bluuebunny/crossref_metadata_2025_split huggingface dataset:
Arteriovenous Fistula Salvage Utilizing a Hybrid Vascular Graft
Authors: Jones Robert G. , Inston Nicholas G. , Brown Timothy 
Published: May 2014

Introduction Loss of arteriovenous fistula as access for hemodialysis leads to significant morbidity and increased mortality risk. Methods Maintenance of this access is of paramount importance and we describe a case of a patient with a functioning radiocephalic fistula with associated arm swelling due to poor narrow caliber venous drainage above the elbow but with normal central veins. Results A hybrid vascular graft was anastomosed to the upper extent of the fistula and the nitonol stent section introduced into the patent axillary vein. Conclusion The described method led to resolution of symptoms and arm swelling. The described method allowed the continued use of a mature fistula.
Satisfactory Reliability among Nursing Students using the Instrument PVC ASSESS to Evaluate Management of Peripheral Venous Catheters
Authors: Ahlqvist Margary , Berglund Britta , Nordström Gun , Klang Birgitta , Johansson Eva 
Published: May 2014

Purpose Nursing students should be given opportunities to participate in clinical audits during their education. However, audit tools are seldom tested for reliability among nursing students. The aim of this study was to present reliability among nursing students using the instrument PVC assess to assess management of peripheral venous catheters (PVCs) and PVC-related signs of thrombophlebitis. Methods PVC assess was used to assess 67 inserted PVCs in 60 patients at ten wards at a university hospital. One group of nursing students (n=4) assessed PVCs at the bedside (inter-rater reliability) and photographs of these PVCs were taken. Another group of students (n=3) assessed the PVCs in the photographs after 4 weeks (test-retest reliability). To determine reliability, proportion of agreement [P(A)] and Cohen's kappa coefficient (κ) were calculated. Results For bedside assessment of PVCs, P(A) ranged from good to excellent (0.80-1.0) in 55% of the 26 PVC assess items that were tested. P(A) was poor (<0.70) for two items: “adherence of inner dressing to the skin” and “PVC location.” In 81% of the items, κ was between moderate and almost perfect: moderate (n=5), substantial (n=3), almost perfect (n=5). For edema at insertion site and two items on PVC dressing, κ was fair (0.21-0.40). Regarding test-retest reliability, P(A) varied between good and excellent (0.81-1) in 85%-95% of the items, and the κ ranged between moderate and almost perfect (0.41-1) in 90%-95%. Conclusions PVC assess demonstrated satisfactory reliability among nursing students. However, students need training in how to use the instrument before assessing PVCs.
Surgical Treatment of Cephalic Arch Stenosis by Central Transposition of the Cephalic Vein
Authors: Sigala Fragiska , Saßen Regine , Kontis Elissaios , Kiefhaber Laura D. , Förster Rolf , Mickley Volker 
Published: May 2014

Purpose After creation of a brachiocephalic (BC) arteriovenous fistula (AVF), stenosis of the cephalic vein close to its junction with the axillary vein (cephalic arch stenosis, CAS) can develop. Flow impairment and access thrombosis are the consequences, sometimes complicated by prestenotic aneurysm of the cephalic vein. We here report our experience with cephalic vein transposition (CVT) for CAS. Methods From March 2007 through February 2012, symptomatic CAS was detected in 25 patients (13 female) with either dysfunction (n=14) or thrombosis (n=11) of their BC AVF. All were treated by CVT: the vein was ligated and cut distally to the stenotic segment, then tunneled subcutaneously to the medial aspect of the upper arm and anastomosed to the proximal brachial or basilic vein in an end-to-side fashion. Simultaneous thrombectomy of the cephalic vein was performed in 11 patients and aneurysmorrhaphy in 9. In addition, one patient had a proximal new AV anastomosis, another angioplasty of an in-stent restenosis of the access-draining subclavian vein. Results After CVT, two acute complications (8%) occurred: access thrombosis (one) and bleeding (one). During follow-up (1 to 54 months, median 13 months, 34.5 patient-years), six patients died with functioning AVF, three were successfully transplanted. Primary (secondary) 1-year patency was 79% (90%), with a reintervention rate of 0.1/patient/year. Conclusions Primary 1-year access patency rates after CVT compare favorably with those after interventional treatment, and reintervention rates are lower. Frequently occurring prestenotic aneurysms could be repaired simultaneously. CVT should therefore be regarded as the treatment of choice for CAS.
Quantification of Fibrin in Blood Thrombi Formed in Hemodialysis Central Venous Catheters: A Pilot Study on 43 CVCs
Authors: Lucas Thabata Coaglio , Tessarolo Francesco , Veniero Patrizia , D'Amato Elvira , Caola Iole , Nollo Giandomenico , Huebner Rudolf , Brunori Giuliano 
Published: May 2014

