bluuebunny/crossref_metadata_2025_split huggingface dataset:
Two-stage Treatment Protocol for Isolated Septic Acetabular Cup Loosening
Authors: Anagnostakos Konstantinos , Jung Jochen , Kelm Jens , Schmitt Eduard 
Published: January 2018

The aim of this study was to evaluate the treatment of isolated septic acetabular cup loosening without involvement of the prosthesis stem by insertion of an antibiotic-loaded spacer head and stem retention. Between 1999 and 2008, 13 patients (5 men, 8 women, mean age 69 years) were treated according to this regimen. S. epidermidis and S. aureus were the two most commonly identified pathogens. In 12 cases the polymethylmethacrylate spacers were impregnated with 0.5 g gentamicin + 2 g vancomycin per 40 g bone cement, except in one patient with vancomycin allergy, in whom 0.5 g gentamicin + 0.4 g teicoplanin were used. The spacers acted as hemiarthroplasties. The mean spacer head implantation time was 88 (35–270) days. At a mean follow-up of 55 (12–83) months, infection eradication was achieved in 11 out of 12 cases (91.6%). Complications included a draining sinus, and one spacer and one definitive prosthesis dislocation. One patient died after reimplantation due to cardiopulmonary decompensation.
Central Vein Catheterization of Dialysis Patients with Real Time Ultrasound Guidance
Authors: Gallieni M. 
Published: January 2018

Internal jugular vein cannulation has become a routinary and clinically important aspect of medical care in critically ill patients. The landmark-guided technique usually affords rapid and easy vascular access, but it is not always successful and may be complicated by arterial puncture, hematoma, pneumothorax. A prospective, descriptive study is reported on the use and success of ultrasound-assisted central vein catheterization in dialysis patients who had an indication for internal jugular vein catheterization. Data were collected prospectively on number of punctures, needle passes, and success rates. Over a 6-year period, there were 220 attempts at internal jugular catheterization in 205 patients and ultrasound guidance was used in 210 of the 220 (95%) attempts. Incidences of successful puncture and cannulation using ultrasound were 100% (210 out of 210) and 99.5% (209 out of 210), respectively, compared with 80% (8 out of 10) and 80% (8 out of 10) in the landmark group. With the availability of the ultrasound device complication rates also improved markedly, suggesting that the ultrasound technique is an easily learned technique that rapidly produces an improvement over the external landmark method. First attempt success improved from 20% to 85%, carotid punctures decreased from 33% to 2.9% (6 out of 210). The patient population also included 32 patients with several high risk conditions, such as no visual or palpable landmarks, severe coagulopathies due to hepatic failure or excess of anticoagulation treatment. In these patients, cannulation was successful in 100% (32 out of 32) using ultrasound guidance. In 9 patients (9/195, 4.6%), preliminary ultrasound evaluation of the neck vessels failed to identify a right internal jugular vein suitable for cannulation, because of thrombosis or a small diameter of the vein. In all cases, the left internal jugular vein could be cannulated without difficulties. Our results confirm that ultrasound-guided cannulation of the internal jugular vein offers several advantages over the external landmarks technique: higher success rate in both vein puncture and catheter placement, lower complications, lower patient discomfort during the procedure because of a low number of needle passes. Ultrasound-assisted cannulation of the internal jugular vein may become the standard approach to dialysis catheter placement in the future.
Vascular Access for Chronic Haemodialysis in Lombardy
Authors: Limido A. , Galli F. , Baiardi P. , Piazza V. , Cantú P. , Salvadeo A. 
Published: January 2018

