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Adv Chronic Kidney Dis 2019 Jan;26(1):16-22

Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI.

Infection-related causes are second only to cardiovascular events for mortality among end-stage renal disease patients. This review will provide an overview of hemodialysis catheter-, graft-, and fistula-related infections with emphasis on diagnosis and management in specific settings. Use of catheters at the initiation of dialysis has remained unchanged at 80%. Read More

Cardiorenal Med 2019 Feb 27;9(3):135-144. Epub 2019 Feb 27.

Nephrology Division, University of Naples - "Luigi Vanvitelli" - Medical School, Naples,

The appropriate vascular access for hemodialysis in patients with cardiac implantable electronic devices (CIED) is undefined. We describe two cases of end-stage renal disease patients with CIED and tunneled central venous catheter (CVC) who developed venous cava stenosis: (1) a 70-year-old man with sinus node disease and pacemaker in 2013, CVC, and a Brescia-Cimino forearm fistula in 2015; (2) a 75-year-old woman with previous ventricular arrhythmia with implanted defibrillator in 2014 and CVC in 2016. In either case, after about 1 year from CVC insertion, patients developed superior vena cava (SVC) syndrome due to stenosis diagnosed by axial computerized tomography. Read More

J Pediatr Surg 2019 Feb 6. Epub 2019 Feb 6.

Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada. Electronic address:

Purpose: Prolonged central vascular access is a source of significant morbidity in children with intestinal failure (IF). In an effort to decrease morbidity, our multidisciplinary IF team has primarily used peripherally inserted central catheters (PICCs) for these patients. We compared outcomes of PICCs to Broviacs®. Read More

G Ital Nefrol 2019 Feb;36(1)

BEL - Bioengineering Laboratories Cantù.

Catheter related bloodstream infections (CRBSI) represent a complication that often requires hospitalization and the use of economic resources. In Italy, there is no literature that considers the costs of CRBSI for tunneled catheters (CVCt). The aim of this work is to evaluate the relative costs of CRBSI through the DRG system. Read More

Am J Kidney Dis 2019 Jan 12. Epub 2019 Jan 12.

Division of Nephrology, Department of Medicine, London Health Sciences Centre, London; Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Canada. Electronic address:

Rationale & Objective: Clinical practice guidelines discourage the use of central venous catheters (CVCs) for vascular access in dialysis. However, some patients have inadequate vessels for arteriovenous fistula creation or choose to use a dialysis catheter. The risks associated with CVC use and their relationship to patient age are poorly characterized. Read More

J Vasc Access 2018 Dec 31:1129729818771883. Epub 2018 Dec 31.

Hemodialysis Department, Bach Mai Hospital, Hanoi, Vietnam.

A well-functioning vascular access is a mainstay to perform an efficient hemodialysis procedure, which directly affects the quality of life in hemodialysis patients. We use three main types of access: native arteriovenous fistula, arteriovenous graft, and central venous catheter. Arteriovenous fistula remains the first and best choice for chronic hemodialysis. Read More

BMC Infect Dis 2018 Dec 20;18(1):688. Epub 2018 Dec 20.

Department of Medicine, Zealand University Hospital, Roskilde, Denmark.

Background: The mortality following blood stream infection (BSI) and risk of subsequent BSI in relation to dialysis modality, vascular access, and other potential risk factors has received relatively little attention. Consequently, we assessed these matters in a retrospective cohort study, by use of the Danish nation-wide registries.

Methods: Patients more than 17 years of age, who initiated dialysis between 1. Read More

J Vasc Surg 2019 Mar 24;69(3):883-889. Epub 2018 Oct 24.

Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.

Background: No independent comparisons, with midterm follow-up, of standard arteriovenous grafts (SAVGs) and immediate-access arteriovenous grafts (IAAVGs) exist. The goal of this study was to compare "real-world" performance of SAVGs and IAAVGs.

Methods: Consecutive patients who underwent placement of a hemodialysis graft between November 2014 and April 2016 were retrospectively identified from the electronic medical record and Vascular Quality Initiative database at two tertiary centers. Read More

Hemodial Int 2018 10 8;22(S2):S75-S82. Epub 2018 Nov 8.

Division of Nephrology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.