Purpose Fibrin deposition and thrombotic occlusion represent a serious cause of access dysfunction in hemodialysis central venous catheters (CVCs). The aim of this work was to define and apply a method for imaging and quantifying fibrin in thrombi formed into the side holes of CVCs. Methods Forty-three CVCs removed from a cohort of dialyzed patients were analyzed in this pilot study. Hematoxylin and eosin and a modified Carstair's staining were applied on permanent thrombus sections. Fluorescence microscopy and image analysis were performed to quantify the fibrin amount. Results Highly fluorescent areas were invariably associated with fibrin by Carstair's method. The deposition of concentric layers of fibrin and erythrocytes was easily identified by fluorescence microscopy, showing growth features of the thrombus. Fibrin amount in diabetic patients was significantly higher than that in nondiabetic patients with median (interquartile range) values of 51% (47-68%) and 44% (30-54%), respectively (p=0.032). No significant difference in fibrin content was found by grouping data according to catheter type, permanence time, insertion site and dialysis vintage. Higher variability in fibrin values was found in thrombi from CVCs removed after 1-15 days compared with 16-60 days. A trend of an increase in fibrin amount in thrombi was noted according to blood platelet count at CVC insertion. Conclusions The analytical method presented here proved to be a rapid and effective way for quantifying fibrin content in thrombi formed on CVCs with potential application in future clinical studies.
Comparison of Tesio and LifeCath Twin Permanent Hemodialysis Catheters: The VyTes Randomized Trial
Authors: Power Albert , Hill Peter , Singh Seema K. , Ashby Damien , Taube David , Duncan Neill 
Published: May 2014

Purpose Central venous catheters for maintenance hemodialysis (HD) are designed to attain the required dialysis dose through sustained high blood flow rates (BFR). The authors studied the immediate and long-term performance and complications of two twin-catheter systems, the Tesio catheter (TC) and the LifeCath Twin (LC), to inform clinical practice. Methods This single-center randomized controlled parallel-group trial allocated 80 incident patients (1:1) to receive either a TC (MedComp) or LC (Vygon). Patients were dialyzed to target BFR 450 mL/min and followed up for 12 months. The primary outcome was achievement of target BFR during the first HD session. Secondary outcomes included thrombotic dysfunction, displacement and catheter-related infection. Catheter dysfunction was defined by a BFR ≤ 250 mL/min. Results More LCs reached the primary endpoint (44% vs. 10%, p=0.001) delivering a higher BFR (mean 383±82 vs. 277±79 mL/min, p<0.001). Significant differences in BFR persisted until the fourth dialysis session. Rates of catheter-related bacteremia (0.40 vs. 0.51/1,000 catheter days, p=0.7) and exit site infection were similar between groups (0.24 vs. 0.09/1,000 catheter days, p=0.4). Overall rates of catheter dysfunction were 2.8/1,000 catheter days (95% CI 2.1-3.5), with no differences in thrombolytic lock use although the LC group required more thrombolytic infusions (6 vs. 0, p=0.01). Conclusions The LC can deliver greater BFRs in the first three HD sessions following insertion although this did not translate into differences in performance, dialysis adequacy or complication rates with long-term use. Both catheter types can consistently deliver high BFRs over an extended period of time.
The use of Tunneled Central Venous Catheters: Inevitable or System Failure?
Authors: Aitken Emma L. , Stevenson Karen S. , Gingell-Littlejohn Marc , Aitken Margaret , Clancy Marc , Kingsmore David B. 
Published: May 2014

Purpose To evaluate reasons for tunneled central venous catheter (TCVC) usage in our prevalent hemodialysis population and assess the impact of a surgically aggressive approach to definitive access creation. Methods Clinical review of all patients in the West of Scotland dialyzing via a TCVC in November 2010 was performed. Reasons for TCVC usage and TCVC complications were evaluated. Over the subsequent year, aggressive intervention was undertaken to achieve definitive access in all suitable patients and outcomes re-evaluated a year later (November 2011). Results There was no significant difference in the proportion of patients dialyzing via a TCVC in 2010 compared to 2011 (30.3% (n=193) vs. 31.7% (n=201), respectively; p=0.56). All patients now have a “vascular access plan.” Of patients dialyzing via a TCVC in 2010, 37% had died by 2011, 22% remained on long-term line, 20% had successful arteriovenous fistula (AVF) creation, 1% had an arteriovenous graft and 2% were transplanted; 10.4% developed complications of vascular access and required ligation of a functioning AVF. A further 6.5% died within 28 days of surgery. The incidence of culture-positive Staphylococcus aureus bacteremia was 1.6 per 1,000 catheter days. Conclusions Aggressive strategies of AVF creation resulted in one-fifth of patients on a long-term TCVC having successful creation of an AVF. This was offset against high failure and significant complication rate from AVF creation in this population. One-third of patients dialyzing via a TCVC died in the subsequent year. Correct patient selection for AVF creation is essential and predialysis care must be optimized to avoid the need for TCVCs entirely.
Accuracy of Early Postoperative Clinical and Ultrasound Examination of Arteriovenous Fistulae to Predict Dialysis Use
Authors: Ferring Martin , Henderson John , Wilmink Teun 
Published: May 2014

