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Agnes Masengu, Jennifer Hanko
Arteriovenous fistulas (AVF) improve survival and morbidity for most haemodialysis (HD) patients. Are they better for all patients? In the enthusiastic pursuit of AVFs for all, concerns have been raised regarding high primary AVF failure rates, continued high incident central venous catheter (CVC) use in some countries, and the limited life expectancy of some HD patients. "Fistula first" is changing to "catheter last". The focus must be on decreasing AVF failure to mature and decreasing incident CVC use. An optimal outcome should be sought for each individual patient, and multiple failed attempts at AVF creation avoided...
March 6, 2017: Journal of Vascular Access
Matthew A Tucker, Ashley Six, Nicole E Moyen, Alf Z Satterfield, Matthew S Ganio
Hypohydration decreases cutaneous vasodilation and sweating during heat stress, but it is unknown if these decrements are from postsynaptic (i.e. sweat gland/blood vessel) alterations. PURPOSE: To determine if hypohydration affects postsynaptic cutaneous vasodilation and sweating responses. METHODS: 12 healthy men participated in euhydrated (EU) and hypohydrated (HY) trials, with hypohydration induced via fluid restriction and passive heat-stress. Changes in cutaneous vascular conductance (CVC; %max) in response to incremental intradermal infusion of the endothelium-independent vasodilator sodium nitroprusside (SNP) and the endothelium-dependent vasodilator methacholine chloride (MCh) were assessed by laser Doppler flowmetry...
February 15, 2017: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology
Naveed Ul Haq, Mohamed Said Abdelsalam, Mohammed Mahdi Althaf, Abdulrahman Ali Khormi, Hassan Al Harbi, Bader Alshamsan, Mamdouh Nasser Albaqumi, Dieter Clemens Broering, Lutfi Alkorbi, Hassan Ali Aleid
BACKGROUND: Native arteriovenous fistulae (AVFs) are preferred while central venous catheters (CVCs) are least suitable vascular access (VA) in patients requiring hemodialysis (HD). Unfortunately, around 80% of patients start HD with CVCs. Late referral to nephrologist is thought to be a factor responsible for this. We retrospectively analyzed the types of VA at HD initiation in renal transplant recipients followed by nephrologists with failed transplant. If early referral to nephrologist improves AVF use, these patients should have higher prevalence of AVF at HD initiation...
November 28, 2016: Journal of Vascular Access
Christopher Filtenborg Brandt, Siri Tribler, Mark Hvistendahl, Rahim M Naimi, Per Brøbech, Michael Staun, Palle Bekker Jeppesen
BACKGROUND/AIMS: Catheter-related complications (CRCs) cause mortality and morbidity in patients dependent on parenteral support at home (HPN) due to intestinal failure (IF). This study describes the incidences of CRCs in an adult IF cohort over 40 years. It illustrates the evolution and consequences of CRCs, their association to demographic characteristics, and potential risk factors in an effort to provide the rationale for preventive precautions to the relevant patients with IF at risk...
November 15, 2016: JPEN. Journal of Parenteral and Enteral Nutrition
Max B van Gent, Wendeline J van der Made, Perla J Marang-van de Mheen, Koen E van der Bogt
OBJECTIVE: To analyze the rate of infections and complications after surgeon-performed, largely ultrasound-guided, central venous catheter (CVC) placement in a pediatric population and to identify patients at high risk of complications. METHODS: All children aged between 4 months and 19 years with a percutaneous CVC inserted between January 1, 2000, and July 31, 2013, were included. Patient records were reviewed retrospectively for the occurrence of infection and other complications until CVC removal or the last outpatient clinic visit and compared between patient groups and with the recent literature...
February 2017: Surgical Infections
Stefano Avanzini, Leila Mameli, Nicola Disma, Clelia Zanaboni, Andrea Dato, Giovanni Montobbio, Luigi Montagnini, Michela Bevilacqua, Filomena Pierri, Massimo Conte, Loredana Amoroso, Giovanna Pala, Sara Pestarino, Elio Castagnola, Angelo Claudio Molinari, Concetta Micalizzi, Giuseppe Morreale, Girolamo Mattioli, A Pini Prato
BACKGROUND: Ultrasound-guided (USG) cannulation of the brachiocephalic vein (BCV) is gaining worldwide consensus for central venous access in children. This study reports a 20-month experience with this approach in children. METHODS: All patients who underwent percutaneous USG central venous catheter (CVC) positioning in the BCV between August 2013 and March 2015 have been included. Devices inserted during this period were open-ended, either single or double-lumen tunneled CVC...
