Central Vein Catheter Research Articles

Treatment of concomitant persistent chylothorax and superior vena cava syndrome through innominate vein-right atrial bypass.

Persistent chylothorax is a major challenge in paediatric patients. We present a case of a 6.5-kg, one-year-old boy with SVCS and persistent chylothorax, who underwent successful surgery without cardiopulmonary bypass. His medical history included multiple co-morbidities such as myeloproliferative disease, short bowel syndrome, and central vein catheterizations. The patient also had IV thrombosis, progressing to SVC, and was on anticoagulants. Despite dietary changes and somatostatin, his high-output chylous pleural effusion persisted. He was treated with innominate vein-to-right atrial bypass using a 6 mm Dacron graft. Postoperatively, there was a significant reduction in effusion and accelerated recovery. Somatostatin failure was likely due to mechanical obstruction of the thoracic duct.

Vascular access in a post-lung transplant patient on maintenance hemodialysis: a case report

BackgroundAn arteriovenous fistula (AVF) is the most common type of vascular access for hemodialysis. As it causes volume overload and sometimes increases pulmonary artery pressure, it is unsuitable for some patients. Herein, we describe a patient with acute kidney disease who required maintenance hemodialysis with vascular access other than an AVF owing to post-lung transplant pulmonary hypertension.Case presentationA 50-year-old man with interstitial pneumonia underwent living-donor lobar lung transplantation at our hospital. Weaning from venoarterial extracorporeal membrane oxygenation was achieved; however, the patient required mechanical ventilation owing to pulmonary hypertension. He developed acute kidney disease and required maintenance hemodialysis with sustainable vascular access. Although echocardiography showed a normal ejection fraction, we expected volume overload after arteriovenous access construction to worsen his pulmonary hypertension because of his inadequate pulmonary vascular bed. Therefore, a tunneled central vein catheter was implanted into the right femoral vein as a bridge, and superficialization of the right brachial artery was performed for long-term vascular access.ConclusionsAs this patient had sustained post-transplant pulmonary hypertension and small grafts, we avoided creating arteriovenous access because of concern over the aggravation of pulmonary hypertension. Evaluation of right heart function and pulmonary hypertension is important before arteriovenous access construction.

A Review of Central Vein Catheter for Hemodialysis: Insertion Sites and Techniques

Chronic kidney disease (CKD) is a global epidemic, being increasingly prevalent in both developed and developing countries, including Indonesia. Hemodialysis (HD) is the primary renal replacement therapy, along with peritoneal dialysis and kidney transplantation. The effectiveness of HD relies on well-functioning vascular access, such as central vein catheters (CVCs). These catheters are classified by their duration of use: short-term, medium-term, and long-term. They are also distinguished by insertion type (central or peripheral), insertion site (jugular, subclavian, femoral), and number of lumens (single, double, triple). The preferred site for insertion is the internal jugular vein, followed by the femoral vein and the subclavian vein. Techniques for CVC insertion include the central approach, the posterior approach, and others. This article reviews the role of CVC for vascular access in HD. Specifically, various CVC insertion sites and techniques will be examined. The authors will also discuss the available research on the application of CVC as vascular access for HD in Indonesia.

Analisa Perawatan Central Vein Catheter (CVC) Terhadap Kejadian Infeksi Aliran Darah Primer (IADP) Pada Pasien Di Ruang Intensive Rumah Sakit Umum Daerah Dr. Zainoel Abidin Banda Aceh

Primary bloodstream infection is a laboratory-confirmed bloodstream infection that cannot be attributed to any source other than a Central Vein Catheter (CVC) and develops 48 hours after placement. Central Vein Catheter (CVC) placement in critical patients is often necessary for measuring central venous pressure, fluid resuscitation, and administration of inotropic and vasoactive drugs. This study aimed to determine the correlation between CVC care and patient-related risk factors for the incidence of primary bloodstream infection in patients in the Intensive Care Unit of Dr. Zainoel Abidin Regional General Hospital. The study employed a quantitative design with a cross-sectional study approach, and samples were selected using accidental sampling. Bivariate data analysis was conducted using the chi-square test, while multivariate data analysis used logistic regression with backward method modeling. The study identified age (p=0.018), underlying disease (p=0.017), and CVC care (p=0.019) as factors associated with the incidence of primary bloodstream infection. The underlying disease was the most dominant factor affecting the incidence of primary bloodstream infection, with EXP (B) = 23.293.

