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Vascular access difficult

Muhammad O Chohan, Serena Marchiò, Leslie A Morrison, Richard L Sidman, Webster K Cavenee, Elisabetta Dejana, Howard Yonas, Renata Pasqualini, Wadih Arap
Importance: Cerebral cavernous malformations (CCMs) are vascular lesions of the brain that may lead to hemorrhage, seizures, and neurologic deficits. Most are linked to loss-of-function mutations in 1 of 3 genes, namely CCM1 (originally called KRIT1), CCM2 (MGC4607), or CCM3 (PDCD10), that can either occur as sporadic events or are inherited in an autosomal dominant pattern with incomplete penetrance. Familial forms originate from germline mutations, often have multiple intracranial lesions that grow in size and number over time, and cause an earlier and more severe presentation...
November 26, 2018: JAMA Neurology
Joseph R Pare, Samara E Pollock, James H Liu, Megan M Leo, Kerrie P Nelson
OBJECTIVES: Ultrasound guided peripheral intravenous catheters (USPIV) are frequently utilized in the Emergency Department (ED) and lead to reduced central venous catheter (CVC) placements. USPIVs, however, are reported to have high failure rates. Our primary objective was to determine the proportion of patients that required CVC after USPIV. Our secondary objective was to determine if classic risk factors for difficult vascular access were predictive of future CVC placement. METHODS: We performed a retrospective review for patients treated at a large academic hospital...
November 17, 2018: American Journal of Emergency Medicine
Marcio S Rassi, Johnni O Zamponi, Duarte N C Cândido, Jean G de Oliveira, Gustavo A R Passos, Luis A B Borba
Introduction  The management of petroclival meningiomas is among the most intimidating in neurosurgery, due to its difficult accessibility and close relationship with vital structures; therefore, an appropriate exposure is mandatory. We present a surgical video demonstrating a presigmoid transtentorial approach, associated with the opening of the retrosigmoid dura to a petroclival meningioma, performed by the senior surgeon (L.A.B.B.), along with its indications and pitfalls. Approach Decision  The patient's clinical history is summed to the tumor's radiological features as its extension, vascularization, and venous drainage, when selecting the appropriate approach...
December 2018: Journal of Neurological Surgery. Part B, Skull Base
Raymond L Merritt, Michael E Hachadorian, Kristof Michaels, Eric Zevallos, Kubwimana M Mhayamaguru, Zuheily Closser, Charlotte Derr
Context: Previous studies have shown that safe venous cannulation is difficult when the internal jugular vein (IJV) overlies the carotid artery (CA) as the probability of inadvertent arterial penetration is greatly increased. Aims: The goal of this study was to examine the anatomical relationships of the IJV and CA as a function of the degree of head rotation in order to minimize the risk for CA puncture. Settings and Design: Our study was a prospective study using a sample of 496 Emergency Department patients...
July 2018: Journal of Emergencies, Trauma, and Shock
Eunjin Bae, Hajeong Lee, Dong Ki Kim, Kook-Hwan Oh, Yon Su Kim, Curie Ahn, Jin Suk Han, Sang-Il Min, Seung-Kee Min, Hyo-Cheol Kim, Kwon Wook Joo
BACKGROUND: The number of elderly patients with end-stage renal disease is increasing rapidly. The higher prevalence of comorbidities and shorter life expectancy in these patients make it difficult to decide on the type of vascular access (VA). We explored the optimal choice for VA in elderly hemodialysis patients. METHODS: We included elderly patients (> 65 years) visiting our VA clinic and divided them into three groups as follows: radiocephalic arteriovenous fistula (AVF), brachiocephalic AVF, and prosthetic arteriovenous graft (AVG)...
November 6, 2018: BMC Nephrology
Carlo Lomonte, Carlo Basile, Sandip Mitra, Christian Combe, Adrian Covic, Andrew Davenport, Dimitrios Kirmizis, Daniel Schneditz, Frank van der Sande
Life-sustaining haemodialysis requires a durable vascular access (VA) to the circulatory system. The ideal permanent VA must provide longevity for use with minimal complication rate and supply sufficient blood flow to deliver the prescribed dialysis dosage. Arteriovenous fistulas (AVFs) have been endorsed by many professional societies as the VA of choice. However, the high prevalence of comorbidities, particularly diabetes mellitus, peripheral vascular disease and arterial hypertension in elderly people, usually make VA creation more difficult in the elderly...
