The journal of vascular access
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Comparative Study Observational Study
A prospective observational study to assess the impact of operator seniority on outcome following arteriovenous fistula formation.
Arteriovenous fistula (AVF) surgery affords an excellent opportunity for junior surgeons to learn key vascular techniques. However, implementation of the European Working Time Directive has reduced trainee surgeon's working hours, leading to concerns regarding a possible effect on patient outcomes. Given high early postoperative failure rates and limited AVF sites, it has been proposed that AVF surgery should be performed by Consultants and senior trainees only. This prospective observational study aimed to establish how seniority impacts upon AVF surgery outcomes. ⋯ The seniority of the operating surgeon does not appear to impact on outcomes following AVF formation. A greater proportion of general anaesthetic cases were undertaken by a Consultant, which may introduce bias. Junior surgeons with appropriate training and modest experience can perform access surgery without detriment to patients patient detriment.
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Central venous catheters are often required in oncologic patients for long-term safe administration of chemotherapeutic agents, antibiotics, and parenteral nutrition. Rupture of these devices and intracardiac migration is a rare complication. ⋯ The catheter rupture and intracardiac embolization is a rare complication associated with totally implantable or tunneled central venous catheters. When such an event happens, the patient should be managed by expert hemodynamists or interventional radiologists making an effort to remove the fragment without surgical measures. When the intravascular percutaneous route fails, the possibility to leave the fragmented catheter in heart chambers should be evaluated, being surgery questionable in asymptomatic patients.
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This paper describes a simple and inexpensive method to make high-fidelity simulators for use in ultrasound-guided vascular access teaching. The phantoms can be created to reflect the ultrasound appearance and feel of central or peripheral arteries and veins. Different clinical states such as hypovolaemia may be readily displayed using the phantoms. ⋯ Using this method, simple and inexpensive phantoms can be created. These are ideal for use in training for ultrasound-guided vascular access. Links to videos describing the phantom construction process, their appearance and the teaching techniques utilised by the authors are found in the text.