Venous Site Research Articles

Correlation Between EtCO2 and PCO2 in Patients Undergoing Critical Care Transport

Objectives End-tidal carbon dioxide (EtCO2) monitoring is widely used as a surrogate for the partial pressure of carbon dioxide (PCO2) in critically ill patients receiving manual or mechanical ventilation in prehospital, emergency, and critical care settings. Specific targets for ETCO2 are a key component of Emergency Medical Services (EMS) protocols, especially for specific patient groups such as those with traumatic brain injury. However, the correlation between EtCO2 and venous or arterial PCO2 is uncertain. We aimed to assess the correlation between EtCO2 and PCO2 in intubated patients undergoing critical care transport (CCT), and in specific subgroups of patients. Methods We performed a retrospective review of patients undergoing emergency transport by a multi-state CCT agency. Patients were included if they had an advanced airway and both an EtCO2 and PCO2 reading within 5 min of each other. We obtained data on patient demographics, transport characteristics, medical categories, vital signs, lab values, and specific interventions. We performed univariable and multivariable binary logistic regression to assess the association between delta PCO2 and these characteristics. Results We included 6,459 patients (mean age 58.4 years [SD 18.5], 57.1% male), of which a subset of 551 patients had multiple EtCO2-PCO2 measurements within 5 min. The median (IQR) initial delta PCO2 was 12.9 mmHg (7.1, 21.9). 3,967 (61.4%) patients had a delta PCO2 >10 mmHg and 1,843 (28.5%) had a delta PCO2 >20 mmHg. We identified an independent association between delta PCO2 >10 mmHg and age, male sex, interfacility transport, venous sampling site, respiratory rate, hypotension, hypoxia, and thoracostomy. In patients with multiple blood gas measurements, 76% had delta PCO2 >10 mmHg over the duration of the transport. Conclusions We identified substantial differences between EtCO2 and PCO2 across patients with medical and traumatic conditions undergoing critical care transport. The PCO2 assessment should be strongly considered as part of ventilatory management in patients encountered in emergency and critical care settings.

Sinus vein thrombosis conundrum: Persistent empty sella vs. flexible optic nerve sheath

IntroductionOur objective was to investigate the potential effect of thrombotic burden on pituitary gland height, bony sella and optic sheath width, taking into consideration the various venous sites and dominant drainage pattern. Patients and MethodsThis retrospective cohort study followed patients diagnosed with cerebral sinus vein thrombosis in a single primary healthcare center between the years 2000 and 2022. Data was collected from both CT/V and MR/V scans available on the local PACS system. Dural sinuses were divided into main anatomical sites and scored for patent, partially or totally blocked lumen. Dominant drainage flow was noted for each patient. For most scans, pituitary mid height, maximal depth and AP width of the bony sella and dorsum sella to tuberculum sella distance were assessed. Optic sheath width was measured for both sides at the maximal retrobulbar diameter. Regression methods, including linear mixed models, and non-parametric tests were used to analyze the data. Results90 patients (mean age, 44 years ±16.8, 54 women) were evaluated. Overall thrombus burden did not correlate with pituitary mid-height, however a relationship was observed between the change (from presentation) in the superficial thrombus score and the average width of the optic nerve sheath; the width of the optic sheath tended to decrease as thrombus burden improved and vice versa (p = 0.010). ConclusionsThrombus recanalization had a favorable effect on the optic nerve sheath diameter but did not appear to reverse the flattening of the pituitary gland, regardless of temporal improvement.