To evaluate the organisation of vascular access surgery, the techniques used to monitor surgical access and the central catheters, a survey was conducted amongst dialysis Units of Lombardy. A questionnaire was sent out to the 43 dialysis centres in Lombardy, 96% of which replied. In almost 90% of dialysis units nephrologists perform vascular access albeit in close cooperation with vascular surgeons for the more complex cases. First choice access is by distal arteriovenous fistula (AVF): 36% end-to-end, 31.7% side-to-end, and 19.5% side-to-side with distal ligature of the vein. As second choice proximal AVF is more widely used than AV grafts, which are implanted only when all native vessels and related surgical procedures are exhausted. Central venous catheters offer valid solutions not only as temporary access, but also as an alternative permanent one. In both cases the jugular vein is the most frequent site of insertion. Despite the documented incidence of related episodes of stenosis/obstruction, the subclavian vein is used as a temporary access in quite a high percentage of cases. Only in selected cases are diagnostic procedures (mainly Venography and Doppler studies) performed prior to permanent access choice. Similarly vascular access is monitored mainly using a recirculation test albeit not routinely. In case of vascular access thrombosis, surgical revision is the most common approach.
Catheter Rupture and Distal Embolisation: A Rare Complication of Central Venous Ports
Authors: Biffi R. , Pozzi S. , Orsi F. , Grasso F. , De Braud F. , Cenciarelli S. , Andreoni B. 
Published: January 2018

Central venous access devices placed through a percutaneous subclavian approach may be compressed by neighbouring bony structures, leading to biomaterial fatigue, catheter fracture at the compression site, and possible embolisation of distal fragment into the central veins. The aim of this paper is to review the experience of the authors, including more than 1300 subclavian port placements, carried out during a five-year period, discussing possible causes and therapeutic options of this rare complication. Nine patients out of 1320 (0.68%) experienced this complication during the five-year period of this study. Two patients only showed a retrospective radiologic evidence of the “pinch-off sign” (e.g. initial compression of the catheter at the costo-clavicular junction). No patients had symptoms from the embolised catheter fragment; the most frequent symptom (8 out of 9 cases) was a painful swelling around the port area during infusion, related to the extravasation of medications or fluids into the subcutaneous tissue. The site of embolised segment varied from azygos vein to right pulmonary artery; however, these findings did not affect the outcome, and all the embolised fragments were successfully retrieved through a transfemoral approach using a radiologic interventional technique. No fatality occurred. The catheter fracture and embolisation of the distal fragment are a well-known complication of subclavian central venous long-term cannulation, whose estimated overall incidence is 0.5–1%. Diagnosis is usually based on the radiologic appearance of the catheter compression (so called “pinch-off sign”), which is far from being constant; a clinical suspicion can derive from intermittent malfunction, which claims differential diagnosis with the presence of a fibrin sleeve around the tip of the catheter. Once diagnosed, the treatment is always an interventional radiologic approach, which has a very high success rate. When it fails, the possibility to leave the fragment embolised in the central veins, heart or pulmonary arteries, should be considered, being the thoracotomy and open catheter retraction questionable, at present time, in patients who have no symptoms and limited life-expectancy.
Vascular Access in Patients Affected by Short Bowel Syndrome
Authors: Fusaro F. , Gamba P.G. , Orzali A. , De Coppi P. , Scarpa M.G. , Zanon G. F. 
Published: January 2018

The aim of this study was to evaluate the problems induced by the use of a central venous catheter (CVC) in a series of patients with short bowel syndrome observed at the university of Padua (Italy) between January 1981 and June 1997. During this period, 14 patients required central venous access for parenteral nutrition (PN); 55 catheters were inserted, 6 with percutaneous and 49 with surgical techniques. We divided the patients into two groups according to PN duration. The first group includes 11 children with short/medium-term PN 8 are now eating, and 3 died from respiratory failure) while the second group includes 3 patients on home long-term PN. Thirteen catheters were placed in the first group, and the mean PN duration was 173 days; the three patients on home PN required 42 catheters. It is our experience that the use of catehters in patients requiring short/medium - term PN is a safe procedure with few complications; patients on home long-term PN present an increasing number of complications, and the vascular access could become a serious problem as the number of PN-dependent increases.
Slow Maturation of Arterio-Venous Fistula in Seven Uremic Patients: Use of Ash Split Cath® as Temporary, Prolonged Vascular Access
Authors: Conz P. A. , Crepaldi C. , La Greca G. 
Published: January 2018