Tunneled central venous catheters used for the provision of hemodialysis are associated with excess morbidity and mortality. Catheter related exit site and blood stream infections are major risks of their use. Although catheter-avoidance is the best strategy to reduce infections and mortality in the hemodialysis population, the use of catheters remains unacceptably high. Read More

Ann Vasc Dis 2018 Sep;11(3):292-297

Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore.

: To review the outcomes of central venoplasty in the treatment of symptomatic central vein stenosis in patients undergoing haemodialysis via an ipsilateral arteriovenous fistula (AVF). : Data were collected retrospectively, and included all the consecutive cases of central venoplasty between January 2008 and December 2015. : A total of 132 central venoplasties in 76 patients were performed, with incidence of symptomatic central vein stenosis at 7. Read More

Blood Purif 2019 25;47(1-3):132-139. Epub 2018 Oct 25.

Background: The literature on the outcomes of tunneled femoral catheters compared to that of jugular catheters is scarce and derived mainly from small cohorts.

Material And Methods: Seven hundred and sixty six catheters were placed in 673 hemodialysis patients, 622 in the jugular/subclavian veins and 144 in the femoral veins. Patients were followed prospectively for 36 months. Read More

Turk J Pediatr 2018 ;60(2):221-224

Departments of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara, Turkey.

Ateş U, Taştekin NY, Mammadov F, Ergün E, Göllü G, Can ÖS, Uçar T, Bingöl-Koloğlu M, Yağmurlu A, Aktuğ T. Stuck tunneled central venous catheters in children: Four cases removed by angiography assistance. Turk J Pediatr 2018; 60: 221-224. Read More

Blood Purif 2019 17;47(1-3):58-61. Epub 2018 Sep 17.

Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy.

In most situations, central catheters are implanted in the right jugular vein as initial access for hemodialysis. However, after repeated punctures, the proximal vessels become stenosed and thrombosed and misplacement is likely to occur. Correct catheter position in the vein can be easily ascertained with X-ray or cross-sectional CT imaging. Read More

Zhonghua Er Ke Za Zhi 2018 Sep;56(9):657-661

Department of Nephrology and Rheumatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China.

To summarize the characteristics of cuffed-tunneled catheters insertion and investigate the values of cuffed-tunneled catheters in pediatric patients. Between March 2015 and July 2017, all the pediatric patients who received maintenance hemodialysis at least 3 consecutive months in our center were included. Sixteen cuffed-tunneled hemodialysis catheters were inserted in patients for long-term hemodialysis access. Read More

Gac Med Mex 2018 ;154(Supp 1):S22-S30

Departamento de Nefrología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México.

El acceso vascular es el primer eslabón para la terapia de apoyo extracorpórea renal. A diferencia de la terapia de reemplazo renal para pacientes con enfermedad renal crónica donde la fístula arteriovenosa es la primera opción, seguida del catéter tunelizado, en pacientes con lesión renal aguda el acceso vascular de elección es el catéter temporal. El presente estudio constituye una revisión narrativa de resumen de los estudios que analizan la elección, colocación y cuidados del acceso vascular temporal para apoyo renal agudo. Read More

J Pediatr Surg 2018 Nov 9;53(11):2318-2321. Epub 2018 Jul 9.

Our Lady's Children's Hospital Crumlin, Cooley Road, Crumlin, Dublin 12, Ireland.

Background/purpose: Tunneled central venous catheters (TCVCs) are commonly used to manage pediatric patients with chronic disease. The aim of this study is to compare the outcomes of external jugular vein (EJV) and internal jugular vein (IJV) tunneled catheters inserted using the open technique.

Methods: This is a single institution retrospective analysis of patients requiring an IJV or EJV TCVC in the period between 2009 and 2014. Read More

Ren Fail 2018 Nov;40(1):384-389

a Pathophysiology Unit, Department of Pathophysiology, School of Medicine in Katowice , Medical University of Silesia in Katowice , Katowice , Poland.

Introduction: Fibrinolysis is one of the methods extending the use of vascular access in patients with tunneled venous catheters thrombosis. The aim of this study was to assess one-year maintenance of tunneled catheters patency after first effective thrombolysis with urokinase and identify its predictors.