12410 Intra-operative Parathyroid Hormone Monitoring: Comparative Evaluation Of Sampling Sites And Assay Methods

Abstract Disclosure: R. Kwayess: None. S. Ajjour: None. M. Rahme: None. M. Assaad: None. J. Abbas: None. S. Jabbour-Khoury: None. R. Daher: None. E. Cavalier: None. O. Kreidieh: None. M. Chakhtoura: None. G. El-Hajj Fuleihan: None. Background: Primary hyperparathyroidism is a common endocrine disorder increasingly managed by minimally invasive parathyroidectomy (MIP) with intra-operative parathyroid hormone (IOPTH) monitoring using 2nd generation parathyroid hormone (PTH) assay. Objective: Compare the use of central sampling versus peripheral sampling, and of 3rd as opposed to 2nd generation PTH assays’ performance. Methods: We collected preoperative baseline characteristics and laboratory values for consenting participants undergoing parathyroidectomy at our center. We then measured IOPTH levels from peripheral and central venous sites using 2nd and 3rd generation assays at various intraoperative time points. We calculated the maximal intraoperative PTH drop from highest baseline (pre-incision or pre-excision) at peripheral site and pre-excision at central site for participants who were normocalcemic at ≥ 6 months post-operatively. We used paired t-test to compare the mean % drop in IOPTH by 2nd vs 3rd generation assays, and peripheral vs central sampling. Results: Out of 88 participants enrolled, 63 had follow-up data at 6 months or beyond and normal serum calcium level (9.41 ± 0.43 mg/dL). Mean age was 56.16 ± 11.5 years, 77.8% females and 47.6% had osteoporosis or osteopenia. Pre-operative mean values were: serum calcium 10.94 ± 0.73 mg/dL, ionized calcium 5.6 ± 0.68 mg/dL, PTH 131.93 ± 120.1 pg/mL and creatinine 0.77 ± 0.19 mg/dL. The majority of patients underwent excision of one abnormal gland (79.4%). On average, 57.3% of patients had the highest PTH drop at 10 mins, 32.7% beyond 10 minutes, and 9.7% at 5 minutes, regardless of assay type and site. Median PTH decrements were 81% and 83.8% for 2nd generation assay, and 86.5% and 89% for 3rd generation assays, at peripheral and central sites, respectively. There was no significant difference in the PTH drop comparing central to peripheral sites using either assay. However, 3rd generation assays displayed a higher drop compared to 2nd generation assay, for both central and peripheral sites (p-value <0.001). Discussion/Conclusion: Our study shows no difference in % drop between peripheral and central sampling, using either 2nd or 3rd generation assays. Central PTH sampling is commonly used by surgeons because of ease of access, while applying the Miami criterion. However, the drop in median 3rd generation PTH level was higher compared to the 2nd generation assay, regardless of the sampling site. Our findings suggest the necessity of defining larger PTH drop cut-off values for 3rd generation PTH assay than the commonly used Miami criterion.

Efficacy and safety of quick penetrating solution heparin, quick penetrating solution diclofenac, and heparin gel in the prevention of infusion-associated superficial thrombophlebitis: A randomized controlled trial.

The present study aimed to compare the efficacy, safety, and cost-effectiveness of quick penetrating solution (QPS) heparin, QPS diclofenac, and heparin gel in the prevention of superficial thrombophlebitis (ST). This randomized controlled trial was conducted after approval from the Institutional Ethics Committee and registration to Clinical Trial Registry of India. Patients of 18-60 years age, American Society of Anesthesiologists I/II, and who needed venous cannulation for at least 72 h were included in the study. Patients were randomly divided into three groups receiving study drugs (heparin gel, QPS heparin, and QPS diclofenac) every 8 hourly for a period of 72 h. Venous cannulation site was graded using the Visual Infusion Phlebitis Scale. Patients developing no ST, mean time to reach ST Grade 1 and 2, prevention of ST probability, and cost-effectiveness of interventions during the study period were assessed. Out of 219 included patients, development of no ST in the study groups at 72 h of treatment were heparin gel (11%), QPS heparin (9.6%), and QPS diclofenac (2.7%). The mean time (hours) to develop any grade ST in the study arms was heparin gel (36.2 [11.9]), QPS heparin (40.0 [13.4]), and QPS diclofenac (37.0 [13.2]). The Kaplan-Meier analysis did not reveal significant differences for the prevention of any grade ST or severe ST in three treatment arms. The average cost-effectiveness ratio for preventing thrombophlebitis was 14.2 in heparin gel-, 13.2 in QPS heparin-, and 95.6 in QPS diclofenac-treated patients. Based on efficacy, safety, and cost-effectiveness, heparin gel or QPS heparin can be used to prevent ST due to intravenous cannulation in surgical patients. QPS diclofenac is not a cost-effective option to prevent ST.