The temporary vascular access is the essential condition required to perfrom hemodialysis in uremic patients in the absence of a permanent and utilizable vascular access. The cannulation of a central vein with a dual lumen catheter may be useful when a few weeks are required for the maturation of AVF. Longer times for AVF maturation (such as in diabetic patients and in aged patients) impose the use of a tunnelled catheter such as Tesio Catheter or Hickman Catheter which lead to minor complications and more efficient dialysis treatment. The Ash Split Cath®, a recently introduced chronic hemodialysis catheter, provides dialysis via a transcutaneous portion containing a 14 French cylindrical shaped catheter with D-shaped lumens and a dacron cuff. Due to the slow maturing of AVF, in our Department the Ash Split Cath has been used in 7 uremic patients (3 males and 4 females) who required hemodialysis. The cannulation of the internal jugular vein was performed by an ultrasound assisted technique and the correct catheter position was verified by standard chest X-rays. The average blood flowrates were 250 ml/min, and the mean KT/V calculated in all patients one month after the beginning of the dialytic therapy was 1.09 ± 0.02. In six patients the catheter was utilized for at least 4 months, in one patient for 8 months. The devices were easily removed when the patient's AVF was functional and usable. We found that the use of the Ash Split Cath as a temporary, prolonged vascular access in uremic patients was optimal allowing for flexibility in organizing the dialysis treatment schedule and in yielding a good performance in the initial dialysis therapy. Moreover, this device allows, in these patients, a satisfactory dialysis efficiency.
Haemodynamics of Brachial Arteriovenous Fistula Development
Authors: Martin A.G. , Grasty M. , Lear P.A. 
Published: January 2018

This study observes the development of brachial arteriovenous fistulae, and assesses methods of predicting potential usefulness for haemodialysis. Creation of an adequate brachial fistula causes significant changes in blood flow to the forearm and hand. A prospective study of fifteen consecutive patients undergoing brachial arteriovenous fistula formation for haemodialysis was undertaken. Clinical measurements and coloured flow Doppler measurements were performed pre operatively, immediately post operatively and at two and eight weeks after surgery. The morphology of the fistula was studied and the volume flow was measured. Digital pressure was measured pre and post exercise at each visit. Fourteen fistulae worked well by eight weeks. There was an immediate large increase in brachial artery blood flow and by two weeks all fistulae that went on to develop well had a brachial artery flow of more than 700 mls/minute. The cephalic vein mean diameter pre operatively was 2.39 mm and increased to 5.4 mm by two weeks post operatively. Fistulae with flows over 400 mls/minute at two weeks had a good outcome. There were significant differences in digital pressure after fistula formation (P ≤ 0.05). Digital mean arterial pressure dropped from 118 mm Hg pre-operatively to 98 mm Hg post operatively, at rest, and 89 mm Hg after exercise. Four patients developed forearm/hand claudication on exercise or signs of distal ischaemia. Three of these were diabetic with calcified vessels. All patients with a suitable cephalic vein should have attempted fistula formation rather than recourse to use of a synthetic graft. In diabetics creating a shunt in an already marginally competent vascular tree exposes the patient to risk of significant hand ischaemia.
Which is the Easiest and Safest Technique for Central venous Access? A Retrospective Survey of more than 5,400 Cases
Authors: Pittiruti M. , Buononato M. , Malerba M. , Carriero C. , Tazza L. , Gui D. 
Published: January 2018