Aim The aim of this article is to assess the accuracy of early clinical and ultrasound (US) examination in terms of predicting arteriovenous fistula (AVF) dialysis use. Methods Physical and US examination of patent AVF was performed 4 weeks after fistula creation. AVF dialysis use was defined as subsequent use of an AVF for at least six consecutive dialysis sessions with two needles and a blood flow of more than 200 mL/min. Results Of 119 AVF patent at 4 weeks, 26 (22%) failed. Clinical examination was 96% sensitive for predicting successful dialysis, but only 21% specific for failure. Vein diameter above 5 mm and an arterial end-diastolic velocity above 110 cm/s were the best US predictors for dialysis use. Vein diameter was slightly better than arterial velocity in terms of predicting maturity (sensitivity: 83% vs 67%, specificity: 68% vs 65%). All assessments predicted AVF maturity (positive predictive value: clinical = 81%, US diameter = 90%, US velocity = 87%) much better than AVF failure (negative predictive value: clinical = 63%, US diameter = 53%, US velocity = 37%). Conclusion One month after surgery, a new AVF with a thrill or a vein diameter >5 mm is likely to be used for dialysis. An AVF not meeting these criteria has an increased risk of failure and further investigations may be required.
Natural History of Venous Morphologic Changes in Dialysis Access Stenosis
Authors: Lee Timmy , Somarathna Maheshika , Hura Arjan , Wang Yang , Campos Begona , Arend Lois , Munda Rino , Roy-Chaudhury Prabir 
Published: May 2014

Purpose Venous stenosis secondary to neointimal hyperplasia is a major etiology of early arteriovenous fistula (AVF) failure. The natural history of AVF failure is likely influenced by progressive vascular insults to the vein prior to and after AVF creation. The main objectives of this study were to ( 1 ) provide a histologic and morphometric description of non-chronic kidney disease (CKD), upper extremity vein specimens and ( 2 ) perform a morphometric analysis to study venous histology from non-CKD upper extremity veins, veins collected at the time of new vascular access surgery and veins collected from failed stenotic AVFs. Methods Vein samples from 11 non-CKD deceased donors, 29 subjects receiving new vascular access creation and 20 subjects with stenotic failed AVFs were collected for histologic and morphometric analysis. Results The mean values of average intima/media thickness ± S.E. from veins collected from non-CKD subjects, subjects receiving new vascular access and subjects with stenotic AVFs were 0.16±0.02, 0.43±0.07 and 3.84±0.55, respectively (p<0.0001). Among donor, non-CKD, vein samples, only diabetes (p=0.0007) was associated with increased average intima/media thickness. Conclusions Our results demonstrate a progressively increasing venous neointimal hyperplasia development from the non-CKD period through the period of AVF creation and failure. Vascular injuries from complications of progressive CKD prior to access placement and vascular injuries after vascular access placement may play important roles in these progressive vascular changes, and need to be further elucidated.
Safe Administration of Vancomycin through a Novel Midline Catheter: A Randomized, Prospective Clinical Trial
Authors: Caparas Jona V. , Hu Jian-Ping 
Published: May 2014

Background According to the 2011 Infusion Nursing Standards of Practice, the low pH of intravenous vancomycin requires that it be administered through a central line. However, a careful review of the literature and a retrospective analysis of the experience at New York Hospital Queens (NYHQ) did not support the position of the Standards. Purpose A prospective, controlled, randomized clinical trial was conducted to determine if intravenous vancomycin could be safely administered through a novel midline catheter (POWERWAND®, Access Scientific, San Diego, CA). Methods Patients scheduled to receive short-term (<6 days) intravenous vancomycin were randomly assigned to receive treatment through either a peripherally inserted central catheter (PICC) or the midline study device. Complications and the costs of insertion were recorded. Results The two groups did not differ significantly with respect to total complications (17.9% with PICCs vs. 19.9% with the midline), phlebitis (0% vs. 0%) or thrombosis (0% vs. 0%). One suspected catheter-associated bloodstream infection did occur in the PICC group. Insertion costs were $90.00 less per insertion in the midline group. Conclusions Short-term intravenous vancomycin can be safely and cost-efficiently administered in the deep vessels of the upper arm using the midline study device.
A New Model of Arteriovenous Fistula to Study Hemodialysis access Complications
Authors: Loveland-Jones Catherine E. , Jayarajan Senthil , Fang Jianhua , Monroy Alexandra , Zhang Hao Mike , Holt-Bright Lewis , Choi Eric T. 
Published: May 2014