Success rate and complication prevalence of peripheral catheterization of the cephalic, lateral saphenous and marginal ear veins in pet rabbits

BackgroundIntravenous catheter placement is a routine procedure in exotic pet medicine, yet the selection of the optimal venous site for catheterization in rabbits (Oryctolagus cuniculus) remains controversial. Recommendations differ between countries and authors, and lack evidence-based data. This prospective study aimed to document and compare the prevalence and types of complications secondary to peripheral venous catheterization in domestic rabbits as related to the vein catheterized. MethodsCatheterization events (n=151) were randomly attributed to three groups, named according to the venous site selected: cephalic (n=39), lateral saphenous (n=58) and marginal ear vein (n=54). Rabbits that needed a catheter for fluid therapy, surgery, or imaging, were included in the study. Catheters were placed by three veterinarians following a standardized method. Data regarding the patient, the type of catheter, and the treatment were recorded. Complications were evaluated every day after the catheter placement, at removal and after 15 days. ResultsMinor complications that were observed included catheters which were bent at the elbow or removed by the rabbit, and twisted or chewed tubing. Ear necrosis and signs of phlebitis were considered major complications. Catheter placement failure was significantly higher in the “cephalic” group (odds ratio = 4, 95% Confidence Interval = [16.67,1.04], p = 0.048), without differences between the operators. For the marginal ear vein, there was also a significant association between the failure rate and the length of the rabbit's ear (Wilcoxon effect size = 0.42, 95% CI = [0.14,0.64], p = 0.003). No major complication was observed in any groups. Minor complications occurred without significant differences between the groups. Conclusionsand clinical relevance: The results suggest that intravenous catheters in rabbits do not carry significant complications irrespective of the chosen site, but cephalic vein placement carries the highest risk of failure.

The Clinical Value of Cranial CT Venography for Predicting Fusobacterium necrophorum as the Causative Agent in Children with Complicated Acute Mastoiditis.

Fusobacterium necrophorum (F necrophorum) is an anaerobic bacteria that causes invasive head and neck infections in children. Several studies have demonstrated an increasing prevalence of F necrophorum as the causative agent in acute mastoiditis in children, with associated high rates of intracranial complications such as epidural abscess and sinus venous thrombosis, to name a few. F necrophorum requires a treatment protocol that differs from the empiric treatment that is tailored to more common pathogens (eg, group A streptococci, Streptococcus pneumonia), and hence expediting the diagnosis is important. For evaluating complicated acute mastoiditis in children, cranial CT venography remains the imaging study of choice in most medical centers due to its availability in emergency situations. Based on our clinical experience, our hypothesis is that children with F necrophorum-associated complicated acute mastoiditis can be differentiated from those with other etiologies using CT venography. CT venography studies of 76 children hospitalized and treated for complicated acute mastoiditis were retrospectively reviewed. Retrieved imaging data included intracranial complications (epidural abscess, sinus venous thrombosis), cranial bone-related complications, and extracranial complications (subperiosteal abscess, temporomandibular joint abscess, and soft-tissue inflammation). The cohort was divided into children with F necrophorum-related disease (study group) and those with non-F necrophorum-related disease (control group). Thirty-seven children (49%) comprised the study group, and 39 children in whom the causative agents were other bacteria comprised the control group. There were significantly higher rates of complications in the study group: sinus venous thrombosis (P < .001), perisigmoid epidural abscess (P = .036), and extramastoid osteomyelitis (P < .001). Thrombosis in venous sites beyond the sigmoid sinus and jugular foramen (a pattern consistent with an otogenic variant of Lemierre syndrome) and emphysematous osteomyelitis were found only among children in the F necrophorum-related study group (32% and 22% accordingly). In children with complicated acute mastoiditis, CT venography findings of emphysematous osteomyelitis and/or thrombosis in venous sites beyond the sigmoid sinus and jugular foramen (a pattern consistent with the otogenic variant of Lemierre syndrome) should lead the radiologist to suggest F necrophorum-related mastoiditis.