There is an ongoing debate on the technique for central venous catheterization associated with the lowest complication rate and the highest success rate. In an attempt to better define the easiest and safest venous approach, we have reviewed our 7-year experience with 5479 central venous percutaneous punctures (by Seldinger's technique) for the insertion of short-term (n=2109), medium/long-term (n=2627) catheters, as well as double-lumen, large-bore catheters for hemodialysis and/or hemapheresis (n=743). We have analyzed the incidence of the most frequent insertion-related complications by comparing seven different venous approaches: jugular vein, low lateral approach; jugular vein, high lateral approach; jugular vein, low axial approach; subclavian vein, infraclavicular approach; subclavian vein, supraclavicular approach; external jugular vein; femoral vein. The results of our retrospective study suggest that the ‘low lateral’ approach to the internal jugular vein, as described by Jernigan and modified according to our protocol, appears to be the easiest and safest technique for percutaneous insertion of central venous access, being characterized by the lowest incidence of accidental arterial puncture (1.2%) and malposition (0.8%), no pneumothorax, and an extremely low rate of repeated attempts (i.e. more than two punctures before successful cannulation) (3.3%). We advocate the ‘low lateral’ approach to the internal jugular vein as first-choice technique for venipuncture in both adults and children, for both short-term and long-term central venous percutaneous cannulation.
Groshong PICC and Home Care: An Opportunity. Clinical Experience after the First 200 Implants
Authors: Spaziani S. , Micheli T. , Vincenzi B. , Campisi C. 
Published: January 2018

Peripherally Inserted Central Catheters (PICC) represent an alternative for critical patient care, and are safer to implant in home patients. The authors report on their experience with the first 200 4 Fr Groshong PICC implanted during the last 18 months. The procedure can be easily applied at home (98% successful implant rate), without the need for fluoroscopic or ultrasound guidance. Moreover, the authors believe that the X-ray control after implant is not strictly necessary. After 11,570 days/catheters, only 5 devices were explanted because of complications: 4 because of sepsis and peripheral phlebitis, and the last was explanted by another medical staff for unclear reasons. The complications needing no explanation were a total of 32: for 12 of them the external portion of tube was damaged during use, while for the other 20 the internal clots were resolved with forced flushing. The authors conclude that Groshong PICC can be considered the gold standard for home care management of critical patients, taking into account the quality of pure silicon, the presence of a valve and the specially-made closed-tip.
Relapsing Seroma in a Uremic Patient Bearing a PTFE Graft as Vascular Access
Authors: Allaria P.M. , Lucatello A. , Gandini E. , Battaglia C. , Giangrande A. 
Published: January 2018

Seroma is one of the most frequent complications of PTFE vascular grafts and its etiology is still unclear. Case report: A 51 year-old male on regular dialytic treatment for seven years underwent the surgical implantation of a vascular prosthesis of homologous safena due to the thrombosis of his native artero-venous fistula. Several years earlier the patient had suffered the amputation of the left forearm because of electric shock. A few months later the vascular prosthesis was replaced with a PTFE vascular graft as a result of aneurysm formation and thrombosis. During the following days a non pulsating swelling occurred near the arterial anastomosis. Ultrasonography, doppler sonography and aspiration confirmed the diagnosis of seroma and it was surgically removed. Some weeks later a new seroma was observed in the same site and associated with a skin ulcer. A new surgical removal had no benefit and about one month later a perigraft collection was found along with signs of bacterial infection. For this reason the patient underwent the surgical excision of the PTFE graft and a vascular access was warranted by placing a Tesio™ catheter. Usually surgery is considered mandatory in seromas larger than 2 cm in diameter and showing continuous growth. In our patient the poor vascular status might have suggested a more conservative management even with a seroma diameter of about 7 cm. Nevertheless the high risk of systemic infection prompted us to remove the PTFE graft.
Real-Time Ultrasound and Endocavitary Electrocardiography for Venous Catheter Placement
Authors: Cavatorta F. , Zollo A. , Galli S. , Dolla D. 
Published: January 2018

The authors report on their experience with internal jugular vein catheterization with temporary and tunnelled cuffed hemodialysis catheters in 527 patients from 1991 to 2001, using ultrasound guidance and monitoring of catheter placement by endocavitary electrocardiography. The incidence of successful puncture and cannulation using ultrasound was 99.62%. The majority of patients had catheters inserted on the first pass (93%) and fewer attempts were required (range, 2 to 5). In the first year of the procedure in 1991, we observed two cases of accidental puncture of the carotid artery because of an error in ultrasound localization of the neck vessel. Arrhythmias were not observed during this procedure. Right atrial electrocardiography was successful on 504 occasions (96.83%), and correct catheter placement was confirmed by plain chest-X-ray in the first 100 patients. The results confirm that real-time ultrasound guidance for catheter insertion is superior to traditional techniques relying on anatomic landmarks and should be adopted as the standard of care. Ultrasound guidance and EC-ECG improves both the success and the safety of internal jugular catheter insertion. The authors propose that EC-ECG be validated as a technique in compliance with recent Food and Drug Administration guidelines regarding the location of central venous catheter tips.
Ultrasound-Guided Cannulation of the Femoral Vein for Acute Hemodialysis Access with Silicone Catheters
Authors: Zollo A. , Cavatorta F. , Galli S. 
Published: January 2018

