Central Venous Catheter Research Articles

Successful Use of a Midline Catheter for Leukapheresis in Patients Undergoing Collection for Immune Effector Cell Therapy, Donor Lymphocyte Infusion, and Hematopoietic Progenitor Cell Collection.

Apheresis is essential to conducting hematopoietic cell transplantation and genetically engineered cellular therapy procedures. Many patients and donors require central venous catheter (CVC) access for apheresis due to lack of adequate peripheral venous access. CVC placement has risks of associated complications and requires additional institutional resources and expertise. We present a single institutional experience with 78 patients, who underwent a total of 87 apheresis procedures after placement of a midline catheter. This included 49 individuals who collected cells for immune effector cell therapy. Apheresis through midline catheter was successful in 81 out of 87 procedures. There were no midline catheter associated thromboses or infections. Six patients required placement of a backup CVC and were able to undergo apheresis without delay. Our experience shows that use of midline catheter for apheresis is feasible and generalizable to most populations requiring cellular therapy, with the potential to decrease utilization of limited healthcare resources.

Using a Serious Game to Teach Central Line Care in Pediatric Critical Care Nursing.

Central venous catheters (CVCs) are used in pediatric patients to deliver IV fluids, blood products, medications, and nutrients. Potential complications include central line infection, which carries a high risk of morbidity and mortality in this population. Pediatric critical care nurses play a crucial role in helping to reduce the risk of infection. The aim of this study was to develop, implement, and evaluate the effectiveness of a serious, simulated, gaming-based intervention to improve the skills and knowledge of RNs in the early stages of their career regarding central line insertion, care, and infection prevention. A single-arm, pre- and postinterventional pilot study was conducted at the Riley Hospital for Children at Indiana University Health, from July 2021 to July 2022. The study participants were bedside pediatric critical care nurses who were provided with education and skills training regarding CVC placement and maintenance through a so-called serious game-essentially, a video game with a purpose. A simulation session and multiple-choice knowledge test were used to assess skills and knowledge retention both before and after the intervention. A total of 32 pediatric critical care nurses participated in the study; however, 1 nurse did not complete the follow-up assessment. The study revealed a statistically significant increase in the overall mean (SD) global performance score from 4.06 (2.11) before the intervention to 5.97 (1.80) afterward. Specific areas of performance also showed significant improvement: handwashing prior to the procedure (P = 0.04), covering the procedure site (P = 0.01), cleaning the site properly (P < 0.01), and ensuring central line placement before use (P < 0.01). However, there was no statistically significant difference in the nurses' performance on the multiple-choice knowledge test before and after the intervention. This study suggests that serious games have the potential to improve nursing education, particularly in complex procedures like central line insertion and maintenance. Our findings indicate that serious gaming is effective in engaging learners and enhancing their skills. More research is needed to evaluate the long-term impact of serious games on learning outcomes and patient care.

The effects of early enteral feeding, fortification, and rapid feeding advancement in extremely low birth weight infants.

Preterm infants are at risk for necrotizing enterocolitis (NEC) and sepsis. Optimal strategies of preterm feeding to achieve full enteral feeding early with minimal duration of central lines without increasing the risk of NEC remain uncertain. We aimed to evaluate if new enteral feeding strategies reflecting early initiation, fortification, and more rapid advancement is beneficial without increasing the risk of NEC. We performed a retrospective cohort study including 122 infants born with birth weight<1000g during Period 1 (old feeding protocol, n=61) and Period 2 (new feeding protocol, n=61) to compare the incidence of NEC, late-onset sepsis, the duration of central line, and the growth outcomes before and after the implementation of feeding strategies to reflect early initiation of feeding within 12h of life, early fortification at 60mL/kg/day, and more rapid feeding advancement up to 30mL/kg/day. Median time to reach full enteral feeds was decreased from 9 to 6days (p<0.001). The duration of central venous catheters was also improved from median 7 to 5days (p<0.001). The incidence of NEC was not different (11.5% in Period 1 vs. 8.2% in Period 2, p=0.54). 14 infants (23%) had late-onset sepsis in Period 1 vs. 8 infants (13.1%) in Period 2 (p=0.16). The growth outcome was comparable between the two periods (p=0.47). Earlier initiation of enteral feeding and fortification, and more rapid advancement were safely introduced with significantly shorter duration of central lines without increasing the incidence of NEC.