February 2017: Pediatric Blood & Cancer
Lynne Li, Elise Fortin, Claude Tremblay, Muleka Ngenda-Muadi, Caroline Quach
BACKGROUND Following implementation of bundled practices in 2009 in Quebec and Canadian intensive care units (ICUs), we describe CLABSI epidemiology during the last 8 years in the province of Québec (Canada) and compare rates with Canadian and American benchmarks. METHODS CLABSI incidence rates (IRs) and central venous catheter utilization ratios (CVCURs) by year and ICU type were calculated using 2007-2014 data from the Surveillance Provinciale des Infections Nosocomiales (SPIN) program. Using American and Canadian surveillance data, we compared SPIN IRs to rates in other jurisdictions using standardized incidence ratios (SIRs)...
October 2016: Infection Control and Hospital Epidemiology
Decenzio Bonucchi, Lucia Palmieri, Silvia Arletti, Gianni Cappelli, Carlo Lomonte, Massimo Lodi, Mario Meola, Monica Spina, Marcello Napoli
PURPOSE: Dialysis settings have generally improved over the last decades, but the vascular access setting did not see significant advances and experienced a progressive worsening in epidemiology and clinical features. The aim of the study was to describe and compare evolution of vascular access in Italy over time. METHODS: A national survey implemented in Italy last year is presented and compared to a previous survey performed in 1998. Present survey collected data from almost 50% of centers involved in vascular access...
September 21, 2016: Journal of Vascular Access
Loris Pironi, Jann Arends, Federico Bozzetti, Cristina Cuerda, Lyn Gillanders, Palle Bekker Jeppesen, Francisca Joly, Darlene Kelly, Simon Lal, Michael Staun, Kinga Szczepanek, André Van Gossum, Geert Wanten, Stéphane Michel Schneider
BACKGROUND & AIMS: Chronic Intestinal Failure (CIF) is the long-lasting reduction of gut function, below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth. CIF is the rarest organ failure. Home parenteral nutrition (HPN) is the primary treatment for CIF. No guidelines (GLs) have been developed that address the global management of CIF. These GLs have been devised to generate comprehensive recommendations for safe and effective management of adult patients with CIF...
April 2016: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Julián Varas, Pablo Achurra, Felipe León, Richard Castillo, Natalia De La Fuente, Rajesh Aggarwal, Leticia Clede, María P Bravo, Marcia Corvetto, Rodrigo Montaña
BACKGROUND: Central venous catheterization (CVC) is a basic requirement for many medical specialties. Simulated training in CVC may allow the acquisition of this competency but few reports have established a valid methodology for learning and acquiring procedural skills for CVC. This study aims to validate the use of a tracking motion device, the imperial college surgical assessment device (ICSAD), by comparing it with validated global rating scales (GRS) to measure CVC performance in a simulated torso...
2016: Annals of Surgical Innovation and Research
Jordan C Patik, Kevin M Christmas, Chansol Hurr, R Matthew Brothers
Microvascular dysfunction contributes to the development of cardiovascular and metabolic disease. This study tested the hypothesis that young obese (BMI>30 kg m(-2)), otherwise healthy, adults (N=15) have impaired microvascular function relative to age and sex matched, lean (BMI<25 kg m(-2)) individuals (N=14). Participants were instrumented with two microdialysis probes in the cutaneous vasculature of one forearm; one for a wide dose range of infusions of the endothelium-dependent vasodilator methacholine (MCh) and the other for the endothelium-independent vasodilator sodium nitroprusside (SNP)...
March 2016: Microvascular Research
Natalie K Bradford, Rachel M Edwards, Raymond J Chan
BACKGROUND: Guidelines and clinical practice for the prevention of complications associated with central venous catheters (CVC) around the world vary greatly. Most institutions recommend the use of heparin to prevent occlusion, however there is debate regarding the need for heparin and evidence to suggest 0.9% sodium chloride (normal saline) may be as effective. The use of heparin is not without risk, may be unnecessary and is also associated with increased cost. OBJECTIVES: To assess the clinical effects (benefits and harms) of intermittent flushing of heparin versus normal saline to prevent occlusion in long term central venous catheters in infants and children...
November 23, 2015: Cochrane Database of Systematic Reviews
Sivaranjani Arivalagan, Nisha Susan Thomas, Balaji Chandrasekaran, Vijay Mani, Aktarul Islam Siddique, Thayalan Kuppsamy, Nalini Namasivayam
Colon cancer is one of the most commonly diagnosed cancers, and is a major cause of cancer morbidity and mortality worldwide. The objective of the present study is to evaluate the combined therapeutic efficacy of carvacrol (CVC) and X-radiation against 1,2-dimethylhydrazine-induced colon cancer. Male albino Wistar rats were randomly divided into six groups. Group 1 served as control; group 2 received 40 mg/kg b.wt of CVC orally everyday throughout the experimental period (32 weeks); groups 3-6 received subcutaneous injections of DMH (20 mg/kg b...