October 17, 2018: Nephrology, Dialysis, Transplantation
Eyal Barzel, John W Larkin, Allen Marcus, Marta M Reviriego-Mendoza, Len A Usvyat, Murat Sor, Franklin W Maddux
INTRODUCTION: Hemodialysis patients with an arteriovenous fistula can use buttonhole techniques for cannulation. Although buttonholes generally work well, patients may report difficult and painful cannulation, and buttonholes may fail over time. We aimed to assess the effectiveness of tract dilation in treatment of failing buttonholes. METHODS: We retrospectively analyzed data from patients treated with buttonhole tract dilation at an outpatient vascular access center between January 2013 and August 2015...
October 14, 2018: Journal of Vascular Access
Sushant Govindan, Ashley Snyder, Scott A Flanders, Vineet Chopra
OBJECTIVES: To quantify variation in use and complications from peripherally inserted central catheters placed in the ICU versus peripherally inserted central catheters placed on the general ward. DESIGN: Retrospective cohort study. SETTING: Fifty-two hospital Michigan quality collaborative. PATIENTS: Twenty-seven-thousand two-hundred eighty-nine patients with peripherally inserted central catheters placed during hospitalization...
December 2018: Critical Care Medicine
Ana M Togneri, Marcela P Pérez, Viviana Vilches, Ivana Martinelli, Roxana Sadorín, Silvia Marone, Mónica A Prieto, Rita I Armitano
Two cases of bacteremia caused by Helicobacter cinaedi are presented. The first case was diagnosed in a 76-year-old male patient, and was secondary to a vascular access device placement; the second case corresponded to a febrile infant of 37 days of life, and was associated with acute gastroenteritis. H. cinaedi is a microorganism difficult to grow in different culture media and also to identify to species level. In both cases, the microscopic observation of blood culture bottles, the use of mass spectrometry and the subsequent sequencing of the hsp60 gene were essential...
September 19, 2018: Revista Argentina de Microbiología
Ryan W Haines, Christopher J Kirwan, John R Prowle
PURPOSE OF REVIEW: Continuous renal replacement therapy (CRRT) is now the mainstay of renal organ support in the critically ill. As our understanding of CRRT delivery and its impact on patient outcomes improves there is a focus on researching the potential benefits of tailored, patient-specific treatments to meet dynamic needs. RECENT FINDINGS: The most up-to-date studies investigating aspects of CRRT prescription that can be individualized: CRRT dose, timing, fluid management, membrane selection, anticoagulation and vascular access are reviewed...
December 2018: Current Opinion in Critical Care
G Kumar, M J Hamoudeh, N M Noureldin, I Alaqqad, N Airon, E Alkhasawneh
No abstract text is available yet for this article.
July 2018: Indian Journal of Nephrology
Junpei Koge, Tomonori Iwata, Tetsuya Hashimoto, Shigehisa Mizuta, Yukihiko Nakamura, Eri Tanaka, Masakazu Kawajiri, Shun-Ichi Matsumoto, Takeshi Yamada
PURPOSE: Transbrachial carotid artery stenting (TB-CAS) is performed as an alternative procedure for patients with hostile vascular anatomy of the aortic arch and aortic or peripheral artery disease. Proximal protection during TB-CAS is not generally feasible because a small size of the brachial artery may preclude using a large-diameter sheath introducer. We, herein present a novel method that enables proximal protection during TB-CAS by sheathless navigation of a 9-F balloon-guiding catheter equivalent to a 7-F sheath...
October 2018: Neuroradiology
Johannes B van Rees, Jose M Montero-Cabezas, Eidrees Ghariq, Martin J Schalij
No abstract text is available yet for this article.
September 10, 2018: JACC. Cardiovascular Interventions
N LeVasseur, C Stober, K Daigle, A Robinson, S McDiarmid, S Mazzarello, B Hutton, A Joy, D Fergusson, J Hilton, M McInnes, M Clemons
Background: Despite advances in systemic therapy choices for patients with early-stage breast cancer, optimal practices for intravenous (IV) access remain unknown. That lack of knowledge holds particularly true for the use of central venous access devices (cvads) such as peripherally inserted central catheters (piccs) and implanted vascular access devices (ports). Methods: Using a survey of Canadian oncologists and oncology nurses responsible for the care of breast cancer patients, we evaluated current access practices, perceptions of complications, and perceptions of risk, and we estimated complication rates and evaluated perceived risk factors for lymphedema...