Methods: Retrospective analysis included 85 patients (age 69 ± 13 years) with permanent venous catheter thrombosis treated with urokinase at one center in the period 2010-2016. Read More

J Vasc Surg 2018 12 28;68(6):1865-1871. Epub 2018 Jun 28.

Division of Vascular Surgery and Endovascular Therapy, University of Southern California, Los Angeles, Calif; Department of Surgery, Huntington Memorial Hospital, Pasadena, Calif. Electronic address:

Objective: Tunneled dialysis catheter (TDC) use has been associated with increased infectious complications and mortality in hemodialysis-dependent patients. Unfortunately, patients who undergo fistula revisions or creation of a new arteriovenous fistula frequently require a TDC during the postoperative period. Bovine carotid artery grafts (BCAGs) can be used as an early-access dialysis conduit to reduce TDC dependence. Read More

Semin Dial 2018 09 11;31(5):449-454. Epub 2018 May 11.

Department of Nephrology, University Health Network, Toronto General Hospital, Toronto, ON, Canada.

Patients with end-stage kidney disease who are considering home hemodialysis (HHD) face the challenge of learning to self-cannulate their arteriovenous access. Current practice discourages the use of tunneled central venous catheters, with recent indications that self-cannulating patients have superior outcomes. Patient-level barriers do not appear to preclude a successful HHD program and should not be viewed as insurmountable by healthcare staff or patients. Read More

J Vasc Access 2018 Sep 3;19(5):501-505. Epub 2018 May 3.

6 Research Core for Interdisciplinary Sciences, Okayama University, Okayama, Japan.

Introduction: The tunneled cuffed catheter is used in hemodialysis patients for whom an arteriovenous fistula or arteriovenous graft is not suitable or for bridging usage of them. Accurate placement of a tunneled cuffed catheter is necessary for safe hemodialysis, but placement is sometimes difficult because of individual body differences. We developed a new device to support accurate placement of the tunneled cuffed catheter. Read More

J Coll Physicians Surg Pak 2018 Apr;28(4):284-287

Department of Nephrology, The Kidney Centre Postgraduate Training Institute, Karachi.

Objective: To evaluate the reasons of removal of non-tunneled double lumen catheters (NTDLC) in incident hemodialysis (HD) patients in a tertiary renal care hospital.

Study Design: Observational retrospective study.

Place And Duration Of Study: Department of Nephrology, The Kidney Centre Postgraduate Training Institute (TKC PGTI), Karachi, from June 2015 to May 2016. Read More

J Vasc Access 2018 May 29;19(3):311-315. Epub 2018 Mar 29.

1 Department of Surgery, Tohoku Rosai Hospital, Sendai, Japan.

Purpose: Peripherally inserted central venous catheters are some of the most useful devices for vascular access used globally. Peripherally inserted central venous catheters have a low rate of fatal mechanical complications when compared to non-tunnel central venous catheters. However, as peripherally inserted central venous catheter access requires a smaller vein, there is a high risk of thrombosis. Read More

J Vasc Access 2018 Sep 27;19(5):484-491. Epub 2018 Mar 27.

5 Pathology Department, University of Nebraska Medical Center, Omaha, NE, USA.

Background And Objectives: We evaluated the location and structure of the fibrous sheath formed after the placement of tunneled, cuffed hemodialysis catheters in large animals, 70 kg pigs. We focused on describing the location of the fibrous sheath in relation to the catheter. Its location explains the fibrous sheath's ability to cause catheter dysfunction by covering the catheter exit ports located at the catheter's tip. Read More

Pediatr Surg Int 2018 May 26;34(5):529-533. Epub 2018 Mar 26.

Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI, 48109, USA.

Purpose: Central catheter placement is one of the most commonly performed procedures by pediatric surgeons. Here, we present a case series of patients where central access was obtained at our institution with the utilization of a novel ultrasound-guided technique. This series represents the first of its kind where the native, parent vessels were inaccessible, resulting in a challenging situation for providers. Read More

J Vasc Access 2018 Sep 20;19(5):473-476. Epub 2018 Mar 20.