Incidental Discovery of Migrated Guidewire from Right Femoral Vein Catheterization: A Case Report

Background: Catheterization of central veins can be life-saving for gravely ill patients and remains the mainstay of vascular access for haemodialysis patients especially in the absence of arterovenous fistula. Femoral vein catheterization often comes in handy especially in emergency situations. This is nevertheless fraught with complications including: hemorrhage, femoral artery puncture, femoral nerve injury, pseudoaneurysm, fistula formation, thrombophlebitis, retroperitoneal hemorrhage, bowel perforation, urinary bladder puncture, and guidewire migration. However, guidewire migration has been considered a rare but serious and preventable complication. Case presentation: We report a case of a 64 year old end stage kidney disease patient who was on maintenance haemodialysis using femoral vein catheters as access. Patient was unaware he had a migrated guidewire in situ following femoral vein cannulation by unqualified health professionals. He remained asymptomatic until the migrated guidewire was incidentally discovered during an attempt at right internal jugular vein cannulation for placement of tunneled catheter for haemodialysis. Guidewire extraction was subsequently done through a right neck open surgery. Conclusion: Migrated guidewire is a rare complication of central vein cannulation. It is potentially preventable but prompt extraction should be done immediately if it occurs.

Risk of Systemic Inflammatory Response Syndrome Following Preoperative Glucocorticoids Administration in Patients After Percutaneous Nephrolithotomy: A Retrospective Cohort Study.

Systemic inflammatory response syndrome (SIRS) is one of the most serious complications in patients undergoing percutaneous nephrolithotomy (PCNL). Although glucocorticoids are increasingly used during PCNL, few studies have been concerned about the association between glucocorticoids and postoperative SIRS. The study aims to explore whether preoperative use of glucocorticoids is associated with SIRS after PCNL. A total of 1259 patients who underwent PCNL between January 2015 and April 2021 were enrolled in the retrospective cohort study. Risk factors for post-PCNL SIRS were identified by univariate and multivariate regression analysis. To further explore the association between preoperative administration of glucocorticoids and SIRS, 113 pairs of patients were matched for the confounding factors using propensity score matching (PSM) analysis. The odds ratios (OR) and 95 % confidence intervals (CI) for the above variables were analyzed. The incidence of SIRS after PCNL was 9.6 % (121/1259) and the patients who suffered from postoperative SIRS had longer hospital stays and higher hospital costs (all p < 0.05). Multivariate logistic regression analysis indicated that female, preoperative leukocyte count, insertion of central vein catheter, serum albumin, preoperative high-sensitive C-reactive protein/albumin ratio, preoperative transfusion, preoperative administration of glucocorticoids were independent risk factors for SIRS (all p < 0.05). After minimization, the effects of confounding factors by PSM, preoperative administration of glucocorticoids was significantly correlated with SIRS in patients after PCNL (OR=2.44, 95 %CI: 1.31-4.55, p = 0.005). Preoperative administration of glucocorticoids is an independent risk factor for SIRS in patients undergoing PCNL.

Efficacy and Safety of a DOAC Compared to Unfractionated Heparin and A Low Molecular Weight Heparin in the Prevention of Thromboembolism in Hematopoietic Stem Cell Transplant Recipients.

