The journal of vascular access
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To assess the value of multi-detector computed tomography venography (MDCTV) in the assessment of tunneled hemodialysis central vein catheters (CVCs) dysfunction. ⋯ MDCTV provided a new possible way to assess dysfunction of tunneled hemodialysis central venous catheters.
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Report the procedural complications of internal jugular vein (IJV) catheter insertion in infants and children and discuss how to prevent them. ⋯ The IJV catheterization was feasible in infants and children. To reduce the risk of complications, the procedure should be performed or supervised by staff anesthesiologists; inserting the needle, guidewire, dilator, and the catheter too far should be avoided. It is now commonly accepted that all central venous cannulations should be performed under ultrasound guidance, especially in children.
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International policy statements from the US and the UK recommend real-time ultrasound guidance (USG) for placement of central venous catheters (CVCs) to improve patient safety. The evidence to support USG for the internal jugular (IJ) route is unequivocal; however, there is conflicting data on the effectiveness of USG in visualization of the subclavian vein (SCV). This study sought to determine whether body mass index (BMI) or clavicle shape affected SCV visualization with USG. ⋯ Higher BMI and the presence of a flat clavicle limit the ability to visualize the SCV. These findings may help account for why USG for placement of SCV CVCs is less utilized. However, patients with a low/normal BMI and protuberant clavicle may benefit from USG when attempting SCV CVCs.
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Multicenter Study
Tunneled hemodialysis catheter-related bloodstream infections: a prospective multicenter cohort study from Spain.
Catheter-related bloodstream infections (CRBSI) are common among patients undergoing long-term hemodialysis (HD) worldwide. The aim of this study was look into the incidence, epidemiology, and risk factors for CRBSI in four medical centers and Spanish dialysis facilities following a common protocol for insertion and management of tunneled hemodialysis catheters (THCs). ⋯ Although some factors, such as vascular cause of renal disease and previous THC medical history, have been related to the onset of tunneled catheter-related bloodstream infections, the incidence of these bacteremia, mainly produced by gram-positive coccus, is low among hemodialysis patients and the mortality rate is not high.