5 Department of Pathology, University of Nebraska Medical Center, Omaha, NE, USA.

Background: Currently, there is insufficient knowledge about the surgical anatomy and surgical techniques in large animals that can be used to test medical devices designed for human use. We encountered this problem in our study requiring the placement of jugular vein, tunneled, cuffed hemodialysis catheter in 70 kg pigs. Despite the operator's extensive expertise in placing tunneled hemodialysis catheters in humans, the important differences in anatomy made the procedure and choosing the appropriate catheter length challenging. Read More

J Vasc Access 2018 Jul 15;19(4):366-369. Epub 2018 Mar 15.

Vascular Institute of New York, Brooklyn, NY, USA.

Objective: It has been a widely accepted practice that a previous placed pacemaker, automatic implantable cardioverter defibrillators, or central line can be a contraindication to placing a hemodialysis catheter in the ipsilateral jugular vein. Fear of dislodging pacing wires, tunneling close to the battery site or causing venous obstruction has been a concern for surgeons and interventionalists alike. We suggest that this phobia may be unfounded. Read More

J Vasc Access 2018 May 12;19(3):252-257. Epub 2018 Mar 12.

1 Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Purpose: The exchange from a non-tunneled hemodialysis catheter to a tunneled one over a guidewire using a previous venotomy has been reported to be safe. However, some concerns that it may increase infection risk prevent its clinical application. This approach seems particularly useful for acute kidney injury patients requiring initial renal replacement therapy, in whom we frequently worry about the choice of non-tunneled versus tunneled catheters. Read More

J Vasc Access 2018 Nov 5;19(6):663-666. Epub 2018 Mar 5.

2 Division of Nephrology, Salisbury VA Health Care System, Salisbury, NC, USA.

While an arteriovenous fistula is the best available access, many patients continue to rely on a tunneled hemodialysis catheter for dialysis therapy. Despite the highest risk of catheter-related bacteremia and associated morbidity and mortality, patients often prefer tunneled hemodialysis catheter to avoid pain associated with cannulation of an arteriovenous access. We report three tunneled hemodialysis catheter-dependent end-stage renal disease patients (age: 38, 35, 33 years), who became pregnant. Read More

Transfusion 2018 02;58 Suppl 1:580-589

Department of Pathology, Division of Laboratory Medicine, University of Alabama at Birmingham, Alabama.

Therapeutic plasma exchange is an apheresis modality in which plasma is separated from the blood cellular components ex vivo, discarded, and replaced with an isosmotic fluid (most commonly 5% albumin) to maintain appropriate oncotic pressure in the patient. Therapeutic plasma exchange is used in the treatment of many diseases and indications. The recent seventh edition of the American Society for Apheresis guidelines indicates approximately 72 diseases and 116 indications for which therapeutic plasma exchange may be effective. Read More

Transfusion 2018 02;58 Suppl 1:549-557

Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri.

Central venous access has become invaluable in the treatment of patients with a wide array of acute and chronic disease entities. Central venous catheters provide durable, short-term and long-term access solutions while saving the patient from repeated peripheral needle sticks. Central venous catheters include: non-tunneled central venous catheters, tunneled central venous catheters, and port catheters. Read More

Transfusion 2018 02;58 Suppl 1:605-608

Division of Transfusion Medicine and Hemostasis, Department of Pathology, UT Southwestern Medical Center, Dallas, Texas.

Tunneled central venous catheters with ports are increasingly used for therapeutic apheresis procedures. Vortex ports have been used as access for therapeutic apheresis procedures, but are not ideal for therapeutic plasma exchange (TPE) procedures due to lower flow rates. We performed an in vitro experiment to compare flow characteristics of the single-lumen Vortex port (AngioDynamics) with the single-lumen TidalPort (Norfolk Medical). Read More

Transfusion 2018 02;58 Suppl 1:558-568

Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri.

Implantable vascular access devices are frequently used in patients who have poor peripheral venous access. These devices can be partially implanted as tunneled and nontunneled central catheters, or they can be fully implanted as ports. Compared with long-term catheters, implanted ports have lower infection rates and improved perceptions of quality of life, but complications still occur in 2% to 18% of patients, frequently requiring removal of the device. Read More

Transfusion 2018 02;58 Suppl 1:590-597

Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, Arizona.