Hematopoietic stem cell transplantation (HSCT) patients are at risk of thromboembolic events, making thromboprophylaxis crucial. This study aimed to compare apixaban, a direct factor Xa inhibitor (DOAC), with dalteparin and unfractionated heparin for thromboprophylaxis in HSCT recipients. The safety outcome included the assessment of hemorrhagic events. In this open-label randomized clinical trial, 182 HSCT recipients were divided into three groups: Apixaban (n = 61, 2.5 mg two times a day), dalteparin (n = 59, 5000 IU daily), and unfractionated heparin (n = 62, 5000 IU twice daily). These anticoagulant regimens were administered after central vein catheterization and during hospitalization. The primary clinical outcome was the risk of thrombosis, and the secondary outcome was the rate of bleeding. Relevant laboratory results were analyzed using appropriate statistical tests. Among the 61 patients in the apixaban group, six experienced thrombosis (9.83%), with four (6.65%) of them on anticoagulants. In the dalteparin group, three patients (5%) developed thrombosis, two of whom (3.38%) were on anticoagulants. In the heparin group, all four thrombosis cases (6.4%) occurred in patients on anticoagulants (P = 0.543 overall and P = 0.776 in anticoagulant users). Only two cases of bleeding were reported (1.09% overall), one in the dalteparin group (1.69%) and the other in the apixaban group (1.63%). Apixaban, dalteparin, and heparin demonstrated similar effectiveness in preventing thromboembolism in HSCT recipients. Furthermore, the comparison of bleeding rates across the study groups did not reveal significant differences. Larger studies with higher event rates may yield more precise conclusions.

Vascular access challenges in hemodialysis patients with superior vena cava syndrome.

Superior vena cava syndrome in hemodialysis patients resulting from previous or current use of a tunneled central vein catheter is a rare but potentially severe condition. Two aspects have to be addressed during management and treatment: the restoration of central venous flow and the creation of an alternative vascular access to guarantee hemodialysis. Conforming to the current guidelines and literature, we present a stepwise approach and discuss therapeutic options. The removal of the tunneled central vein catheter should be attempted and a native vascular access created whenever feasible. First, an upper extremity AVF should be preserved or, as in our case, made functional. Endovascular treatment of CVSO should primarily consist of balloon dilatation. Placement of a stent or stent graft should be considered as a secondary option. HeRO graft placement may be considered in recurrent CVSO and recanalization with a Surfacer. LL-AVF or AVG need to be discussed and may be an alternative for certain HD patients when the risk of lower limb ischemia and infection is considered. Several therapeutic options are available and the basic principles are well established in the literature, although the level of evidence is not high. Therefore, we propose a stepwise and interdisciplinary approach to guide the challenging decision-making process in SVC.

Design and application of a warming fixation device for premature infants

A warming fixation device for premature infants was made and its clinical application effect was discussed. The warming fixation device for premature infants was designed and used in clinic. Sixty premature infants admitted to the neonatal ward of Baoding Hospital, Beijing Children's Hospital, Capital Medical University from January to June 2022 were selected as the control group, and 60 premature infants admitted from July to December 2022 were selected as the experimental group. In the control group, umbilical vein catheterization or central vein catheterization were performed using Astro Boy heating box, restraint band or artificial restraint. The preterm infants in the experimental group were radiated into the Astro Boy warm box with self-designed preterm warming fixation device for catheterization. The time of catheterization, the number of limb protrusion, the number of participants in catheterization operation, and the body temperature from 20 minutes of catheterization operation to the end of catheterization operation were recorded in the two groups. The frequency of hypothermia (< 36.5 centigrade) was calculated, and the differences in various indexes between the two groups were compared. (1) The warming fixation device for premature babies consists of two parts: warm sleeping bag and soft pad. The warm sleeping bag includes 4 parts: head, arm, chest and abdomen, and lower limbs. The chest and abdomen were designed with rectangular covering cloth, which can be opened to facilitate umbilical vein puncture for premature infants. There were 3 groups of restraint belts on the rectangular soft pad, which can respectively fix the arms, chest and abdomen of the warm sleeping bag and the lower limbs. During the catheterization operation, use Velcro to secure the warm sleeping bag to the cushioned surface, and select the area of exposed skin according to the piercing site. (2) There were no significant differences in gender, body weight and gestational age between the experimental group and the control group [male: 48.3% vs. 46.7%, body weight (kg): 1.86±0.06 vs. 1.82±0.06, gestational age (weeks): 31.33±0.31 vs. 32.25±0.34, all P > 0.05]. Compared with the control group, the catheterization time of experimental group was significantly shortened (minutes: 21.30±0.43 vs. 30.02±0.64, P < 0.01), the number of limb protrusion was significantly reduced (0 time: 70.0% vs. 33.3%, 1 time: 26.7% vs. 50.0%, P < 0.01), and the number of participants in catheterization operation was significantly reduced (people: 1.77±0.06 vs. 2.37±0.06, P < 0.01). The frequency of hypothermia in experimental group was significantly lower than that in the control group [6.12% (6/98) vs. 26.50% (31/117), χ2 = 15.536, P < 0.01]. The warming fixation device for premature infants is convenient to use, which can effectively shorten the tube placement time, save human resources, and reduce the incidence of hypothermia in premature infants.

