The journal of vascular access
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Both ultrasound-guided subclavian venipuncture (US-SV) and landmark-guided subclavian venipuncture (LM-SV) are important in critical care, because the clinical utility of ultrasound guidance is still debated. Education of residents and medical students should include both techniques. The aim of this study is to compare learning these two techniques in a simulation environment. ⋯ US-SV was learned more quickly than LM-SV in a simulation model.
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Randomized Controlled Trial
Distal tourniquet-facilitated radial arterial cannulation in adults--a double-blinded, prospective, randomized and controlled study.
Relatively small radial artery may be challenging for cannulation. We investigated whether a distal tourniquet would inflate the proximal radial artery and therefore facilitate cannulation in adults. ⋯ Distal tourniquet could inflate the proximal radial artery and facilitate palpation of radial artery cannulation.
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We describe an 80-year-old man with end-stage renal disease due to type 2 diabetes who had been maintained on hemodialysis for 9 years. He developed refractory ulcers from an abraded wound in the right hand of his access arm. The arteriovenous fistula (AVF) was located between the right brachial artery and the median antecubital vein draining into the cephalic vein and the deep veins close to the elbow. ⋯ One month after surgery, the skin ulcer healed, and maintenance hemodialysis was performed by using the preserved cephalic vein for blood access. In conclusion, we successfully treated a refractory wound associated with steal syndrome, without terminating the AVF. SPP-guided surgery may be safe and effective to adjust the blood flow in patients with AVF having steal syndrome.
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Comparative Study Observational Study
A comparison of infections and complications in central venous catheters in adults with solid tumours.
The aim of this study is to compare the complication rates of three vascular access devices in patients with solid tumours having infusion chemotherapy. ⋯ In our study, we demonstrated that central venous ports and PICC lines in patients undergoing infusional chemotherapy had lower line infection rates than tunnelled catheters, and only ports have been shown to be almost complication-free. In addition, we found infection rates higher in CVCs s cared for by patient/carers rather than hospital only care, and higher in colorectal patients with stomas. Therefore, we recommend that central venous ports are a safe, acceptable CVC option for infusional chemotherapy for adults with solid tumours.
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An interventional vascular access unit is usually part of an interdisciplinary centre, including departments of nephrology, vascular surgery, angiology and interventional radiology. We present recommendations on quality control, equipment and diagnostic and interventional techniques for the treatment of vascular access insufficiency.