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Use of a Vascular Sheath in the Axillary Artery as an Alternative Access Approach for Placing an Impella 5.0 Device.

Many patients who are in cardiogenic shock need mechanical support for clinical stabilization after acute insults such as myocardial infarction. However, the placement of advanced devices can be hindered by anatomic constraints or the physiologic sequelae of shock, as we describe in this report. A 67-year-old woman with prior coronary artery bypass grafting and extensive chest-wall scarring from previous defibrillator implantations presented with myocardial infarction and refractory cardiogenic shock. The patient's vascular anatomy and prior surgery precluded conventional percutaneous implanta

Use of a breakaway vascular access device to preserve peripherally inserted central catheter integrity in a neonate.

Peripherally inserted central catheters (PICCs) in neonatal and paediatric patients are susceptible to unintentional dislodgement during routine care-giving activities, which may result in catheter complications such as tip migration or complete loss of vascular access. This case study describes the use of a breakaway device on a 27-day-old female infant's PICC line during antibiotic therapy for bacterial meningitis. Over a 26-day dwell period, three device separation events occurred during routine care-giving activities. In each instance, the device functioned as intended, automatically stopp

International experts consensus on optimal central vascular access device selection and management for patients with cancer.

BACKGROUND: In patients with cancer, the choice of an appropriate venous access device is crucial for effective treatment, minimizing complications, and reducing healthcare costs. Key management decisions, such as the timing of device removal post-therapy, can impact clinical outcomes. As current international guidelines lack specific directives for these issues, a global consensus of experts, representing different countries, was deemed appropriate. METHODS: A panel of 11 experts from three continents, including oncologists and healthcare professionals, was chosen. After a comprehensive revi

Insertion of a totally implantable vascular access device in a patient with dextrocardia and colon cancer: a case report.

Colon cancer in patients with situs inversus totalis is rarely associated with dextrocardia, and chemotherapy is commonly used for treatment. Central venous access devices are used to administer intravenous fluids and chemotherapy in patients with colon cancer. Compared with peripherally inserted central catheters and Hickman-type tunneled catheters, totally implantable vascular access devices (TIVADs) are safer and more effective. However, positioning the catheter tip may be challenging in patients with dextrocardia and situs inversus. We herein describe a novel case involving a patient with …

Catheter-Related Bloodstream Infections Among Critically Ill Patients With Central Vascular Access Devices: A Cross-Sectional Study in China.

OBJECTIVE: The aim of this study is to assess catheter-related bloodstream infections (CRBSIs) in Chinese intensive care units (ICUs), covering prevalence, risk factors, pathogen distribution, and impacts of outcome. METHODS: A cross-sectional study was conducted in ICUs across 22 tertiary hospitals (2023-2024), with CRBSI diagnoses following Chinese national guidelines. Data were analyzed using R software (version 4.4.2), employing chi-square tests, robust Poisson regression, and Bayesian logistic regression (P < .05). RESULTS: The prevalence of CRBSI was 1.19% (1.53/1000 catheter days, 32

Inhibition of heparin precipitation, bacterial growth, and fungal growth with a combined isopropanol-ethanol locking solution for vascular access devices.

BACKGROUND: Clinical reports of ethanol-lock use for the prevention of catheter-related bloodstream infections have been marked by the occurrence of serious catheter occlusions, particularly among children with mediports. We hypothesized that precipitate forms when ethanol mixes with heparin at the concentrations relevant for vascular access devices, but that the use of a combination of two alcohols, ethanol and isopropanol, would diminish heparin-related precipitation, while retaining anti-bacterial and anti-fungal effects. METHODS: Heparin (0-100units/mL) was incubated in ethanol-water solu…

Translation and validation of the Brazilian Portuguese version of the quality of life vascular access device questionnaire for chemotherapy patients.

BACKGROUND: The use of long-term devices for chemotherapy in neoplastic diseases is very common. The CAVA trial was an extensive study that … o that it can be used in the Brazilian population. METHODS: A total of 167 patients with long term vascular access devices for chemotherapy participated in the study. After translation and retranslation, construct validity was analyzed by identifying the correlation between QoLVAD and the European Quality of Life Questionnaire (EuroQol). To determine the reliability, in …

Extending the interval of flushing procedures of totally implantable vascular access devices in cancer patients: It is time for a change.