Inadvertent insertion of dialysis catheter into subclavian artery treated with a covered stent: A case report.

When inserting central venous catheters, inadvertent injury of major vessels is a rare yet critical complication. Direct surgery is sometimes overly invasive. This report describes a subclavian artery injury caused by inadvertent cannulation of a dialysis catheter, successfully treated with a covered stent. An 82-year-old woman with acute renal failure due to sepsis required emergency dialysis. During the insertion of a 12-Fr dialysis catheter into the right jugular vein, pulsatile reflux was noted. Computed tomography revealed catheter misplacement in the subclavian artery. Considering the patient's fragility, endovascular repair was performed. After embolization of side branches, a GORE VIABAHN stentgraft was delivered using a pull-through technique and deployed to seal the injury site. The patient was discharged without neurological or vascular complications. Covered stents offer an effective solution for major vessel injuries requiring immediate hemostasis, particularly when direct surgery is complicated by underlying medical or anatomical conditions.

Does a central venous catheter influence fluid and vasopressor use in patients undergoing high risk colorectal resection?

Does a central venous catheter influence fluid and vasopressor use in patients undergoing high risk colorectal resection?

Innominate artery repair via upper sternotomy after misplacement of central venous catheter - a case report -

Innominate artery repair via upper sternotomy after misplacement of central venous catheter - a case report -

Best evidence summary for the management of exercise in patients with central venous access devices.

Central venous access devices (CVAD) are widely used in patient care, providing an essential, reliable pathway for patients to receive chemotherapy, long-term infusions, and nutritional support. However, a system of exercise management has not been developed in patients with CVAD. To evaluate and summarize the evidence for management exercise in patients with CVAD and provide guidance for clinical practice. Systematic searches were conducted in domestic and international databases for evidence on exercise in patients with CVAD. The types of literature included clinical decisions, guidelines, systematic reviews, expert consensus, and original research. The retrieval time is from the database construction to October 2023. We finally identified 20 articles that had high-quality results. We summarized the 26 pieces of best evidence from these articles, covering nine aspects: the effects of exercise interventions; ways of exercise; type of exercise tools; timing of exercise; dose of exercise; exercise precautions; monitoring of exercise safety; complications of exercise interventions; scales to assess the effect of exercise. Of these pieces of evidence, 12 were "strong" and 14 were "weak," 14 pieces of evidence were recommended in level 1, and 12 pieces of evidence were recommended in level 5. The following 26 pieces of evidence for exercise management of CVAD in patients were finally recommended. However, as this evidence comes from only one country, relevant factors such as the clinical environment should be evaluated before application. Further studies should include diverse populations from multiple countries to ensure the findings are widely applicable and to identify any potential variations in exercise outcomes for patients.

Experience with the implementation of central venous catheters by medical oncologists in a non-surgical setting

Totally implantable central venous catheters (CVCs) are widely used in the management of patients with malignant diseases. Conventionally, port implantations were carried out by general surgeons and vascular radiologists. In recent years, the medical staff of the Medical Oncology department at the Central University Hospital of Asturias (HUCA) has developed a simplified methodology for the routine implantation of these devices. The aim of this study was to review our experience of CVCs and analyze the outcomes regarding catheter duration, complications, and cost comparison with respect to conventional port implantation by vascular radiologists. An observational epidemiological study was conducted, analyzing the methodology performed in a non-surgical, outpatient setting utilizing the Seldinger technique, without fluoroscopic control. A thorax X-ray was performed after each procedure and no prophylactic antibiotics were required. From January 2015 to March 2019, five hundred port systems were implanted, with a median age of 62 years (range 18–81), male 286/female 214. Most patients had a digestive tumor (79.4%). The right jugular vein was the most accessed in 345 patients (69%), followed by right subclavian in 144 (29%). Complications were observed in 49 patients (9.8%), immediate in 16 (3.2%), and late in 33 (6.6%). Thirty-nine devices were removed (7.8%). The cost incurred for port implantations by medical oncologists was lower (994.38 € cheaper for each device) compared to those implanted by vascular radiologists. Our experience suggests that implantation of port devices by medical oncologist in a non-surgical environment is safe and cost saving regarding conventional procedures.