Catheterization of the internal jugular vein and subclavian/axillary vein under ultrasound control in the wounded with hemorrhagic shock due to combat trauma: a retrospective cohort study

INTRODUCTION: Catheterization of central veins using ultrasound navigation increases the rate of successful catheterizations and reduces the number of complications. The use of ultrasound navigation can improve the efficiency and safety of catheterization in conditions where central vein puncture is difficult. OBJECTIVE: Comparison of the readiness of the internal jugular vein and the subclavian vein/axillary vein for puncture, the effectiveness and safety of their catheterization using ultrasound navigation in patients with hemorrhagic shock. MATERIALS AND METHODS: A retrospective study of the medical data of 146 victims who required puncture and catheterization of vessels under the control of ultrasound navigation was performed. In all victims, using ultrasound, the readiness of the vessels for puncture was visually assessed by the compression and collapse of the vein at the moment of slight superficial pressure with the sensor. RESULTS: Assessment of the vessel's readiness for catheterization showed that, at all degrees of shock, the readiness of the subclavian vein/axillary vein for catheterization was higher than that of the internal jugular vein. Analysis of all central venous catheterizations performed showed that they were completed on the first attempt, but during the attempt it was necessary to redirect, sometimes tighten and advance the needle again. The data obtained showed statistical differences in patients with II and III degrees of shock (p = 0.001). CONCLUSIONS: Against the background of infusion therapy through a peripheral venous catheter for all degrees of shock, readiness for puncture and catheterization of the subclavian vein/axillary vein was higher compared to the internal jugular vein. Such tactics for shocks of degree II and III result in fewer needle passes.

Precise Terminology and Specified Catheter Insertion Length in Ultrasound-Guided Infraclavicular Central Vein Catheterization.

Background and Objectives: As the latest research encourages the ultrasound-guided infraclavicular central venous approach, due to the lateral puncture site displacement, in comparison to the anatomical landmark technique based on subclavian vein catheterization, the need to re-calculate the optimal catheter insertion length and possibly to rename the punctuated vessel emerges. Although naming a particular anatomical structure is a nomenclature issue, a suboptimal catheter position can be associated with multiple life-threatening complications and must be avoided. The main study objective is to determine the optimal catheter insertion length by the most proximal ultrasound-guided, in-plane infraclavicular central vein approach, to compare results with the anatomical landmark technique based on subclavian vein catheterization and to clarify the punctuated anatomical structure. Materials and Methods: 109 patients were enrolled in this study. All procedures were performed according to the same catheterization protocol. In order to determine optimal insertion length, chest X-ray scans with an existing catheter were performed. The definition of punctuated vessel was based on computer tomography and evaluated by radiologists. Independent predictors for optimal insertion length were identified, prediction equations were generated. Results: The optimal catheter insertion length is approximately 1.5 cm longer than estimated by Pere's formula and can be accurately calculated based on anthropometric data. Computed tomography revealed: five cases with subclavian vein puncture and three cases with axillary vein puncture. Conclusions: Even the most proximal ultrasound-guided infraclavicular central vein access does not guarantee subclavian vein catheterization. A more accurate term could be infraclavicular central venous access, with the implication that the entry point could be through either subclavian or axillary veins. The optimal insertion length is approximately 1.5 cm deeper than the length determined for the anatomical landmark technique based on subclavian vein catheterization.

