2022…WOW! We have come so far and progressed, or should we say regressed? We were finally able to have an in-person face to face conference (664) with virtual attendance (366) too!!! (Excitement and shouts of joy!!!). We started the conference with a great poem written by my nephew Mikey Stevens, (a vascular need patient):

To live is to grow, to grow is to learn.
As we grow and learn, we must lead so they know.
AVA will grow as members align; together we will say “We can save that line!”
We raise our flag on the mountain of knowledge,

Highlights

Femoral central venous catheter placement is a common procedure performed in the pediatric intensive care unit.
Complete heart block is a rare but possible complication during pediatric central venous access procedures.
Knowledge of this complication is vital to safely performing this procedure well.

Abstract

Femoral central venous catheter (CVC) placement is a common procedure performed in the pediatric intensive care unit. Femoral CVCs have a relatively low intraprocedural complication rate compared with other access sites. We describe a case of guidewire-induced transient complete heart block during femoral CVC insertion. This complication is rare in the pediatric population. The incidence of its occurrence and guidance to prevent this complication are discussed.

Highlights

Femoral central line insertion is sometimes difficult in small children due to small vein size.
Compression of external iliac vein may provide a tourniquet effect and increase femoral vein size.
In this study, we showed that external iliac vein compression significantly increased femoral vein size.
By average, anteroposterior diameter increased by 41%; medial-lateral diameter increased by 19%.

Abstract

Aim:

Pediatric femoral central venous catheter insertion is sometimes difficult due to small vein size. External iliac vein (EIV) compression may provide a tourniquet effect to the femoral vein (FV) and may facilitate catheterization. This study was conducted to determine the effect of EIV compression on FV size and femoral venous catheterization success rates.

Methods:

This study had 2 parts. The first part was a single-arm experimental study. The second part was a randomized controlled trial. Children weighing 2.5–15.0 kg were included. First part: All patients received the same intervention and measurements. FV anteroposterior and medial-lateral diameters were measured by ultrasound without EIV compression, after which EIV was compressed using the assistant’s finger, and FV diameters were measured. Second part: Patients were randomized into compression and control groups. The compression group received EIV compression during femoral venous catheterization. The control group did not receive the compression.

Results:

A total of 30 patients (15 in each group) participated. EIV compression significantly increased FV anteroposterior diameter (3.36 ± 1.01 mm with compression, 2.39 ± 0.76 mm without compression, mean difference = 0.97 mm, 95% CI = 0.73, 1.21, P < 0.001) and medial-lateral diameter (4.58 ± 1.40 mm with compression, 3.86 ± 1.32 mm without compression, mean difference = 0.72 mm, 95% CI = 0.43, 1.01, P < 0.001). Catheterization success rates were not different between groups.

Conclusions:

EIV compression increased FV size, but the effect on femoral venous catheterization success rates was inconclusive due to a small sample size.

Abstract

Background

Despite the increasing popularity of midline catheters, data on the use of alteplase for restoring midline catheter patency is scarce.

Aims

This study aimed to evaluate off-label use of alteplase for midline catheter occlusions. Method: Adults who received alteplase into a midline catheter between January 2015 and May 2018 within a multi-hospital health system were included in this study. The primary outcome was restoration of infusion or withdrawal function from at least one lumen of a treated midline catheter.

Findings

Following alteplase administration, withdrawal function was restored in 47% (25/53) of occlusion events, infusion function was restored in 65% (11/17) of complete occlusion events, and infusion or withdrawal function was restored in 58% (31/53) of occlusion events. Only 34% (17/50) of catheters were replaced because of malfunction. Local bleeding was documented in 9% (n=5) of occlusion events after alteplase administration.

Conclusion

Most midline catheter occlusions treated with alteplase demonstrated restoration of infusion or withdrawal function.

Full Issue PDF

President’S Message

2022 Association for Vascular Access Scientific Meeting: Poster Abstracts

Transient Complete Heart Block during Femoral Central Venous Catheter Placement in a Pediatric Patient: A Case Description and Literature Review

Highlights

Abstract

Manual Compression of External Iliac Vein to Increase the Size of Femoral Vein for Femoral Central Venous Catheter Insertion in Small Children: Pilot Experimental Study and Randomized Trial

Highlights

Abstract

Aim:

Methods:

Results:

Conclusions:

Alteplase for the treatment of midline catheter occlusions: a retrospective, single-cohort descriptive study

Abstract

Background

Aims

Findings

Conclusion

Changes in nurses’ knowledge and clinical practice in managing local IV complications following an education intervention

Abstract

Background

Aim

Design

Conclusion

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