Outcome-based simulation training for ultrasound-guided central venous catheter placement: clinical impact on preventing mechanical complications

BackgroundCentral venous catheter placement has been associated with mechanical complications, some of which can be life-threatening. Recent studies have shown that simulation-based education on ultrasound-guided central venous catheter placement improves puncture success rates; however, its effect on reducing mechanical complications remains unclear. This observational study examined how outcome-based simulation training for ultrasound-guided central venous catheter placement affects the incidence of mechanical complications in a clinical setting.MethodsThe Safe Central Venous Catheter Placement and Management Committee established a reporting system to monitor central venous catheter placement. In 2016, a skill assessment of ultrasound-guided central venous catheter placement was conducted. Outcome-based simulation training was introduced in 2017. Skills were evaluated using the skill assessment tool developed by the Japanese Society for Medical Simulation.ResultsAfter implementing skill assessment and outcome-based simulation training, the mechanical complication rate decreased from 2.2% in 2015 to 1.2% in 2023.ConclusionsA recent meta-analysis reported a 2.3% mechanical complication rate during ultrasound-guided central venous catheter placement. In comparison, the 1.2% complication rate at our institution is notably lower. This study suggests that outcome-based simulation training for ultrasound-guided central venous catheter placement may help reduce the incidence of mechanical complications in clinical settings.

Impact of Type of Vascular Access on Clinical Outcomes in Peritoneal Dialysis Patients Transitioning to Haemodialysis: An ANZDATA Study

Abstract Background Vascular access on haemodialysis corresponds with long term outcomes. However, the effect of access on haemodialysis transfer for peritoneal dialysis (PD) patients has not been fully explored. Methods Retrospective cohort study of incident adult PD patients from the Australian and New Zealand Dialysis and Transplant (ANZDATA) Registry who transferred to haemodialysis between 2004-2022. Associations between vascular access on transfer (central venous catheter [CVC] or arterio-venous access [AVA]) and clinical outcomes (all-cause mortality, cause-specific mortality, kidney transplantation and return to PD) were compared using Cox proportional hazards analysis and competing risk models. Results Of 6,824 patients, 65% used a CVC on transfer and 35% an AVA. Variability of access type at transfer between centres was high (range 13% to 98% for CVC). AVA transfer was associated with a longer PD vintage (1.6 versus 1.2 years, P&amp;lt;0.001) and inadequate PD as a cause of transfer (29% versus 15%, P&amp;lt;0.001). All-cause mortality was lower for AVA transfer compared to a CVC (hazard ratio (HR) 0.71, 95% confidence intervals (CI) 0.66- 0.77). The risk was lowest for infection-related mortality (HR 0.59, 95%CI 0.45- 0.77) Kidney transplantation was more likely in AVA transfer compared to a CVC (HR 1.18, 95%CI 1.05- 1,33), but return to PD was less likely (HR 0.67, 95%CI 0.59- 0.71). Results remained consistent in the competing risk analysis. Conclusions Patients who transferred with an AVA, compared to a CVC, showed better survival and kidney transplantation rates, but were less likely to return to PD.

Impact of practice changes on catheter-related exit-site and bloodstream infection rates in a Canadian hemodialysis center: A retrospective study.