Incidence and Challenges in Management of Blood Stream Infections in Hemodialysis

Bloodstream infections pose a significant threat to patients undergoing hemodialysis, leading to hospitalizations, increased morbidity, and mortality. The Centers for Disease Control and Prevention (CDC) has prioritized the prevention of bloodstream infections in hemodialysis through their Making Dialysis Safer initiative.Most bloodstream infections linked to vascular access primarily occur in patients undergoing dialysis using central vein catheters. The Centers for Disease Control and Prevention (CDC) advocates core interventions as the best practices for catheter care in hemodialysis, demonstrating their effectiveness in reducing catheter-associated bloodstream infections. However, bloodstream infections linked to hemodialysis catheters persist at undesirable levels, it is likely due to failures in maintaining rigorous aseptic techniques or other factors beyond the scope of the CDC's core interventions. There is a urgent need for innovation of preventive measures. This review focuses on the current therapies, recent developments and also addresses potential drawbacks and adverse effects associated with thealternatives. This review also highlights the challenges and future perspectives which might prove to be beneficial in reducing infection rates in hemodialysis patients.

Factors Associated with Dialysis Initiation in Patients with Predialysis Arteriovenous Fistula

Introduction: A large proportion of patients initiated hemodialysis with a central vein catheter rather than a permanent vascular access which was recommended by guidelines. One major barrier was the paucity of evidence regarding the optimal timing of vascular access creation in predialysis patients. Methods: Our study prospectively enrolled 300 patients undergoing predialysis arteriovenous fistula (AVF) creation in our center from 2015 to 2018. Cox proportional hazard regression was performed to identify which demographic and clinical factors were associated with the initiation of hemodialysis after AVF surgery. A receiver operating characteristic area under the curve (AUC) was used to assess the predictive power of preoperative factors for the likelihood of hemodialysis initiation. Results: Overall, 163 (54.3%), 214 (71.3%), and 275 (91.7%) patients initiated hemodialysis within 3 months, 6 months, and 1 year, respectively, after AVF creation. The median time between AVF creation and hemodialysis start was 71.5 days. Using multivariate Cox regression analysis, three factors were associated with hemodialysis initiation within 1 year: serum phosphorus (HR = 1.407, p = 0.021), diabetic kidney disease (DKD) (HR = 1.429, p = 0.039), and cystatin C (HR = 1.179, p = 0.009). Cystatin C alone had a moderate predictive value for dialysis initiation (AUC = 0.746; p < 0.001), whereas the full model had a higher predictive value (AUC = 0.800; p < 0.001). Conclusion: DKD, serum cystatin C, and phosphorus at access surgery were associated with hemodialysis initiation within 1 year of the predialysis AVF creation. Our findings provide a basis for a more customized approach to planning AVF placement in patients with chronic kidney disease.

The outcome of ultrasound-guided insertion of central hemodialysis catheter.

To point out our experience and assess the efficacy and safety of real-time ultrasound-guided central internal jugular vein (IJV) catheterization in the treatment of hemodialysis patients. This retrospective study comprised 150 patients with end-stage renal disease (ESRD) who had real-time ultrasonography (US)-guided IJV HD catheters placed in our hospital between March 2019 and March 2021. Patients were examined for their demographic data, etiology, site of catheter insertion, type (acute or chronic) of renal failure, technical success, operative time, number of needle punctures, and procedure-related complications. Patients who have had multiple catheter insertions, prior catheterization challenges, poor compliance, obesity, bony deformity, and coagulation disorders were considered at high-operative risk. All patients experienced technical success. In terms of patient clinical features, an insignificant difference was observed between the normal and high-risk groups (p-value > 0.05). Of the 150 catheters, 62 (41.3%) were placed in high-risk patients. The first-attempt success rate was 89.8% for the normal group and 72.5% for the high-risk group (p = 0.006). IJV cannulation took less time in the normal-risk group compared to the highrisk group (21.2 ± 0.09) minutes vs (35.4 ± 0.11) minutes, (p < 0.001). There were no serious complications. During the placing of the catheter in the internal jugular vein, four patients (6.4%) experienced arterial puncture in the high-risk group. Two participants in each group got a small neck hematoma. One patient developed a pneumothorax in the high-risk group, which was managed with an intercostal chest tube insertion. Even in the high-risk group, the real-time US-guided placement of a central catheter into the IJV is associated with a low complication rate and a high success rate. Even under US guidance, experience lowers complication rates. Real-time USguided is recommended to be used routinely during central venous catheter insertion.

