The journal of vascular access
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Comparative Study
Image-guided placement of port catheters: is there an increased risk of infection if the port is immediately accessed and used?
To compare complication rates in patients who have port-a-catheters inserted and left accessed for immediate use and those who have ports inserted but not accessed. ⋯ Leaving the port accessed immediately after placement does not increase the risk of infection or other complications.
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Despite the efforts to promote the native artero-venous fistula as dialysis access, the use of tunneled central venous catheters (tCVC) is increasing. Main complications remain infections of the access, and the environment plays an important role in determining them; however, no studies are available that report dialysis provided in prefabricated temporary buildings. The aim of our study was to assess the incidence of tCVC infections in a container building. ⋯ Our study demonstrates that, when a dialysis center is moved to a prefabricated temporary building, the likelihood of tCVC infections increases within the initial months and returns back to the previous levels after a period of adaptation.
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Case Reports
Massively calcified intravascular cast after removal of a tunneled central vein catheter for hemodialysis.
Vascular calcifications usually affect the arteries, while central vein calcifications are rare. A 45-year-old hemodialysis patient underwent a chest CT scan before central vein catheterization required for arteriovenous access thrombosis, in July 2011. He was on hemodialysis since 1995 and from 2005 on warfarin treatment because of repeated thrombosis and dysfunction of arteriovenous fistula and central vein catheters (CVC). ⋯ Catheter removal or over the wire substitution in the presence of a calcified cast could also be considered a risky procedure. Retained calcified cast should be included among the long-term complications of hemodialysis CVCs. At the time of publication, the patient is alive without any complication related to the pathology reported.
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Randomized Controlled Trial Comparative Study
Subclavian central venous catheters and ultrasound guidance: policy vs practice.
Policy statements recommend the use of ultrasound guidance (USG) to improve patient safety during placement of central venous catheters (CVCs). Studies have conclusively demonstrated greater success rates and fewer complications with the use of USG in catheter placement using the internal jugular vein approach. Data supporting the use of USG for the subclavian vein (SCV) approach, however, have been less conclusive, and USG for SCV cannulation is rarely used in clinical practice. We compared USG placement versus anatomic placement during subclavian insertion of a CVC. ⋯ The use of USG to access the SCV utilizing a task trainer did not improve time to cannulation or success rates. Further study is required to delineate why USG for SCV cannulation has not been widely adopted in clinical practice.