Several recent literature reports regarding the flushing technique of TIVADs highlight how the definition of the optimal flushing interval is still a source of controversy. Several recent studies indicate more and more frequently how 4 weeks can be considered a too short interval for the flushing of a totally implantable access device (TIVAD); on the other hand most of the main guidelines and instructions for use provided by the device's manufacturers still suggest an interval between 4 weeks and 1 month as the ideal one. The recent meta-analysis by Wu et al. on this topic, promotes an importa

Limitations of closing percutaneous transthoracic ventricular access ports using a commercial collagen vascular closure device.

INTRODUCTION: Closed-chest access and closure of direct cardiac punctures may enable a range of therapeutic procedures. We evaluate the safety and feasibility of closing percutaneous direct ventricular access sites using a commercial collagen-based femoral artery closure device. METHODS: Yorkshire swine underwent percutaneous transthoracic left ventricular access (n = 13). The access port was closed using a commercial collagen-based vascular closure device (Angio-Seal, St. Jude Medical) with or without prior separation of the pericardial layers by instillation of fluid into the pericardial sp

[Automated exchange transfusion in premature and newborn infants with hyperbilirubinemia using a peripheral arteriovenous vascular access device].

The technique of exchange transfusion using a plastic catheter in the umbilical vein developed by Diamond and modified by Allen was instrumental in decreasing the mortality and morbidity in newborn infants with jaundice. Allen et al. demonstrated that the development of kernicterus in infants with erythroblastosis with indirect hyperbilirubinemia could be prevented by this method. Since that time numerous modifications of this "single site, push pull technique" have been described to further reduce the risk of morbidity and mortality. On the basis of the successful use of percutaneous radial a

Real-World Experience With a Large Bore Vascular Closure Device During TAVI Procedure: Features and Predictors of Access-Site Vascular Complications.

BACKGROUNDS: Among vascular closure devices (VCDs), the novel collagen plug-based MANTA VCD is the first designed for large bore percutaneous access. We aimed to assess the features and predictors of access-site vascular complications in an unselected trans-femoral transcatheter aortic valve replacement (TF-TAVR) population. METHODS: Patients undergoing large bore arteriotomy closure with 18F MANTA VCD following TF-TAVR at a large tertiary care center from September 2019 to January 2021 were prospectively analyzed. Primary Outcome was the MANTA VCD access-site-related complications according

Effect of a novel cannulation device for vascular access on AVF maturation in a goat carotid-jugular fistula model.

OBJECTIVE: The Ark is a 3-D printed titanium device designed to be implanted around the draining vein of an arteriovenous fistula (AVF) to facilitate vascular access. The purpose of this study was to assess AVF maturation after Ark implantation in a large animal model. METHODOLOGY: End-to-side AVFs were created between the carotid artery and jugular vein in nine pygmy goats that included three control (AVF only) and six experimental (AVF and Ark device) animals. For experimental animals, an Ark device was implanted approximately 10 cm downstream of the anastomosis at the time of AVF creation.

Prolonged flushing and locking interval for totally implantable vascular access device: A systematic review and meta-analysis.

The objective of this systematic review is to evaluate the safety ad feasibility of the totally implantable vascular access devices (TIVADs) flushed more than 4 weeks. We searched the following electronic databases from the date their build-up to February 2020: PubMed, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL. The final selection resulted in 14 trials fulfilling the inclusion criteria and being included in our review. A pooled frequency of port-related late complications with longer flushing intervals (>4 weeks) was 8.0%, and the pooled frequency of occl…

Implanted vascular access device related deep vein thrombosis in oncology patients: A prospective cohort study.

BACKGROUND: Implanted vascular access devices (IVADs) have significantly improved the management of cancer patients. These patients are at an increased risk of venous thromboembolism and IVADs are a known risk factor. We sought to assess the incidence of IVAD-related upper extremity deep vein thrombosis (IVAD-related UEDVT) associated with BioFlo® IVADs (Angiodynamics, Inc.). METHODS: A total of 394 cancer patients were enrolled over 12 months. The primary outcome was the incidence of IVAD-related UEDVT confirmed by diagnostic imaging. IVAD-related UEDVT was defined as symptomatic ipsilateral…

Vascular Access Devices for Stem Cell Transplantation: A Review of Catheter Types-A Crucial Step Towards the Enhancement of Patient Care.