Risk and Prognosis of Upper Extremity Deep Vein Thrombosis.

Objectives: We aimed to investigate the clinical features of upper extremity deep vein thrombosis (UEDVT). Methods: We retrospectively reviewed the background, thrombus site, treatment, and outcome of 76 UEDVT patients. Results: Of the 76 UEDVT patients, 44 (57.9%) were men, and 51 (67.1%) were complicated by malignancy, 44 (57.9%) had an indwelling central vein (CV) catheter, 8 (10.5%) had concomitant pulmonary embolization (PE), and 33 (43.3%) were symptomatic. Regarding the thrombus site, the right internal jugular vein was the most common, with 30 cases (35.3%). As regards the treatment method, 53 patients (69.7%) received oral anticoagulants. In 2015, when direct oral anticoagulants (DOACs) was covered by insurance, there were 44 UEDVT cases, of which 34 (77.3%) received DOACs. Outcomes at a mean observation period of 37.5±41.5 months included 40 deaths (52.6%) with a mean survival of 16.3±21.3 months. The most common cause of death was malignancy, with 33 cases (82.5%). Conclusion: In the background of UEDVT, the combination of indwelling CV catheter placement and malignancy was frequently observed. While the risk of recurrence or PE complications is low, the prognosis of UEDVT complicated by malignancy is extremely poor.

The correlation between oxidative stress markers and increasing intracranial pressure: a study of Malondialdehyde (MDA), Superoxide Dismutase (MnSOD), Nicotinamide Adenine Dinucleotide Phosphate Hydrogen (NADPH), and catalase

Link of Video Abstract: https://youtu.be/nINFPi4uVow Background: Abnormalities in the neurosurgical field concerning cranial structure are almost always followed by increased intracranial pressure (ICP), which causes cerebral hypoxia and disrupts the whole cellular system. This study analyzes the correlation between ICP changes and oxidative stress markers, in subjects with various anatomical pathology abnormalities who underwent surgery. Methods: This was a cross sectional study of 24 subjects with ICP conducted in the Department of Neurosurgery, Cipto Mangunkusumo Hospital, Jakarta, from November to December 2009. In this study, ANOVA analysis has been done to measure the mean difference oxidative stress (MnSOD, NADPH, MDA, and catalase) in subjects with various changes in ICP who have undergone surgery and Spearman analysis to measure the correlation between each oxidative stress markers. Oxidative stress markers were measured from normal brain tissue taken intra-operatively, cerebrospinal fluid (CSF) taken while doing ventriculostomy, and peripheral blood taken from a central vein catheter (CVC). Results: The results showed that MDA concentrations in blood were significantly correlated with MDA in brain tissue (P = 0.029) in all of the ICP groups, CSF MnSOD concentration and CSF NADPH concentrations correlated with brain tissue NAPDH (p= 0.000) in congenital group and CSF catalase concentration correlated with brain tissue catalase (p = 0.00) in congenital group. Conclusion: Increased ICP caused by various pathological conditions causes changes in oxidative stress markers in brain cells, CSF and blood. Oxidative stress markers in blood and CSF are correlated strongly with the brain. It is suggested that it could be used to predict intracranial high pressure in all cases with intracranial abnormalities.