A STUDY TO ASSESS THE EFFECT OF CRYOTHERAPY ON PAIN AND SELECTED BIOPHYSIOLOGICAL PARAMETERS DURING ARTERIOVENOUS FISTULA CANNULATION AMONG PATIENTS ON MAINTENANCE HAEMODIALYSIS

The current study entitled a study to assess the effect of Cryotherapy on pain and selected Biophysiological parameters during arteriovenous fistula cannulation among patients on maintenance Hemodialysis at KMCH, Coimbatore was undertaken, during the year 2010 - 2011 in partial fulfillment of the requirement for the degree of Master of Science in Nursing at KMCH College of Nursing, Coimbatore which is affiliated to Dr. M.G.R. Medical University, Chennai. Objectives: To assess the pain intensity during Xylocaine infiltration. To determine the effect of Cryotherapy on pain and Biophysiological parameters during AV fistula cannulation. To associate the level of pain with selected demographic variables. Design: Repeated Measures design. Setting: Hemodialysis unit of Kovai Medical Center and Hospital, Coimbatore. Sample: Sample size was 50. Conceptual framework: Modified Orlando‟s Nursing process model. Outcome measures: The demographic data was collected from the subjects. The pain intensity was measured during cannulation with Xylocaine and with Cryotherapy using Numerical Pain rating Scale. The investigator recorded the Biophysiological parameters during the procedure. Intervention: Cold application was done prior and during cannulation over on the web between the thumb and index finger of the hand which does not have the AV fistula. Results: The mean pain score with Xylocaine infiltration at arterial site was 4.81 and at the venous site was 4.86.There was a significant reduction in the pain score during cannulation with the application of Cryotherapy. The mean pain score during cannulation after Xylocaine at the arterial site was 1.59 and at the venous site was 1.51 whereas the mean pain score during cannulation after Cryotherapy was 0.96 and 0.92 correspondingly. But there was no statistically significant difference between the values of Biophysiological parameters such as BP, PR and RR during cannulation done with Xylocaine and with Cryotherapy. There was no significant association between pain score and age and gender of the subjects but there was significant association between pain and duration of illness and duration of treatment Conclusion: Cryotherapy is an effective nonpharmacological measure in reducing pain during AV fistula cannulation among Hemodialysis patients.

Syncope Due to Iatrogenic Cava Vein Obstruction: Rare Complication of Cardiac Implantable Electronic Device Leads

A 77-year-old female patient with multiple pacemaker leads experienced hypotension and syncope during right heart catheterization. Imaging studies revealed a stenotic inferior vena cava with superior vena cava obstruction and well-developed retrograde collateral vessels, suggesting that balloon obstruction of the sole venous return site caused low cardiac output leading to syncope.

Should Blood Cultures Be Drawn Through an Indwelling Catheter?

There is no practical way to definitively diagnose a catheter-related bloodstream infection in situ if blood cultures are only obtained percutaneously unless there is the rare occurrence of purulent drainage from a central venous catheter insertion site. That is why the Infectious Diseases Society of America guidelines for diagnosis and management of catheter-related bloodstream infections and Infectious Diseases Society of America guidelines for evaluation of fever in critically ill patients both recommend drawing blood cultures from a central venous catheter and percutaneously if the catheter is a suspected source of infection. However, central venous catheter-drawn blood cultures may be more likely to be positive reflecting catheter hub, connector, or intraluminal colonization, and many hospitals in the United States discourage blood culture collection from catheters in an effort to reduce reporting of central-line associated bloodstream infections to the Centers for Disease Control and Prevention. As such, clinical decisions are made regarding catheter removal or other therapeutic interventions based on incomplete and potentially inaccurate data. We urge clinicians to obtain catheter-drawn blood cultures when the catheter may be the source of suspected infection.