Extracorporeal photopheresis is an immunomodulatory therapy indicated for patients with cutaneous T-cell lymphoma, graft-versus-host disease, and heart or lung allograft rejection. Whole blood from the patient is drawn into the photopheresis instrument where it is separated into its components. Plasma, red blood cells, and the treated buffy coat are subsequently returned to the patient. Read More

Pediatr Radiol 2018 06 8;48(6):889-894. Epub 2018 Feb 8.

Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St., Houston, TX, 77030, USA.

Background: Femoral tunneled central line placement in the pediatric population offers an alternative means for intravenous (IV) access, but there is concern for higher complication and infection rates when placed at bedside.

Objective: To describe the complications and infection outcomes of primary femoral tunneled central venous catheter placement in the interventional radiology suite compared to the portable bedside location at a single tertiary pediatric institution.

Materials And Methods: We conducted a retrospective review comparing interventional radiology suites vs. Read More

Enferm Infecc Microbiol Clin 2018 02;36(2):112-119

Unidad de Cuidados Intensivos, Hospital Universitari Parc Taulí, Sabadell, Barcelona; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España.

Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Read More

Am Surg 2017 Oct;83(10):1095-1098

David Geffen School of Medicine at UCLA Dean's Leadership in Health and Science Scholarship, Torrance, California, USA.

Prolonged use of central venous catheters (CVCs) for hemodialysis (HD) is associated with greater morbidity and mortality when compared with autogenous arteriovenous fistulas (AVF). The objective was to assess compliance with CVC guidelines in adults referred for hemoaccess at a county teaching hospital. Out of 256 patients, 172 (67. Read More

Med Princ Pract 2018 4;27(4):337-342. Epub 2018 Jan 4.

Objective: To determine the difference in the rates of dialysis events stratified by vascular access type and to describe the microbiological profile and sensitivity patterns of positive blood cultures over a 3-year period.

Subjects And Methods: The dialysis event data of 10,751 chronic hemodialysis patients collected from March 2013 to February 2016 at an outpatient dialysis unit in Kuwait were reviewed. The dialysis events studied were: intravenous (IV) antimicrobial use, a positive blood culture, and signs of inflammation at the vascular access site. Read More

BMC Nephrol 2017 Dec 4;18(1):351. Epub 2017 Dec 4.

Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Background: Acute kidney injury requiring renal replacement therapy (AKI-RRT) is associated with high morbidity, mortality and resource utilization. The type of vascular access placed for AKI-RRT is an important decision, for which there is a lack of evidence-based guidelines.

Methods: We conducted a prospective cohort study over a 16-month period with 154 patients initiated on AKI-RRT via either a non-tunneled dialysis catheter (NTDC) or a tunneled dialysis catheter (TDC) at an academic hospital. Read More

Zhong Nan Da Xue Xue Bao Yi Xue Ban 2017 Nov;42(11):1270-1274

Department of Nephrology, Xiangya Hospital, Central South University, Changsha 410008, China.

Objective: To investigate the status of vascular access in hemodialysis patients in our center.
 Methods: The general information of hemodialysis patients and types and complications of vascular access at Xiangya Hospital of Central South University from April 2015 to April 2016, were retrospectively analyzed.
 Results: Among 258 prevalent patients, 87. Read More

Korean J Intern Med 2017 Nov 20. Epub 2017 Nov 20.

Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.

Background/aims: This study aims to demonstrate whether the association between initial vascular access and mortality among hemodialysis patients varies by age.

Methods: We conducted a retrospective study that included 2,552 patients who started hemodialysis. Vascular access was divided into three categories: percutaneous catheter, tunneled cuffed catheter, and arteriovenous (AV) access. Read More

Nephrol Ther 2017 Nov 22;13(6):463-469. Epub 2017 Sep 22.

Polyclinique Saint-Côme, 7, rue Jean-Jacques-Bernard, 60204 Compiègne, France.

Background: International guidelines recommend to limit the long-term use of central-veinous catheters in patients undergoing hemodialysis, because they expose the patient to a higher infectious risk than the fistulas. However, for some patients with comorbidity, switching to a permanent vascular access is not possible. In such case, the catheter is used for a longer period. Read More

Am J Nephrol 2017 21;46(4):268-275. Epub 2017 Sep 21.

Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA.