#6511 EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS OF MIGRANTS ON CHRONIC HEMODIALYSIS TREATMENT

Abstract Background and Aims The rate of migrants with end-stage kidney disease is rising in Italy. Migrants often present to nephrologists with advanced kidney disease, a condition that limits the choice to perform a diagnosis and prevent the progression of the disease. Low literacy, language barriers, lack of medical insurance, illiteracy and cultural diversity are the main factors limiting the referral to physicians. Data about the prevalence and clinical characteristics of migrants in dialysis units are scarce in the literature. Our study aimed to evaluate and characterize the epidemiological profile of migrants on chronic hemodialysis (HD) treatment. Data about demographics, clinical characteristics health-related quality of life (HRQoL) were compared with the Italian population. Method A retrospective cross-sectional observational study was conducted on patients who underwent HD at the University Hospital of Modena from December 2021 to August 2022. All patients on chronic HD treatment aged &amp;gt; 18 years were enrolled in the study. Data were collected from electronic health databases and interviews with a selected number of patients. HRQoL was evaluated by "EQ-5D" questionary. Overall, it ranged between a score from level 5 (no problem) to 25 (extreme problems). A scale (EQ VAS), numbered from 0 (worst imaginable health) to 100 (best imaginable health) was used to assess global assessment of own health. Patients have been subdivided based on their origin into "migrants" and "non-migrants”(or Italians). According to the International Organization for Migrations (IOM), we considered migrants all patients that were born in a foreign country and came to Italy for work, family reunification, economic or political reasons. Results In our hemodialysis center, 302 patients underwent hemodialysis for kidney failure. Migrants accounted for 18.2% (n. 55) of the HD population. They moved to Italy from Africa (62%), Europe (20%), Asia (16%) and Latin America (2%) for seeking work (84.3%) and family reconciliation (15.7%). A consistent percentage of migrants (37.5%) crossed the national border as undocumented migrants. Migrants started hemodialysis at a younger age than non-migrants (48.1[IQR, 39.7-56.7] vs 70.7 [IQR, 70.7-78.5]) years (P = .001) (Fig. 1). Most of them were male (69%). Migrant starter HD after 12.3 (IQR 6.5-20) years from their arrival in Italy. The age of migrants varied according to the geographic area: Subsaharian Africa (44.7 years), Asia (46 years), Europe (53.9 years) and northern Africa (54.5 years), although there was no statistically significant difference between groups (P = .67). The etiology of kidney disease was unknown in 40% of patients. Most of the patients (54.5%) started HD with a central vein catheter (CVC) and 53% of them were not referred to a nephrologist before HD. After a follow-up of 1.8 years, the rate of CVC decreased to 26.3%. Only 14.5% of the interviewed patients declared to be informed about home dialysis. Although, 87.2% of the patients were potentially eligible for kidney transplantation (age criteria) only a few of them(18.7%) was active on the waiting list. Migrants have a better perception of health-related quality of life than non-migrants. In the migrants and non-migrant groups, median “EQ-5D" score was 5 (IQR, 5-6) and 7 (IQR, 5-10), respectively (p= p&amp;lt;0.001). Global health assessment in migrants and non-migrant accounted for 90 (IQR, 80-91.5) and 80 (IQR, 70-90), respectively (P = .028). It is worth noting that these differences became not statistically significant when EQ-5D (P = .45) score and EQ VAS scale (P = .52) were adjusted for the age of participants. Conclusion Migrants were a consistent percentage of patients in our Dialysis Unit. This group of patients was formed by young people often unaware of their kidney disease. Late referral to the nephrologist had a profound implication on vascular access for HD. The language barrier and cultural diversity were the major limitations to entry into the kidney transplant waiting list.

Blood Culture Result Profile in Patients With Central Line-Associated Bloodstream Infection (CLABSI): A Single-Center Experience.