763 Is Central Venous Catheter the Main Culprit for Clinically Significant Venous Thromboembolism in Burn Patients

Abstract Introduction Venous thromboembolism (VTE) is a significant clinical problem for burn patients. The incidence of VTE has been reported as 0.25% to 47.1%. Known risk factors include large burn size, increasing age, male gender, active smoker or alcohol use, blood transfusion and surgeries. Central venous line (CVL) use is also a known risk factor for VTE. With all the known factors, we retrospectively analyzed our patients with VTE. Methods Retrospective chart review was performed on a single institution burn center in the calendar year of 2022. Pediatric patients were excluded. Following data were collected: age, burn size, mechanism, length of hospital stays, VTE diagnosis, VTE chemoprophylaxis, and central venous line days. VTE diagnosis was made using CT venogram or ultrasound. This project was a quality improvement initiative. Results There were 420 patients in the study period. Of all the admitted patients, there were 6 patients diagnosed with 7 VTE. One patient had 2 separate diagnoses of VTE at 2 distinct period and anatomical site. The incidence of VTE is 1.7%. Upon further chart review, all the VTE were at the site of central venous catheters. All the patients were on VTE chemoprophylaxis. The correlation between burn size, age, length of hospital stay and VTE was not significant. Conclusions Risk of VTE is high in burn patients due to the correlation with the Virchow’s Triad. All the patients admitted to the burn unit are placed on chemoprophylaxis unless contraindicated. The 7 patients diagnosed with VTE were on chemoprophylaxis. All the VTE were at the site of central venous catheter insertion sites, which is a known complication of catheters. The incident of 1.7% is on par with VTE incidents of burn patients, but much less than VTE caused by central venous catheters in non-burn patients. Large multicenter data collection is needed to validate this finding. Applicability of Research to Practice Directly appliable

Rejoining Veins for Forced Maturation of Small-Caliber Arteriovenous Fistula

ObjectivesTo evaluate the efficacy of rejoining mainstream and accessory veins for forced maturation of autogenous arteriovenous fistula (AVF) MethodsTwenty-three patients who underwent forced maturation through vein rejoining between January 2018 and September 2022 were included. In cases where AVF maturation failure due to the presence of accessory veins, rejoining was primarily considered when distinguishing the main branch becomes challenging. This difficulty typically occurs when the sizes of the two vessels are nearly equal and the combined diameters of these veins exceed 6 mm. ResultsThe mean age and follow-up duration were 57.39 ± 16.22 years and 965.65 ± 573.42 days, respectively. Rejoining of both arterial and venous cannulation sites was performed in 11 patients (47.8%), and rejoining of only the venous cannulation site or only the arterial cannulation site was performed in 11 patients (47.8%) and one patient (4.3%), respectively. The mean vein size was 0.35 ± 0.06 cm before rejoining and 0.69 ± 0.07 cm after surgery, indicating a significant increase in size (p < 0.01), whereas flow did not change significantly following rejoining surgery. Maturation and cannulation success was 100%. The 1-year primary patency rate after surgery was 82.0%. During the follow-up period, 34.8% of the patients required additional percutaneous transluminal angioplasty to maintain patency, and two patients (11.8%) had stenosis in the rejoined section. ConclusionsRejoining surgery is an effective method for achieving AVF maturation in patients with accessory veins when identification of the mainstream vein is difficult, and this method may be considered when achieving maturation by sacrificing one vein is expected to be challenging.

Non-surgical interventions to control bleeding from arteriovenous fistulas and grafts inside and outside the hemodialysis unit: a scoping review.

Prolonged bleeding from arteriovenous fistulas (AVF) and arteriovenous grafts (AVG) associates with worse outcomes; Within the hemodialysis unit these outcomes include anemia and quality of life disruptions, and outside the hemodialysis unit includes fatal hemorrhage. However, various guidelines for AVF/AVG bleeding management inside and outside the hemodialysis unit lack consensus. A scoping review was conducted of four databases, from inception to 17 February 2024. The study population was hemodialysis patients experiencing bleeding from AVF or AVG. Studies that assessed non-operative management were included. Sixteen studies met inclusion criteria. Most (14/16) addressed post-cannulation bleeding from AVF/AVG within the dialysis unit. Compared with standard dressings, hemostatic dressings (chitosan-, cellulose- or thrombin-based) decreased post-cannulation bleeding time at arterial and venous site 35.7%-84.0% (P<.05) and 38.5%-78.7% (P<.05), respectively. Use of chitosan-based dressings decreased percentage of patients bleeding 4-min post-cannulation by 16.3%-39.2%. One pilot observational study demonstrated no access thromboses or infections with short-term use of a compression device within the hemodialysis unit. However, the role of compression devices and tourniquets within the dialysis unit remains unclear, despite widespread use. Long-term AVF/AVG survival was not reported in any study. Limited research confirms that devices are effective in prevention of catastrophic out-of-hospital bleeding. It remains uncertain if device availability enhances patient confidence in managing out-of-hospital bleeding. This may impact patient choices around dialysis modality, access and transplant, but this remains uncertain. In hemodialysis patents with bleeding from AVF/AVG, several alternative dressings or devices decrease post-cannulation bleeding time within the hemodialysis unit. Existing research has not established criteria on when it might be appropriate to use specialized dressings. There is very limited research on methods to control bleeding from AVF/AVG outside the hemodialysis unit. More data are required before evidence-based guidelines can be made. Recommendations for future research are provided.