Hemodialysis vascular access predisposes patients to exit-site infections (ESIs) and bloodstream infections (BSIs), resulting in significant morbidity and mortality. The objective was to characterize hemodialysis catheter-related (CR) ESIs and BSIs while considering potential factors associated with infection. The study period was selected to coincide with new CR-infection prevention measures at the midpoint. These included masking during exit-site care, using chlorhexidine-alcohol versus povidone-iodine antiseptic, administering cefazolin prophylaxis with central venous catheter (CVC) insertions, and reducing temporary CVC use for chronic hemodialysis starts. Data were collected retrospectively, including patient characteristics, hemodialysis history, CVC details, and CR-infections. Quarterly infection rates were calculated per 1000 CVC days, and potential factors associated with infection were investigated. Modeling was used to characterize infection rates and covariates over time. Over 39 months, data for 267 patients, 499 CVCs, and 114,825 CVC days were captured. During the study period, there were 113 ESIs and 64 BSIs, with >80% of infections caused by gram-positive bacteria. ESI and BSI rates were 0.98 and 0.56 per 1000 CVC days, respectively. There were significant reductions in infection rates over time. The ESI rate dropped when new CR-infection prevention measures were introduced (p < 0.01), from a mean of 1.28 to 0.73 per 1000 CVC days (p = 0.003). The rate of BSI trended downward to a low of 0.10 per 1000 CVC days in the last quarter of the study. The BSI rates associated with temporary and permanent CVCs were 1.25 and 0.53 per 1000 CVC days, respectively (p = 0.1). There was a strong correlation between the declining BSI rates and declining temporary CVC use over time (rho = 0.73, p = 0.005). CR-ESI rates dropped significantly when new hemodialysis CR-infection prevention measures were introduced. CR-BSI rates declined over the study period, as did the use of temporary CVCs.

Creating an Ellipsys percutaneous arteriovenous fistula after a failed ipsilateral WavelinQ fistula: A case report of an endovascular approach for access restoration.

The introduction of devices for endovascular dialysis access creation (WavelinQ and Ellipsys) offers practitioners more options for access management in dialysis patients. Especially in terms of reducing the usage of central venous catheters, a native fistula is desirable as an initial dialysis access. We present a case in which a failed WavelinQ type fistula was reactivated using the Ellipsys procedure on the same arm. This specific rescue method is based on the idea that the proximal part of an endoAVF from an earlier WavelinQ procedure which resulted in adequately dilated veins, comprising the perforating vein, may allow a subsequent Ellipsys procedure. This case report shows how the use of endovascular techniques such as WavelinQ and Ellipsys can be incorporated in a clinical context and create new options for the patient.

Mortality-related risk factors of carbapenem-resistant Enterobacteriaceae infection with focus on antimicrobial regimens optimization: a real-world retrospective study in China

ObjectivesTo determine the mortality-related risk factors for carbapenem-resistant Enterobacteriaceae (CRE) infection in hospitalized patients and to compare the clinical efficacy of different antimicrobial regimen.MethodsData were retrospectively collected from a 3,500-bed regional medical center between January 2021 and June 2022. Mortality-related risk factors were analyzed by the Cox proportional regression model for multivariate analysis.Results120 patients were included and the all-cause mortality was 20.8% (25/120). Multivariate analysis showed that age (HR = 1.035, 95%CI: 1.002–1.070, P = 0.036), SOFA score (HR = 1.169,95%CI: 1.066–1.281, P = 0.001), central venous catheter (HR = 3.858, 95%CI: 1.411–10.547, P = 0.009), the length of hospital stay (HR = 0.868, 95% CI: 0.806–0.936, P = 0.000) and combination therapy (HR = 3.152, 95%CI: 1.205–8.245, P = 0.019) were independent mortality risk factors after CRE infection. All patients received definitive therapy and 65.0% (78/120) received sensitive drug treatment. Among those 65.4% (51/78) received combination therapy and 34.6% (27/78) received monotherapy. Subgroup analysis of the non-sepsis group showed significantly lower mortality in monotherapy than in combination therapy (0% versus 22.2%, P = 0.034). Patients who received carbapenem-containing therapy had significantly higher mortality than those who received carbapenem-sparing therapy (31.3% versus 13.9%, P = 0.022). CAZ-AVI-containing therapy presented a lower mortality (19.0%) and a higher 7-day microbiological clearance (47.6%) compared to other antimicrobial regimens, but there were no statistical significance (P>0.05).ConclusionsPatients with older age, higher SOFA score, central venous catheter, shorter hospital stay after CRE infection may had poor outcomes. Since patients with non-sepsis have a lower mortality rate from monotherapy, combination antibiotic treatment should not be routinely recommended. Patients who received CAZ-AVI-containing therapy presented a lower mortality compared to other antimicrobial regimens without statistical significance, further larger sample size is needed for verification.