August 2018: Current Oncology
Alexey N Shkarubo, Konstantin V Koval, Mikhail A Shkarubo, Ilia V Chernov, Dmitry N Andreev, Andrey A Panteleyev
OBJECTIVE: To present the basic topographic and anatomic features of the clivus and adjacent structures with an objective of possible improvements and optimization of the extended endoscopic endonasal posterior (transclival) approach when removing tumors of the clivus and anterior regions of the posterior cranial fossa. MATERIALS AND METHODS: A craniometric study was conducted on 125 human skulls. A topographic anatomic study was conducted on 25 cadaver head specimens with arterial and venous beds stained with colored silicone, according to the method developed by us, to visualize its features and individual variability...
November 2018: World Neurosurgery
António Norton de Matos, Clemente N Sousa, Paulo Almeida, Paulo Teles, Duarte Rego, Gabriela Teixeira, Luís Loureiro, Sérgio Teixeira, Inês Antunes
Vascular access dysfunction is a serious problem in dialysis units. Some patients have complex dysfunctions that are difficult to resolve. In this article, we report the case a of two patients with radiocephalic arteriovenous fistulae (RC-AVF) who had stenosis/occlusion of the forearm median vein and where we used the basilic vein of the forearm as a solution. We reviewed the use of this surgical solution in RC-AVF. Two male patients on hemodialysis exhibited stenosis/occlusion of the forearm median vein. The forearm basilic vein was isolated and rotated toward the forearm median vein in order to solve RC-AVF problems...
July 25, 2018: Therapeutic Apheresis and Dialysis
Amit Bahl, Bophal Hang, Abigail Brackney, Steven Joseph, Patrick Karabon, Ammanee Mohammad, Ijeoma Nnanabu, Paul Shotkin
INTRODUCTION: Establishing peripheral intravenous (IV) access is a vital step in providing emergency care. Ten to 30% of Emergency Department (ED) patients have difficult vascular access (DVA). Even after cannulation, early failure of US-guided IV catheters is a common complication. The primary goal of this study was to compare survival of a standard long IV catheter to a longer extended dwell catheter. METHODS: This study was a prospective, randomized comparative evaluation of catheter longevity...
July 19, 2018: American Journal of Emergency Medicine
Mary E Mollie Meek, James C Meek, Blake Hollowoa, Ruizong Li, Linda A Deloney, Kevin D Phelan
RATIONALE AND OBJECTIVES: Competency in ultrasound (US) imaging and US-guided procedures is often difficult for medical students and residents to master. The use of simulation training has been strongly encouraged but the quality of phantom models available for US-guided procedures is limited. As a feasible alternative, we describe the innovative use of a lightly embalmed cadaver for realistic practice of common interventional radiology (IR) procedures prior to direct patient care. MATERIALS AND METHODS: Lightly embalmed cadavers were positioned as patients would be in the IR suite: supine, prone, and erect seated position...
July 14, 2018: Academic Radiology
G Trasimeni, F Laurino, D Lamusta, N Limbucci, S Mangiafico
We report a case in which navigation of the micro catheter (Headway 027) with the conventional single microwire technique became impossible because of the difficult intracranial vascular anatomy. In order to achieve access, we used two Terumo 012 inches micro guide-wires with a 45° angle inside a single micro catheter. The manoeuver was easy and can be reproduced in specific and challenging cases.
September 2018: Journal of Neuroradiology. Journal de Neuroradiologie
Nicholas Inston, Charmaine E Lok
The timing of referral for creation of vascular access in a patient with declining kidney function is difficult to predict. Current methods may result in patients undergoing unnecessary procedures and subsequent interventions on accesses that are never used. Multiple variables, including time for assessment, surgery and follow-up that considers the likelihood of access failure, and the estimated rate of kidney function decline, make vascular access planning challenging and difficult to balance. Better prediction tools that incorporate the risks of progressive decline in kidney function with the risk of access failure and the competing risk of death would facilitate decision-making in vascular access...
July 1, 2018: Journal of Vascular Access
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