Central venous access devices (CVADs) play a pivotal role in managing stem cell recipients, providing reliable access for the administration of chemotherapy, blood products, progenitor infusion, parenteral nutrition, and other crucial treatments. This review critically evaluates the various types of CVADs commonly employed in transplant settings, examining their indications, complications, and best practices to enhance patient outcomes. Moreover, it emphasizes the significance of broadening the selection algorithm for vascular devices and incorporating patient expectations and comfort into rou

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… CICCs remain the preferred vascular access device in most transplant centers due to their widespread availability and operator preference. … Table 5 Comparative summary of vascular access devices in HSCT settings. ↓ - decrease; ↑ - increase. …

A prospective, randomized study assessing different modalities for flushing totally implanted vascular access device in children with malignancy.

BACKGROUND: The totally implanted vascular access device (TIVAD) is commonly used in patients with malignant tumors requiring chemotherapy or long-term intravenous infusion and those with difficulty placing peripheral venous catheters. It could also be used to draw blood in pediatric patients. Thus, how to maintain the patency and longevity of TIVAD is always emphasized. METHODS: In this prospective study, TIVAD was randomly infused in patients under 18 years with three different concentrations of heparinized solutions: 10 mL with 100 U/mL heparin, 20 mL with 10 U/mL heparin, and 30 mL with 1

Influence of use of a vascular closure device on incidence and surgical management of access site complications after percutaneous interventions.

AIM: The study aimed to evaluate vascular access site complications (ASCs) after percutaneous interventions (PIs) in our institution for changes in annual incidence and surgical management after increased usage of a vascular closure device (VCD; in all cases: Angioseal™). MATERIAL AND METHODS: All patients who underwent repair of arterial pseudo-aneurysms or access site stenosis/occlusion leading to leg ischaemia (LI) or new-onset disabling claudication (CI) after PIs between 2001 and 2008 were included. Annual rates of procedures and methods of repair of ASC were evaluated. RESULTS: After a

The outcome and complications of the DiaTAP bioCarbon button-graft vascular access device in haemodialysis patients: a two-year experience.

The outcome and complications which developed in 8 hemodialysis patients who received 12 DiaTAP bioCarbon button vascular-access devices were reviewed. All patients had a poor vascular access history. Three of twelve devices have been replaced because of thrombosis and two because of infection. Four patients have had 10 episodes of reduced blood flow. Streptokinase infusion into the DiaTAP button led to improved blood flow in 8 of 10 episodes. The 6-month survival rate of the DiaTAP access device was 67% and the average functioning life was 9.4 months. It was a valuable form of access when oth

A Real World 10-Year Experience With Vascular Closure Devices and Large-Bore Access in Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation.

Transcatheter aortic valve replacement (TAVR) has established itself as a safe and efficient treatment option in patients with severe aortic valve stenosis, regardless of the underlying surgical risk. Widespread adoption of transfemoral procedures led to more patients than ever being eligible for TAVR. This increase in procedural volumes has also stimulated the use of vascular closure devices (VCDs) for improved access site management. In a single-center examination, we investigated 871 patients that underwent transfemoral TAVR from 2010 to 2020 and assessed vascular complications according to

Successful ventricular tachycardia ablation in a patient with limited vascular and left ventricular endocardial access due to multiple mechanical cardiac support devices.

UNLABELLED: A 48-year-old male with ischemic cardiomyopathy was admitted because of cardiogenic shock due to incessant ventricular tachycardia (VT). Despite the introduction of multiple mechanical cardiac support (MCS) devices, his hemodynamics were unstable; therefore, VT ablation was performed. Due to the limited vascular and left ventricle (LV) access with the multiple MCS devices, only the left femoral artery and vein were accessible. In addition, the transseptal approach as an LV access was difficult because of the MitraClip (Abbott Park, IL, USA). Posterior papillary muscle-origin VT was