CO2 field-flooding devices offer potential value for cardiopulmonary bypass procedures for CHD performed via a right-side small incision approach

ObjectiveThis study sought to evaluate the value of a CO2 field-flooding device in cardiopulmonary bypass (CPB) surgical procedures for congenital heart disease (CHD) performed via a right-side small incision approach.MethodsBetween April 2022 and December 2023, 234 children with simple CHD who underwent CPB via a right-side small incision approach were separated into a control group (n = 93) without the use of a CO2 field-flooding device and a treatment group (n = 141) in which this device was added to the traditional surgical manual exhaust. Demographic, perioperative, arterial blood gas (ABG), and laboratory test data were then compared between these groups of patients.ResultsThere was a significant difference in abnormal electrocardiogram (ECG) after aorta de-clamping during CPB, and interventions for abnormal ECG after aorta de-clamping during CPB between the control and treatment groups (17(18.3%) vs.14(9.9%), P = 0.048;12(85.7%) vs.7(50%),P = 0.013). The treatment group exhibited a lower pH (7.34 ± 0.07 vs. 7.36 ± 0.06, P = 0.039) and a higher PaCO2 (43.08 ± 7.36 vs. 38.86 ± 5.65 mmHg, P = 0.042) at the time of 30 min after initiation of CPB. A significant reduction in postoperative CK-MB was observed in treatment group (41.20 ± 17.88 vs. 56.57 ± 22.99 U/L, P = 0.002). Lower 3-day postoperative CRP levels were also observed in the treatment group relative to control (5.77 ± 0.48 vs. 9.45 ± 0.98 mg/L, P < 0.001). The S100ß concentration in the relevant patient cohort increased significantly from the time just after induction, intubation, and installation of the right central venous line to the time of admission to CCU (71.61 ± 11.83 vs. 124.04 ± 38.80, P = 0.01) and at the time of 24 h after operation (71.61 ± 11.83 vs. 101.97 ± 30.31, P = 0.01). No differences on S100β serum concentration level were found at the time of installation of the right central venous line between two groups. But there were statistically significant differences in S100β serum concentration level at the time of admission to CCU between control group and treatment group. (161.19 ± 6.62 vs. 86.89 ± 9.69 pg/ml, P = 0.01). Similar results were observed at the time of 24 h after operation. (127.62 ± 19.44 vs. 76.33 ± 10.40, P = 0.01).ConclusionThese data suggest that the CO2 field-flooding device can safely be used when performing CPB surgical procedures via a right-side small incision approach to treat CHD without hypercapnia. The use of such a CO2 field-flooding device at a flow rate of 5 L/min may help protect against cardiac and nervous system damage in children undergoing CHD surgery.

Tortuous Internal Carotid Artery on Ultrasound: A Cautionary Case of Ultrasound Guided Central Venous Catheter Insertion

No abstract available

Early coagulation disorder and the predictive value of D-dimer for deep vein thrombosis in major burn patients.

To investigate coagulation disorders and thrombotic complications in the earlystage after burn, and to evaluate the predictive reliability of D-dimer for deep vein thrombosis (DVT) diagnosis in major burn patients. This retrospective study was performed in the Department of Burns, Southwest Hospital, and included 288 adult major burn patients (≥40 % TBSA) without prophylactic anticoagulant therapy. All patients received routine screening assays of coagulation indicators and Doppler ultrasound scan (DUS) during the 28 days post-burn regardless of the clinical symptoms of DVT. Coagulation abnormalities were commonly observed during the 28 days post-burn. There were 24 patients (8.33 %) diagnosed with DVT based on DUS on a median of 23 days after burn. Older age (OR=1.47) and increased insertions of central venous catheter (OR=1.67) were identified as independent risk factors for DVT. Serum D-dimer levels were elevated in 97.6 % (281/288) of patients in the first week post-burn. Patients identified with DVT had significantly higher serum D-dimer levels on the 3rd and 7th days post-burn. The D-dimer level on the 7th post-burn day showed a moderate predictive value for DVT by ROC analysis (AUC=0.711). The optimal threshold was 2.25 mg/L, with a sensitivity of 0.818 and a specificity of 0.566 at this threshold. Early coagulation disorder can occur and last for over 28 days after major burn injury. The serum D-dimer level on the 7th post-burn day may be used as a risk factor to identify the individuals with high-risk of DVT among major burn patients.