Factors Affecting the Early Maturation of Arteriovenous Fistulae Created at a Tertiary Centre in Oman.

This study aimed to determine the risk factors associated with the failure of arteriovenous fistulae (AVF) maturation. This retrospective cohort study was conducted from January 2014 to December 2018 in Sultan Qaboos University Hospital, Muscat, Oman. Patients were followed-up 3 months after surgery, and their electronic medical records were accessed for demographic and clinical data. Univariate analysis was used to determine the risk factors associated with early AVF maturation and multivariant analysis was used to determine the predictive factors for AVF failure. A total of 269 patients were included. Female gender was a significant factor affecting AVF maturity (P = 0.049), while age (P = 0.626), diabetes (P = 0.954), hypertension (P = 0.378), dyslipidaemia (P = 0.907), coronary artery disease (P = 0.576), cerebrovascular accident (P = 0.864), congestive heart failure (P = 0.685), previous central venous catheterisation (P = 0.05), fistula type (P = 0.863) and fistula site (P = 0.861) did not affect AVF maturation. Binary logistic regression showed that all the risk factors were insignificant. Failure of early AVF maturation affected 11.5% in the cohort. This study found that the proportion of early AVF maturation at our hospital is at par with that in the international literature. Failure of AVF maturation was significantly associated with the female gender. These findings can help nephrologists and vascular surgeons prognosticate AVF maturation rates. However, a larger study is needed for definitive conclusions.

Experimental comparative study of a novel drug-eluting arteriovenous graft in a sheep model.

Arteriovenous (AV) grafts often develop severe complications of stenosis due to neointimal proliferation that occurs either at the venous anastomosis site or at the outflow receiving vein. This study compares primary patency during 12 months of follow up for a new experimental Biomodics© interpenetrating polymer network (IPN) drug-eluting graft prototype with state-of-the-art GORE® ACUSEAL (ACUSEAL) in an AV graft model in sheep. An end-to-end bypass from the common carotid artery to the jugularis vein was performed bilaterally in 12 sheep. The usage of ACUSEAL or the IPN, both 6.0 mm in diameter, was determined via randomization. The sheep were followed up every 4 weeks with ultrasonic duplex scanning to determine patency; the experienced observer was blinded to the randomization. One sheep died after 11 days, and the final sample accordingly consisted of 11 animals. When comparing neointimal hyperplasia after 12 months in the two grafts, Fisher's exact test showed a significant difference with none out of 11 in the IPN grafts and 9 out of 11 in the ACUSEAL graft (p < 0.001). However, the Biomodics© IPN exhibited severe deterioration over time. Almost all of the grafts occluded during the 12 months of follow up. Although the zwitterion-bounded interpenetrating drug eluting polymer network showed signs to impair neointimal hyperplasia and thrombosis, age-related degeneration hindered demonstrating a potential improvement in patency.