The percutaneous femoral approach for temporary central venous hemodialysis access is a mandatory part of patient management in many clinical settings. It is usually achieved with a blind, external landmark-guided technique. The aim of this study is to evaluate whether an ultrasound technique can improve on the external landmark method. From 1990 to January 2000, cannulation of the femoral vein was performed on 230 patients (125 male, 105 female, mean age 72 years, range 52–95 years) for temporary vascular access for hemodialysis (172 patients with acute renal failure and 58 patients in end-stage renal disease), using landmark localization with semi-rigid, uncuffed catheters. Between January 2000 and February 2001, ultrasound-guided cannulation of the femoral vein was utilized in 38 patients (20 male, 13 female, mean age 71, range 55–93 years) for temporary vascular access for hemodialysis (28 patients with acute renal failure and 10 patients in end-stage-renal failure). Uncuffed, dual-lumen silicone catheters were used. Cannulation of the femoral vein was achieved in 100% of cases using ultrasound, and in 87% using the landmark-guided technique. Using ultrasound, puncture of the femoral artery occurred in 2.6% of patients, and hematoma in 0%. Using the “blind” technique, puncture of the femoral artery occurred in 11.2% of patients, and hematoma in 3.9%. The average catheter dwell time, in accordance with NKF-DOQI guidelines, was 5 days (range 2 - 14 days) for semi-rigid catheters and 45 days (range 5–120 days) for silastic catheters. The number of complications rose significantly in the patients with semi-rigid catheters. In this group, local exit infection occurred in 105 persons (45% of cases), total catheter thrombosis in 46 (20%), bacteriemia in 28 (12%), and phlebitis of the leg in 6 (2.6%). In the group with silicone catheters local exit infection occurred in 4 patients (10 % of cases), total catheter thrombosis in 1 (2.6%), bacteriemia in 2 (5.2%) and phlebitis in 0 (0%). The result of the study suggests that ultrasound-guided cannulation of the femoral vein is superior to traditional techniques relying on anatomic landmark; it reduces the numbers of unsuccessful attempts and the possible acute complications of the procedure. We believe that femoral cannulation with modern flexible silicone catheters can be considered as a reliable temporary access, even for extended periods.
Anatomical variations of the Internal Jugular Vein in Non-Uremic Outpatients
Authors: Dolla D. , Cavatorta F. , Galli S. , Zollo A. , Ervo R. 
Published: January 2018

The internal jugular vein (IJV) should be the preferred form of venous vascular access for the placement of dialysis catheters. “Blind” puncture or “skin mark” ultrasound technique puncture present multiple complications due to the significant variations in IJV location in normal subjects and even more so in uremic patients. The aim of this study is to demonstrate the important rate of IJV site variations in a random healthy population. We tested 450 subjects (244 male, 206 female) in our hospital Ultrasound Ambulatory using an Ansaldo AUS ultrasound device with linear 10 MHz probe on both sides at the Sedillot triangle level and noticed the relations between IJV and carotid artery course. The most frequent location of IJV was the anterior lateral (79.3% on the right side, 83.5% on the left). The remaining options were lateral, anterior, posterior-lateral, anterior-medial. We found no significant difference in IJV diameter on either side of the neck. We therefore consider IJV puncture with ultrasound guidance to be the first choice in central venous cannulation for hemodialysis treatment. This procedure helps avoid incorrect puncture of the carotid artery related to its abnormal location.