On the Ground Running

As we approach the halfway point of 2019, I, along with the Editorial Review Board of the Journal of the Association for Vascular Access (JAVA) are proud to present the summer issue, our second under the self-publishing model completed with publisher-services partner Allen Press, Inc. I eagerly await feedback from subscribers and Association for Vascular Access (AVA) members on this issue, which contains numerous research articles and a powerful patient perspective column submitted by a mother of a pediatric patient.

The latest installment of JAVA represents the considerable work put

Abstract

Background: Central venous catheters are necessary for infusion therapy and often used for blood sampling. Dressings are used to protect the skin and the catheter; however, the pediatric population presents a special challenge because of catheter size, location, and fragile skin.

Methods: A quality improvement project was initiated to minimize frequent or unplanned dressing changes for pediatric catheters. Lean methodology was employed in order to decrease waste within the dressing inventory and maximize value. An interdisciplinary committee was formed to create an evidence-based dressing inventory list, and data were collected before and after implementing the new inventory to ensure that the quality of care was maintained.

Results: Comparing the preimplementation and postimplementation periods, the types of dressings used were reduced from 10 to 4 types (each type in 1 to 3 sizes). We also recorded a significant reduction in central line-associated bloodstream infections (CLABSIs) postimplementation from a rate of 2.12 to 1.40 per 1000 central line days (P = 0.0297). The number of dressings (units) used decreased after the implementation, while the average monthly cost associated with products dropped from $12,684.83 to $4848.95 (P = 0.0037).

Conclusions: We successfully simplified and standardized our dressing inventory for pediatric central venous catheters without compromising the quality of care. The project led to a decrease in infections and number of dressing changes and to substantial cost savings. Education and training was key in the success of this initiative.

Abstract

Purpose: To present a unique case in which intravenous medications were administered intermittently through a peripherally inserted central catheter (PICC) line over 2 years in the presence of an occluded superior vena cava (SVC) due to impressive collateral development. However, SVC recanalization was ultimately needed to allow for long-term future access needs.

Case Description: This is a 25-year-old female with cystic fibrosis with known chronic occlusion of the SVC requiring multiple ports and PICC lines to maintain venous access. Despite conservative measures, it eventually became impossible to pass the occlusion via guidewire to properly place a PICC line. Sharp recanalization of the SVC occlusion with port placement was scheduled and successfully performed. The SVC was stented due to severe residual stenosis following recanalization and balloon angioplasty.

Results: Imaging revealed a significantly enlarged hemiazygos vein and numerous prominent collaterals throughout the mediastinum and chest wall, resulting in the majority of chest venous drainage entering the inferior vena cava. After recanalization, her SVC and port remained patent and functional.

Conclusions: For patients with SVC occlusion requiring venous access, a PICC line with the tip placed near the confluence of the brachiocephalic veins may serve as a temporary method for venous access in the presence of extensive collateral flow. However, for long-term access, sharp recanalization of the occlusion should be considered to restore normal laminar blood flow patterns and allow for optimum central venous catheter tip placement at the cavoatrial junction.

Abstract

Objective: The number of elderly patients requiring hemodialysis has consistently increased, but outcomes of hemodialysis vascular access in octogenarians are poorly described. The aims of this study were to evaluate the outcome of vascular access in octogenarians.

Methods: We analyzed 262 vascular access treatments performed at a single center. Cases were divided into 2 groups based on age: ≥80 years old (group A, n = 62) and <80 years old (group B, n = 200). The differences in baseline characteristics, procedural variables, and patency rates between the 2 groups were subsequently analyzed. Results: Mean age was 85.3 ± 4.6 years and 66.5 ± 10.3 years in groups A and B, respectively (P < 0.001). Height did not differ significantly between groups; however, weight and body mass index (BMI) were significantly different (51.0 ± 9.7 kg versus 56.1 ± 16.9 kg, P = 0.040; 25.2 ± 4.0 kg/m² versus 27.5 ± 6.5 kg/m², P = 0.018). Nephrosclerosis as the cause of renal failure requiring hemodialysis was significantly more common in group A (29.0% vs 16.0%; P = 0.023). The older patient group had a significantly higher prevalence of chronic obstructive pulmonary disease (COPD; 11.3% vs 0.5%, P < 0.001). No significant intergroup differences were found with respect to primary, assisted primary, and secondary patency rates.

Conclusions: Elderly patients had lower weight and BMI and were more commonly diagnosed with COPD. Our results demonstrated that the primary, assisted primary, and secondary patency rates of octogenarians did not differ from those of younger patients.

CEO's Message

Bet on Women

Editor's Message

On the Ground Running

CE Article: A Quality Improvement Approach in Standardizing Pediatric Central Venous Catheter Dressings and Its Impact on the Reduction of Central Line-Associated Bloodstream Infections and Costs

Abstract

Sharp Recanalization of a Chronically Occluded Superior Vena Cava in a Patient with Multiple Prior Peripherally Inserted Central Catheters

Abstract

Outcomes of Vascular Access in Octogenarians: An Analysis of Cases

Abstract

Everly's Intravenous Infiltration Journey

Abstract

Looking for the Benefit of Regional Anesthesia in Dialysis Access Surgery

Abstract

The Use of Optical Detection for Continuous Monitoring of Pediatric IV Sites

Abstract

President’s Message

Full Issue PDF

Post Hoc Analysis of Experimental Studies on Hemolysis Marker Levels in Red Blood Cells Infused through Manual and Electronic Flow Control Devices

Before You Say Yes: The Responsibilities of Volunteering in Healthcare: Editor’s Message

Vessel Depth vs. Catheter Length: How Deep Should My Catheter Go? A Deeper Dive