Thrombotic Complications, Disease Progression, and Survivals in BCR::ABL1-Negative Myeloproliferative Neoplasms: A 12-Year Retrospective Study at a Single Center in Thailand

Objective: To assess the incidence of thrombotic events among patients with BCR::ABL1-negative myeloproliferative neoplasm (MPN) within a single center in Thailand. Materials and Methods: Conducted as a retrospective cohort study between 2008 and 2019, the present research focused on patients diagnosed with BCR::ABL1-negative MPN. Diagnoses were reviewed and reclassified based on the WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues (2017). Data collected encompassed demographic details, comorbidities, investigation results, treatments, and outcomes. The primary focus was on thrombosis rates in arterial and venous sites. Secondary outcomes included the incidence of major bleeding, thrombosisfree survival (TFS), and overall survival (OS). Results: One hundred seventy-five patients participated in the present study and comprised of 46 patients (26.3%) with polycythemia vera (PV), 123 (70.3%) patients with essential thrombocythemia (ET), and six patients (3.4%) with primary myelofibrosis (PMF). Most patients were over 60 years old. The rate of overall thrombosis rate was 28.0%, with 43.5% in PV and 23.6% in ET. Common sites of thrombotic events included the cerebral artery at 16.6%, coronary artery at 6.3%, peripheral artery at 4.0% and venous thromboembolism at 3.4%. The overall bleeding event rate was 13.7%, with 70.8% classified as major bleeding. The all-cause mortality rate within the present cohort was 30.9%. TFS and OS stood 72.0% and 69.1%, respectively. Conclusion: Thrombosis emerged as a significant complication in patients with BCR::ABL1-negative MPN, affecting 28.0% of individuals in the present cohort. Arterial thromboses, particularly ischemic stroke and cardiovascular events, were the predominant occurrences. Keywords: Myeloproliferative neoplasm; Polycythemia vera; Essential thrombocythemia; Thrombosis; Bleeding

Rapid and Self-Administrable Capillary Blood Microsampling Demonstrates Statistical Equivalence with Standard Venous Collections in NMR-Based Lipoprotein Analysis.

We investigated plasma and serum blood derivatives from capillary blood microsamples (500 μL, MiniCollect tubes) and corresponding venous blood (10 mL vacutainers). Samples from 20 healthy participants were analyzed by 1H NMR, and 112 lipoprotein subfraction parameters; 3 supramolecular phospholipid composite (SPC) parameters from SPC1, SPC2, and SPC3 subfractions; 2 N-acetyl signals from α-1-acid glycoprotein (Glyc), GlycA, and GlycB; and 3 calculated parameters, SPC (total), SPC3/SPC2, and Glyc (total) were assessed. Using linear regression between capillary and venous collection sites, we explained that agreement (Adj. R2 ≥ 0.8, p < 0.001) was witnessed for 86% of plasma parameters (103/120) and 88% of serum parameters (106/120), indicating that capillary lipoprotein, SPC, and Glyc concentrations follow changes in venous concentrations. These results indicate that capillary blood microsamples are suitable for sampling in remote areas and for high-frequency longitudinal sampling of the majority of lipoproteins, SPCs, and Glycs.

Evaluation of the effect of proximal massage and palm fisting in reducing the risk of peripheral venous catheter-related phlebitis: randomized control study.

Peripheral venous catheter (PVC) is a clinical procedure often performed by nurses in hospitals. Phlebitis can be prevented with more nursing care by applying PVC by trained nurses and using preventive methods. The aim of this study was to investigate the effect of proximal massage and palm fisting on the prevention of phlebitis in patients with a PVC. This randomized controlled study was conducted with patients who were hospitalized in the orthopaedics and traumatology service of a state hospital and had PVC. While the study group (n = 36) received proximal massage and palm fisting on the side with a PVC, the control group (n = 36) received standard care for PVC. The data were collected by using the 'Patient Demographics and Clinical Information Form', 'Peripheral Venous Catheter-Related Phlebitis Risk Scale', and 'Visual Infusion Phlebitis Assessment Scale'. There were no statistically significant differences between the groups regarding phlebitis development based on age, sex, chronic disease status, PVC insertion site, devices in the PVC, or fluids administered from the PVC. However, there was a significantly higher risk of PVC-induced phlebitis in patients who received proximal massage and palm fisting at 48 and 96 h, when the severity of phlebitis was evaluated on daily basis. The study showed promising results, suggesting that proximal massage and palm fisting may be a simple and inexpensive technique to prevent the occurrence of phlebitis in PVC patients. ClinicalTrials.gov: NCT05714137.