An iliac arteriovenous fistula associated with leg swelling 2 years after the removal of a hemodialysis catheter: A case report.

Temporary central venous catheters are commonly used for patients who require emergency hemodialysis. In rare instances, this procedure can result in a very serious complication known as arteriovenous fistula (AVF). Although some cases of femoral arteriovenous fistula have been reported previously in the literature; however, the incidence of iliac AVF precipitated by a hemodialysis catheter is exceedingly uncommon. The purpose of this study is to report a case in which a hemodialysis catheter caused a femoral arteriovenous fistula and to describe the successful treatment, thereby providing a reference for the diagnosis and treatment of such conditions in the future. Herein, we report the case of a patient with diabetes and end-stage kidney disease (ESKD) who presented with an iliac arteriovenous fistula as a complication of hemodialysis catheter insertion into the right femoral vein. Two years after hemodialysis catheter removal, the patient was admitted to our institution with swelling of the right lower limb and calf pain. The patient was subsequently diagnosed with an iliac arteriovenous fistula by computed tomography angiography and angiography. The patient was transferred to the Vascular Surgery Department for surgical treatment. The patient's leg swelling improved after surgery. After 1 year of follow-up, there was no occurrence of swelling in the patient's right leg. If the patient has a history of femoral venous catheter placement and develops limb swelling, in addition to considering the presence of a femoral arteriovenous fistula, it is important to consider the possibility of an iliac AVF. Iliac AVF are rare disorders. The primary goal for treatment of IAVF is to relieve associated symptoms. Based on the results of this study, the endovascular approach is safe and effective for the treatment of iliac AVF. Iliac AVFs are rare disorders. The primary goal of treatment for iliac AVFs is to relieve associated symptoms. Based on the results of this study, the endovascular approach is safe and effective in the treatment of iliac AVFs.

Evaluating the Adequacy of Central Line-Associated Bloodstream Infection As a Quality Measure: A Cross-Sectional Analysis at a Single Tertiary Care Center.

The current definition of central line-associated bloodstream infection (CLABSI) may overestimate the true incidence of CLABSI as it is often unclear whether the bloodstream infection (BSI) is secondary to the central line or due to another infectious source. We aimed to assess the prevalence and outcomes of central CLABSI at our institution, to identify opportunities for improvement, appropriately direct efforts for infection reduction, and identify gaps in the CLABSI definition and its application as a quality measure. Retrospective cross-sectional study of patients identified to have a CLABSI in the period 2018-2022 cared for at the value-based purchasing (VBP) units of a 1200-bed tertiary care hospital located in Cleveland, OH. Each CLABSI episode was assessed for relationship with central venous catheter (CVC), suspected secondary source of BSI, mortality associated with the CLABSI hospital encounter, and availability of infectious disease physician or primary physician documentation of infectious source. CLABSI episodes were classified as CVC related, CVC unrelated, and CVC relationship unclear. Mortality during the same encounter as the CLABSI event was assessed as an outcome measure. Descriptive statistics were performed. A total of 340 CLABSI episodes occurred in adult patients in VBP units. Majority of the CLABSI, 77.5% (266), occurred in the ICU. Of the CLABSI analyzed, 31.5% (107) were classified as unrelated to the CVC; 25.0% (85) had an unclear source; 43% (148) were classified as CVC related. For CVC-related cases, Staphylococcus and Candida were the predominant organisms. For the CVC unrelated and unclear groups Enterococcus was most prevalent. The mortality rate was lowest among patients classified with a CVC-related BSI. The positive predictive value (PPV) of the Centers for Disease Control and Prevention CLABSI definition to predict a true CVC-related infection was found to be 58.0%. The definition of CLABSI as a surrogate for catheter-related BSI is inadequate, with a PPV of 58.0% (43.1-67.6%). Efforts should be redirected toward revising the CLABSI definition and possibly reevaluating its criteria. Resources should be assigned to further investigate and systematically prevent BSIs from secondary sources while adhering to existing CLABSI prevention bundles.