Background Central line-associated bloodstream infection (CLABSI) is among the most common bloodstream infections in the university hospital and intensive care unit settings. This study evaluated the routine blood test findings and microbe profiles of bloodstream infection (BSI) by the presence and types of central vein (CV) access devices (CVADs). Methods A total of 878 inpatients at a university hospital who were clinically suspected for BSI and underwent blood culture (BC) testing between April 2020 and September 2020 were enrolled. Data regarding age at BC testing, sex, WBCcount, serum C-reactive protein (CRP) level, BC test results, yielded microbes, and usage and types of CVADs were evaluated. Results The BC yields were detected in 173 patients (20%), suspected contaminating pathogens in 57 (6.5%), and 648 (74%) with a negative yield. The WBC count (p=0.0882) and CRP level (p=0.2753) did not significantly differ between the 173 patients with BSI and the 648 patients with negative BC yields. Among the 173 patients with BSI, 74 used CVADs and met the diagnosis of CLABSI; 48 had a CV catheter, 16 had CV access ports, and 10 had a peripherally inserted central catheter (PICC). Patients with CLABSI showed lower WBC counts (p=0.0082) and serum CRP levels (p=0.0024) compared to those with BSI who did not use CVADs. The most commonly yielded microbes in those with CV catheters,CV-ports, and PICC wereStaphylococcus epidermidis(n=9; 19%),Staphylococcus aureus(n=6; 38%), andS. epidermidis(n=8; 80%), respectively. Among those with BSI who did not use CVADs,Escherichia coli(n=31; 31%) was the most common pathogen, followed byS. aureus(n=13; 13%). Conclusion Patients with CLABSI showed lower WBC counts and CRP levels than those with BSI who did not use CVADs.Staphylococcus epidermidiswas among the most common microbes in CLABSI and accounted for the majority of yielded microbes in patients who used PICC.

Non-surgical external jugular vein catheterization using an ear vein access in piglets.

The objective of this study was to investigate the feasibility of external jugular vein catheterization through an ear vein in piglets. Forty-six sevoflurane-midazolam anaesthetized piglets were included. External jugular vein catheterization was conducted through the ear vein using the Seldinger technique. Part 1 (n = 27): optimal puncture site was based on the deltoid tuberosity as a landmark to reach the external jugular vein. The final position of the catheter was verified in 25 piglets using computer tomography. Catheterization time was recorded and patency of the catheter assessed by repeated blood sampling for up to 4 h. Part 2 (n = 19): ear vein catheterization was without taking into account any landmarks. Functionality for blood sampling was evaluated as described in part 1. Catheter advancement was possible in 25/27 and 18/19 piglets in parts 1 and 2, respectively. Median (range) time required for successful catheterization was 1.95 (1-10) min (n = 38). The deltoid tuberosity was a good landmark to reach the external jugular vein. But blood sampling was also possible through catheters ending slightly cranial to the external jugular vein. Despite successful catheter advancement, blood sampling was not possible from one catheter in each part of the study (total: two piglets). One of these catheters presented luminal damage, while the other one presented as normal after being removed from the animal. Summarizing, central vein catheterization through the ear vein was feasible in 93.5% and repeated blood sampling was possible in 89.1% of the piglets (n = 46).

Comparative evaluation between external jugular and internal jugular venous catheterization through landmark technique.

Cannulation of a central vein is crucial in patients for hemodynamic management and when insertion of a peripheral line is not possible. The internal jugular vein is the preferred access site; however, in the case of not being accessible, the second cannulation site of choice is still unclear. The study aimed to access the feasibility of external jugular vein cannulation versus internal jugular vein cannulation in terms of success, cannulation time, number of attempts and complications. In this prospective, randomised double-blinded study, 100 patients received 7Fr size triple-lumen central vein catheter either in the internal jugular vein (n = 50) or external jugular vein (n = 50) through the landmark technique as a part of anaesthetic care in the operation theatre. The number of attempts, cannulation time and incidence of complications in both the techniques were observed and recorded. The success rate in internal jugular vein cannulation was 88%, while in the external jugular vein, it was 78% (p = 0.17). The external jugular vein cannulation was comparatively quicker in our study (p = 0.01). Similarly, elevated body mass index did not affect the success rate in the number of cannulations attempts in either group (p = 0.08). In terms of complications, the internal jugular vein group had a total of 20% and the external jugular vein group had 28% complications; however, the complications were more severe in the internal jugular vein group. Anaesthetists should rethink alternate routes for the insertion of central vein cannulation. The external jugular cannulation route is one of them.