Comparison of ultrasound features and lesion sites in dysfunctional arteriovenous fistula

This study aimed to investigate ultrasound features of arteriovenous fistula stenosis and their relationship with primary patency after percutaneous transluminal angioplasty (post-intervention primary patency) and compare this classification with that using lesion location. Hemodialysis patients who underwent ultrasound-guided percutaneous transluminal angioplasty for arteriovenous fistula stenosis from July 2020 to December 2021 were retrospectively evaluated. Lesions (excluding inflow arteries) were categorized into five groups based on ultrasound features, and the clinical characteristics and risk factors affecting the post-intervention primary patency of the arteriovenous fistula were analyzed. Among 185 patients, 100 (54.05%), 36 (19.46%), 22 (11.89%), 11 (5.95%), and 16 (8.65%) were classified into the intima-dominant, non-intima-dominant, valve obstruction, vascular calcification, and mixed groups, respectively. The dialysis duration and arteriovenous fistula use time were the highest in the vascular calcification group at 86 (interquartile range: 49–140) and 77 (interquartile range: 49–110) months, respectively. Diabetes mellitus was most common in the intima-dominant group (42.0%). In Kaplan–Meier and univariate Cox analysis, type III lesion location (stenosis in the venous confluence site) was associated with the lower post-intervention primary patency. In the multivariate Cox analysis, percutaneous transluminal angioplasty times (the number of times patients were treated with percutaneous transluminal angioplasty for arteriovenous fistula stenosis dysfunction), vascular calcification, calcification at the lesion site requiring percutaneous transluminal angioplasty, and serum parathyroid hormone levels were independent risk factors for post-intervention primary patency. Ultrasound features showed that calcification of the arteriovenous fistula was detrimental to the post-intervention primary patency of arteriovenous fistula.

Exploring Axillary Vein Central Cannulation in Critically Ill Trauma Patients: A Focus on Infraclavicular Techniques

Managing major trauma in hospital settings, especially in emergency departments, presents significant challenges. Hypovolemic shock, often resulting from hemorrhage, is commonly due to bleeding in non-compressible areas like the abdomen and thoracic cavities, complicating intravenous access. Central vein cannulation is typically performed for effective volume resuscitation and blood transfusions prior to surgery, with common sites including the internal jugular, subclavian, and femoral vessels. However, in acutely bleeding trauma patients, early pre-hospital interventions such as cervical collars and pelvic binders can impede the cannulation of these veins and limit access to traditional central venous sites. This article explores the cannulation of central axillary veins, an underutilized yet advantageous route. Central axillary veins are readily accessible and provide a viable alternative for resuscitation in major trauma patients in emergency settings, offering a practical solution when other central venous access points are compromised.

Sites of blood collection and topical disinfectants associated with contaminated cultures: An ambidirectional cohort study.

We aimed to determine whether puncture sites for blood sampling and topical disinfectants are associated with rates of contaminated blood cultures in the emergency department (ED) of a single institution. This single-center, ambidirectional cohort study of 548 consecutive patients ≥20 years of age was performed in the ED of a university hospital in Japan over a 13-month period. Pairs of blood samples were collected for aerobic and anaerobic cultures from patients in the ED. Physicians selected puncture sites and topical disinfectants according to their personal preference. Potential contamination was identified in 110 of the 548 patients (20.1%). One hundred fourteen (20.8%) patients showed true-positive results for bacteremia, and 324 (59.1%) patients showed true-negative results. Multivariate analysis revealed more frequent contamination when puncture sites were disinfected with povidone-iodine (PVI) than with alcohol/chlorhexidine (ACHX) (adjusted risk difference, 19.1%; 95% confidence interval [CI]), 15.7-22.6; p < 0.001). In terms of blood collection sites, femoral and central venous (CV) catheter with PVI disinfection showed more frequent contamination than venous sites with ACHX (adjusted risk differences: 26.6%, 95% CI 21.3-31.9, p < 0.001 and 41.1%, 95% CI 22.2-59.9, p < 0.001, respectively). Rates of contaminated blood cultures were significantly higher when blood was collected from the CV catheter or femoral sites with PVI as the topical disinfectant.