Background: Arteriovenous accesses (AVA) in patients performing hemodialysis (HD) are labeled "permanent" for AV fistulas (AVF) or grafts (AVG) and "temporary" for tunneled central venous catheters (TCVC). Durability and outcomes of permanent vascular accesses based on the sequence in which they were placed or used receives little attention. This study analyzed longitudinal transitions between TCVC-based and AVA-based HD outcomes according to the order of placement. Read More

Vascular 2018 Jun 13;26(3):338-340. Epub 2017 Sep 13.

Vascular Institute of New York, Brooklyn, NY, USA.

Objective With the implementation of the K-DOQI guidelines, more patients are in need of long-term dialysis catheters until maturation of the arteriovenous fistula. However, on occasion, when placing a tunneled cuffed catheter for hemodialysis, we have encountered difficulty with passing the guidewire in spite of demonstration of a patent cervical portion of the internal jugular vein on duplex. Herein, we review our experience with intraoperative venoplasty for placement of Tesio™ catheters (Medcomp Harleysville, PA). Read More

BMC Cancer 2017 Aug 30;17(1):595. Epub 2017 Aug 30.

School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.

Background: Central venous access device (CVAD) associated complications are a preventable source of patient harm, frequently resulting in morbidity and delays to vital treatment. Dressing and securement products are used to prevent infectious and mechanical complications, however current complication rates suggest customary practices are inadequate. The aim of this study was to evaluate the feasibility of launching a full-scale randomized controlled efficacy trial of innovative dressing and securement products for pediatric tunneled CVAD to prevent complication and failure. Read More

J Vasc Surg 2017 09;66(3):969

Department of Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom.

J Vasc Surg 2017 11 16;66(5):1427-1431.e1. Epub 2017 Aug 16.

Department of Nephrology, Ain Shams University, El Demerdash Hospital, Cairo, Egypt.

Background: Long-term (tunneled cuffed) hemodialysis catheters are frequently used vascular access in renal failure patients. Catheter-related bloodstream infection (CRBSI) is a common complication of long-term hemodialysis catheters, with severe morbidities and high risk of mortality. Management of CRBSI by systemic antibiotics while keeping the catheter in place is not effective. Read More

Transfusion 2017 11 7;57(11):2567-2570. Epub 2017 Aug 7.

Department of Dermatology, Venereology and Allergology, University of Leipzig, Leipzig, Germany.

Background: Extracorporeal photopheresis (ECP) is commonly performed via peripheral venous access catheter. If this is not possible, a tunneled central venous catheter may be considered. However, this access mode may be associated with high complication rates. Read More

J Vasc Access 2017 Nov 29;18(6):535-539. Epub 2017 Jul 29.

Department of Anaesthesia, Great Ormond Street Hospital, London - UK.

Introduction: The peripherally inserted central catheters (PICCs) are vascular access devices (VAD) that are increasingly being used in the pediatric population. If a small vein caliber prevents positioning the catheter in the arm, the following step is to position the same catheter in the supraclavicular area, which can be defined as an off-label use or "atypical" approach, first described by Pittiruti.

Materials And Methods: We retrospectively reviewed PICC positioning with puncture-site in the supra-clavicular area ("atypical" PICC insertion) and then tunneled on the chest. Read More

Ann Vasc Surg 2018 Jan 23;46:331-336. Epub 2017 Jul 23.

Department of General Surgery, Vascular Surgery Service, Tan Tock Seng Hospital, Singapore.

Background: To analyze the outcomes of arteriovenous fistulae (AVFs) creation in octogenarians.

Methods: A retrospective study of 47 AVFs created in patients aged 80 years and above from 2008 to 2014. Patient and AVF characteristics and outcomes were evaluated. Read More

Pediatr Radiol 2017 Nov 18;47(12):1682-1687. Epub 2017 Jul 18.

Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA, USA.

Background: Despite the demonstrated feasibility of the single-stick technique in the femoral vein, its use in neonates and infants for placing central lines in internal and external jugular veins has not been reported.

Objective: Describe and assess the safety and efficacy of tunneled jugular central venous catheter placement performed under ultrasound (US) and fluoroscopic guidance in neonates and infants weighing <5 kg using the single-stick technique at three tertiary pediatric hospitals.

Materials And Methods: Thirty-three children weighing less than 5 kg received tunneled central venous access in either internal or external jugular veins using the single-stick technique. Read More