December 2015: Molecular and Cellular Biochemistry
Precil D M M Neves, Ramaiane A Bridi, Rosilene M Elias, Rosa M A Moyses
Patients with end-stage renal disease (ESRD) on dialysis have poor overall survival, and cardiovascular (CV) is the main cause of mortality among these patients. Coronary calcification is an independent predictor of mortality and CV events in dialysis patients and can be accessed by using a computerized tomography scanning. The high cost of this procedure, however, precludes routine implementation of this method for the purposes of risk stratification. Aortic arch calcification has been associated with CV mortality in the general population...
September 2015: Journal of Clinical Medicine Research
Christopher A Guidry, Laura H Rosenberger, Robin T Petroze, Stephen W Davies, Tjasa Hranjec, Matthew D McLeod, Amani D Politano, Lin M Riccio, Robert G Sawyer
BACKGROUND: Blood stream infections (BSIs) are a common source of morbidity and death in hospitalized patients. We hypothesized that the proportions of bacteremia from gram-positive and fungal pathogens have decreased over time, whereas rates of gram-negative bacteremia have increased as a result of better central venous catheter management. METHODS: All U.S. Centers for Disease Control and Prevention-defined BSIs in patients treated on the general surgery and trauma services at our institution between January 1, 1998, and December 31, 2009 were identified prospectively...
August 2015: Surgical Infections
A Boban, C Lambert, C Hermans
INTRODUCTION: Continuous infusion (CI) of clotting factors has facilitated surgical procedures and intensive replacement therapy in haemophilia patients. This procedure could, however, be further optimized by using a short-term central venous catheter (CVCs) instead of via peripheral venous access. AIM: In this paper, we present our results on using a short-term CVC in haemophilia patients during major surgical operations. METHODS: In total, 40 patients with haemophilia A or B (37 and 3, respectively), aged 21-81 years, underwent 67 surgeries with 65 CVCs...
September 2015: Haemophilia: the Official Journal of the World Federation of Hemophilia
Maristela Böhlke, Gustavo Uliano, Franklin C Barcellos
PURPOSE: Infectious complications associated with central venous catheters (CVCs) are a major source of morbidity and mortality among hemodialysis (HD) patients. This review aims to discuss prevention, diagnosis criteria and management of CVC-related infections in HD patients. METHODS: We searched Medline for articles published in the last 10 years, with the keywords "catheter," "hemodialysis," "infection," "treatment," "diagnosis," "prophylaxis" and "adults." Only English language articles were reviewed...
September 2015: Journal of Vascular Access
Jacob A Akoh, Panoraia P Paraskeva
BACKGROUND: There is ongoing debate about the use of transposed basilic vein (TBV) fistula and the choice between it and prosthetic arteriovenous graft (AVG). This paper reviews the available literature relating to TBV fistula in terms of surgical technique, patency rates, complications, access survival and compares it with prosthetic AVG for hemodialysis (HD). METHODS: Review of English language publications on TBV during the last two decades. FINDINGS: The rate of fistula maturation was higher in the two-stage group, although the mean diameter of the basilic vein was smaller...
September 2015: Journal of Vascular Access
Krishna Pokharel, Binay Kumar Biswas, Mukesh Tripathi, Asish Subedi
OBJECTIVE: The inadvertent loss of an entire guide wire during central venous catheterization can lead to serious patient harm and require additional investigations as well as retrieval procedures. We aimed to analyze globally published reports of lost wires during central venous catheterization to understand its possible etiology, presentation, treatment, and outcomes with an objective of finding solutions to make the procedure safer. DATA SOURCES: MEDLINE, Scopus, and CINAHL, supplemented by scanning the reference lists of relevant publications...
August 2015: Critical Care Medicine
Naoto Fujii, Gabrielle Paull, Robert D Meade, Ryan McGinn, Jill M Stapleton, Pegah Akbari, Glen P Kenny
This study evaluated the separate and combined roles of nitric oxide synthase (NOS) and cyclooxygenase (COX) in forearm sweating and cutaneous vasodilatation in older adults during intermittent exercise in the heat. Twelve healthy older (62 ± 7 years) males performed two 30 min cycling bouts at a fixed rate of metabolic heat production (400 W) in the heat (35°C, 20% relative humidity). The exercise bouts were followed by 20 and 40 min of recovery, respectively. Forearm sweat rate (ventilated capsule) and cutaneous vascular conductance (CVC, laser Doppler perfusion units/mean arterial pressure) were evaluated at four skin sites that were continuously perfused via intradermal microdialysis with: (1) lactated Ringer solution (Control), (2) 10 mm ketorolac (non-selective COX inhibitor), (3) 10 mm N(G) -nitro-l-arginine methyl ester (l-NAME; non-selective NOS inhibitor) or (4) a combination of 10 mm ketorolac + 10 mm l-NAME...
July 15, 2015: Journal of Physiology
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