Abstract

Background: With the advent and popularity of peripherally inserted central catheter (PICC) use, reflected in clinical benefits, growing evidence suggests a possibility for significant consequences due to unsatisfactory securement. Such consequences may be avoided if stabilization has been optimal. Novel securement devices have shown effectiveness; however, each device has had its challenges. With the recognized need to endorse an agent aimed at reducing migration, would the use of a tissue adhesive (TA) be a pioneering alternative to securement?

Methods: A quantitative, causal comparative, descriptive design was proposed to evaluate the relationship between TA applied at the insertion site and the exposed visible catheter length (EVL), with the intent to determine migration. Two groups were compared, 1 group having received the intervention. Analysis of data quantified the efficacy of the intervention.

Results: A 2-sample t-test and χ² test were used to analyze the variables. Statistical analyses were applied to equate baseline to innovation, encapsulated the solution, and offered a qualitative narrative, presenting a decrease in catheter migrations from 19.35% to 0%; P = 0.010 (FE 0.02), which was statistically significant. No adverse events or central line bloodstream infections were documented in those receiving TA.

Conclusions: This study reports TA as a safe, inexpensive, and highly effective alternative to secure and stabilize PICCs. The continuation of the study for an additional 10 months yielded a 1.4% migration rate in more than 411 participants (P = 0.02), which speaks to the continued use and the sustainability of TA for securement and stabilization of PICCs.

Abstract

Background: Arteriovenous fistula (AVF) is one of most common types of vascular access used in end-stage renal disease (ESRD) patients in renal replacement therapy. Many factors can affect the maturation of AVF. This study aimed to investigate the factors that influence AVF maturation.

Methods: Retrospective data of subjects who underwent the AVF procedure from May 1 to June 31, 2017 in South Ring Road Surgery Hospital were examined through medical records. Analysis of predictive models was done using logistic regression with backward stepwise procedure.

Results: Mature AVF occurred in 82.8% of 87 total subjects, with average AVF maturity duration of 26.6 ± 8.30 days. There was a significant difference in the average age of the subjects with regard to AVF maturation, in that the average age in the mature group and the immature group was 52.47 ± 14.5 and 45.17 ± 10.92 years, respectively (P = 0.029, Mann-Whitney). There was no significant difference between the mature group and the immature group with regard to AVF maturation in males (P = 0.361) and some comorbid factors such as diabetes mellitus (P = 0.765), hypertension (P = 0.448), smoking history (P = 0.394), and peripheral vascular disease (P = 1.000). The majority of the AVF were located in the forearm (56.3%). Arterial diameter above 2 mm resulted in a more than 4 times increase in AVF maturity (P = 0.010, odds ratio [OR] = 4.85, 95% confidence interval [95%CI]: 1.46–16.11), while venous diameter above 2 mm (P = 0.620, OR = 0.72, 95%CI: 0.20–2.59) showed no statistically significant difference in logistic regression.

Conclusions: Arterial diameter appears to be a strong predictor of AVF maturity, with outcomes being more than 4 times better with arterial diameter above 2 mm.

Abstract

Background: Peripheral intravenous catheters (PIVs) are routinely used for venous access in hospitalized pediatric patients to administer fluids and medications and to aspirate blood. Unfortunately, PIVs do not remain functional for the entire duration of intravascular need. We hypothesized that PIV malfunction may be related to venous changes that can be visualized with ultrasound (US) imaging. The purpose of this study was to describe and document such changes in pediatric patients.

Methods: This Institutional Review Board-approved study was performed at a tertiary pediatric medical center. Patients underwent US scans of their PIV-containing veins, documenting venous characteristics such as depth, diameter, wall thickness, blood flow, valves, branch points, and presence of thrombus. Patient demographics and PIV characteristics were also recorded.

Results: Data from 30 patients including 12 males and 18 females with a mean age of 11 years were analyzed. Mean venous depth and diameter were 2.07 ± 0.13 and 2.02 ± 0.18 mm, respectively. Mean PIV dwell time at time of evaluation was 3.3 days. PIV-associated venous changes were seen in 73% of accessed veins and included lumen narrowing (47%), wall thickening (33%), presence of thrombus (20%), and absence of blood flow around the PIV tip (40%).

Conclusion: PIV-associated venous changes are seen with US in the majority of pediatric patients with indwelling PIVs but are not necessarily appreciated on physical exam. These changes may help explain the high rate of pediatric PIV device failure. Given the small sample size, further investigation is needed to better characterize PIV-associated venous changes in children.

Introduction / Summary

The history of arterial catheter insertion and pressure monitoring dates back to the early 1950s. Critically ill patients requiring serial blood sampling and real-time pressure monitoring for continuous assessment for treatment of hypertension or hypotension benefit from invasive hemodynamic monitoring. Continuous monitoring is more precise than currently available noninvasive monitoring systems. Rapid physiologic changes of the critically ill patient demand frequent titration of drugs that exceed the capability of noninvasive intermittent blood pressure devices. Over the last 60 years, technological advances have improved catheter design and insertion techniques that reduce insertion-related complications and improve first-stick success. In

The Editorial Review Board of the Journal of the Association for Vascular Access (JAVA) acknowledges all of our 2019 reviewers. Thank you for your time and expertise. Your thoughtful evaluations ensure only quality articles are published in the journal. JAVA reviewers with reviews completed in 2019 (* indicates reviewed five or more articles):

Amy Bardin-Spencer
Leigh Ann Bowe-Geddes
Peter Carr
Chris Cavanaugh
Naceur Chouayet
Lois Davis
Michelle DeVries
Salomão Faintuch
Anne Marie J. Frey
J. Hudson Garrett Jr.
Mary Beth Hovda Davis
Mark R. Hunter
R. Terry Jones
James C. Lacy*
Jack LeDonne
Britt

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