reduction of vascular access infection in hemodialysis patients, in particular in NCC patients.
ObjectiveTo compare dialysis catheter function and complications according to catheter site in patients undergoing hemopurification.MethodsLiteratures were searched from PubMed, Medline, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Data, and VIP Database according to the inclusion and exclusion criteria. Publication years of these literatures ranged from April 1998 to April 2018. Meta-analysis was performed with RevMan 5.3 software. The odds ratio (OR) and 95% confidence intervals (CI) were calculated for uncontinuous outcomes, and the weighted mean difference (WMD) and 95%CI were calculated for continuous outcomes. The incidence of catheter related infection, other complications and patients outcome were compared between different sites for dialysis vascular access.ResultsA total of 9 articles were included, including 2 randomized controlled trials and 7 observational clinical studies, and 5 220 adult patients undergoing renal replacement therapy. Meta-analysis showed that there was no significant difference in incidences of catheter colonization or catheter-related bloodstream infection, as well as arterial puncture, local thrombosis, catheter dysfunction and spontaneous catheter withdrawal, between femoral and non-femoral (jugular or subclavian) catheterization (P≥0.05). Whereas the incidence of bleeding and local hematoma was lower in femoral catheterization [OR=0.44, 95%CI (0.23, 0.82), P=0.009], and the duration of catheters was shorter in femoral catheterization [WMD=–1.40 d, 95%CI (–2.17, –0.62) d, P=0.000 4]. The blood flow rate, filters clotting incidence and patients intensive case unit mortality were similar in different catheterization.ConclusionsIn patients undergoing renal replacement therapy, the bleeding and local hematoma incidence is lower in femoral catheterization but the duration of catheters is shorter. Nevertheless the patients have similar clinical outcome. This result may provide reference for clinical decision-making.
目的探討為維持性血液透析患者行肘部動靜脈內瘺的手術方法及技巧。 方法回顧性分析我院2009年8月至2012年8月期間行肘部動靜脈內瘺68例患者的臨床資料。 結果68例患者手術均成功。所有患者術后血流量都能滿足血液透析需要，無感染、皮下血腫等并發癥。隨訪至今，未發現血管內血栓形成、造瘺口狹窄等。 結論對于腕部自體動靜脈不能行造瘺術時，肘部動靜脈內瘺為血液透析患者提供了一條新的血管通路。
ObjectiveTo evaluate the safety and efficacy of second central venous catheterization in tunnel cuffed dialysis catheter (TCC) dysfunction with fibrin sheath.MethodA total of 14 maintenance hemodialysis patients who required second central venous catheterization were enrolled in West China Hospital of Sichuan University from June 2016 to June 2017 and the clinical information and procedure-related complications were recorded.ResultsAll of the 14 patients were successfully performed with second central venous catheterization, of whom 4 cases had superior vena cava cannulation, 7 cases had right brachiocephalic vein cannulation, 2 cases had internal jugular vein cannulation, and 1 case had external jugular vein cannulation. No procedure-related major complication occurred. During the follow-up, catheter malfunction occurred in 2 cases, which improved by urokinase seal and catheter change, respectively. The rest patients’ catheter function remained normal.ConclusionsWith increasing difficult to construction and maintenance of vascular access, preservation of central vein resource is of high importance. For patients with TCC dysfunction with fibrin sheath, second central venous catheterization based on percutaneous brachiocephalic vein or superior vena cava cannulation is a safe and effective method to establish the lifeline for hemodialysis patients.
目的 總結鎖骨下動脈-頸內動脈人工血管通路輔助頸內動脈支架置入術治療復雜頸總動脈閉塞的 可行性和有效性。 方法 在同側鎖骨下動脈-頸內動脈人工血管搭橋建立腔內治療的通路后，行頸內動脈支架置 入治療復雜頸總動脈閉塞，總結其可行性。 結果 該例患者的手術時間為125 min，術中出血量為10 mL。行鎖骨 下動脈-頸內動脈人工血管通路輔助頸內動脈支架置入術后，頸內動脈血流恢復通暢。術后沒有過度灌注綜合征 及其他并發癥發生。術后6 d 患者康復出院，出院后隨訪7 個月，未再發生頭暈及頭痛。 結論 鎖骨下動脈- 頸內 動脈人工血管通路輔助頸內動脈支架置入術適用于治療復雜頸總動脈閉塞患者。
Objective To clarify the views of healthcare providers on the current vascular access shared decision-making model under the daytime chemotherapy mode, and to determine improvement measures to promote the conventional implementation of the daytime chemotherapy vascular access shared decision-making model. Methods Based on the SWOT model, an interview outline was developed. Using purposive sampling method, 7 doctors and 6 intravenous therapy nurses working at Tianjin Medical University Cancer Institute & Hospital from April to June 2023 were selected for semi-structured interviews, and content analysis method was used for data analysis. Results Four themes were extracted for internal advantages: alleviating the pressure of diagnosis and treatment and decision-making for doctors, ability and willingness of specialized intravenous therapy nurses to implement, promoting the rational selection of vascular pathways, enhancing the recognition of vascular pathways in daytime chemotherapy patients, and enhancing communication stickiness between nurses and patients. Four themes were extracted for internal weaknesses: increased workload, impractical decision support tools, unsmooth implementation processes, and incomplete informatization. Three themes were extracted for external opportunities: national policy support, willingness of daytime chemotherapy patients to participate in decision-making, and sufficient evidence-based evidence. Three themes were extracted for external threats: poor communication between healthcare providers under daytime chemotherapy mode, cognitive differences related to intravenous therapy among healthcare providers, and insufficient confidence in nurse leadership. Conclusions The vascular pathway shared decision-making led by intravenous therapy nurses has certain advantages in the daytime chemotherapy mode. In the future, we should seize existing opportunities, avoid our own weaknesses, face external threats, and develop a standardized vascular access shared decision-making model led by intravenous therapy nurses under the daytime chemotherapy mode, promoting the best evidence-based practice for vascular access decision-making during daytime chemotherapy.
The patency of vascular access is of great significance to hemodialysis patients. Combining with guidelines and literature associated with vascular access for dialysis in recent years, the authors interpret the effectiveness and limitations of prophylactic drug strategies, including using fish oil, anticoagulation, anti-platelet, lipid-lowering agents, etc., in order to promote the proper use of these agents in clinical practice, and improve the effect of prophylaxis and treatment of vascular access dysfunction.