Use of vascular access methods for hemodialysis in Serbia: Results from SerbVasc registry.

In many countries, hemodialysis is still the most common method of renal replacement. Significant regional variations exist in creating and maintaining vascular access for hemodialysis. Therefore, analyzing national registries with vascular access data is essential for developing effective national treatment strategies. The Serbian national vascular surgery registry was established as part of the VascuNet collaboration network in 2019. The registry comprehensively records vascular procedures across Serbia, including those related to vascular access for hemodialysis. This study aims to evaluate the prevalence of different vascular access methods for hemodialysis in Serbia, focusing on both new and prevalent patients and examining demographic differences and risk factors. The data were collected from the vascular accesses section of the SerbVasc registry over a 3-year observational period, focusing on the following aspects: number of incident and prevalent patients with types of vascular access, as well as comparison of patients with arteriovenous fistulas (AVF), arteriovenous grafts (AVG), central venous catheters (CVC), and tCVC based on age, gender, smoking, and comorbidities. There were total of 1024 incident hemodialysis patients. AVF was created in 219 patients (21.4%), AVG in 5 patients (0.5%), and tCVC in 150 patients (14.6%), while hemodialysis via CVC was initiated in 650 (63.5%) patients. The total number of permanent vascular accesses for HD was 1402, comprising 686 (48.9%) distal AFVs, 220 (15.7%) proximal AVFs, 91 (6.4%) AVGs, and 405 (28.8%) tCVCs. The prevalence of current smoking was highest in the tCVC (48.3%) and lowest in the dAVF group (18.40%). The percentage of patients starting hemodialysis with AVF remains suboptimal. tCVC is used substantially as first and permanent access, particularly among older patients.

A nomogram for predicting central venous catheter-related infections in maintenance hemodialysis: A 4-year single-center study.

To develop and validate a nomogram model for predicting central venous catheter-related infections (CRI) in patients with maintenance hemodialysis (MHD). MHD patients with central venous catheters (CVCs) visiting the outpatient hemodialysis (HD) center of Xuzhou Medical University Affiliated Hospital from January 2020 to December 2023 were retrospectively selected through a HD monitoring system. Patient data were collected, and the patients were divided into training and validation sets in a 7:3 ratio. The training set was used to establish the model, which was verified using the validation set. Multiple logistic regression analysis was performed to identify risk factors for central venous CRI and develop a nomogram prediction model. A total of 300 MHD patients were enrolled. Multivariate analysis showed that catheter duration, catheter site, catheter reinsertion, history of catheter infection, diabetes, and albumin <35 g/L were risk factors for central venous CRI. The area under the receiver operating characteristic (ROC) curve (AUC) for the training set was 0.902 (95% confidence interval (CI) = 0.862-0.941), with a sensitivity of 85.7%, specificity of 80%, and a Youden index of 65.7%, and that for the validation set was 0.826 (95% CI = 0.726-0.905), with a sensitivity of 80.5%, specificity of 77.9%, and a Youden index of 58.4%. The model demonstrated good discrimination and calibration (Hosmer-Lemeshow goodness-of-fit test statistics: training set: χ2 = 4.709, p = 0.788; validation set: χ2 = 7.171, p = 0.518). This study identified six risk factors associated with central venous CRI in MHD patients. This predictive model demonstrates good prognostic performance and can be used by clinicians to screen for high-risk patients with central venous CRI, thereby enabling the early implementation of risk management strategies.