Purpose This report presents a new animal model of arteriovenous fistula (AVF) with attention given to surgical techniques as well as hemodynamic and pathologic measurements. Of note, this model was created with a tunneled central catheter with the purpose of studying therapeutic interventions, including hemodialysis. Methods Side-common carotid artery to end-external jugular vein AVFs were created in eight minipigs. A tunneled central catheter was also placed in the internal jugular vein. After 28 days, hemodynamic measurements of AVF flow and stenosis were performed. The minipigs were then euthanized and the AVFs were harvested for pathologic measurements of neointimal hyperplasia and thrombus volumes. In order to account for variable size of the AVFs, percentage luminal stenosis and degree of intima–media thickening were calculated. Results After 28 days, all eight AVFs remained patent. On average, 19% of arterial blood flow that approached the AVF traveled through the anastomosis. The average luminal stenosis by angiogram was 61.1%. The average neointimal hyperplasia and thrombus volumes were 1.4×108 and 3.8×108 μm3, respectively. The average luminal stenosis and intima–media thickening were 65.2% and 430.4 μm, respectively. Conclusions This AVF model is ideal because of the relative ease of surgery and husbandry, lack of complications, as well as consistent and rapid development of the neointimal lesion which underlies AVF failure.
Autologous Surgical Reconstruction for True Venous Hemodialysis access Aneurysms–-Techniques and Results
Authors: Sigala Fragiska , Kontis Elissaios , Saßen Regine , Mickley Volker 
Published: May 2014

Purpose Due to their relatively low complication rates autogenous arteriovenous fistulas (AVFs) are the preferred access for hemodialysis. In long-standing AVF, however, aneurysmatic degeneration of the fistula vein can develop. Several treatment options have been published. We evaluated our experience with autologous surgical reconstruction in patients with AVF aneurysms in order to assess complication and patency rates. Methods Demographics and comorbidities of all patients operated on for true AVF aneurysms in our institution, during a 7-year period, were reviewed. Access function and surgical outcomes were evaluated with pre- and postoperative Doppler ultrasonography. Patient survival, primary and secondary access patency rates are presented. Results From April 2006 through March 2013, 31 patients presented with access-associated upper extremity venous aneurysms. The mean time from AVF creation to aneurysm formation was 4.9±3.6 years. The most frequent indication for surgery was aneurysm-associated stenosis (n=16) followed by high flow (n=9), complete thrombosis (n=3) and uncontrolled bleeding (n=3). All patients had autologous reconstructions: 5 resections with end-to-end anastomosis and 26 aneurysmorrhaphies. Overall patient survival at 1 and 2 years was 89% and 84%, respectively. The primary (secondary) patency rates at 6 mo, 1 and 2 years were 87%, 81% and 81% (96%, 96% and 90%), respectively. Conclusions Autologous surgical reconstruction is feasible in the majority of AVF aneurysms. It preserves fistula function and–-in contrast to graft interposition and endovascular repair–-keeps the advantages of an autogenous access: low complication and high patency rates.
Hemodialysis Tunneled Central Venous Catheters: Five-Year Outcome Analysis
Authors: Mandolfo Salvatore , Acconcia Pasqualina , Bucci Raffaella , Corradi Bruno , Farina Marco , Rizzo Maria Antonietta , Stucchi Andrea 
Published: May 2014

Background Tunneled central venous catheters (tCVCs) are considered inferior to arteriovenous fistulas (AVFs) and grafts in all nephrology guidelines. However, they are being increasingly used as hemodialysis vascular access. The purpose of this study was to document the natural history of tCVCs and determine the rate and type of catheter replacement. Methods This was a prospective study of 141 patients who underwent hemodialysis with tCVCs between January 2008 and December 2012. The patients used 154 tCVCs. Standard protocols about management of tCVCs, according to European Renal Best Practice, were well established. All catheters were inserted in the internal jugular vein. Criteria for catheter removal were persistent bloodstream infection, detection of an outbreak of catheter-related bloodstream (CRBS) infections, or catheter dysfunction. Event rates were calculated per 1,000 catheter days; tCVC cumulative survival was estimated by Kaplan-Meier analysis. Results Catheter replacement occurred in 15 patients (0.29 per 1,000 days); catheter dysfunction was the main cause of replacement (0.18 per 1,000 days), typically within 12 months of surgical insertion. A total of 53 CRBS events in 36 patients were identified (0.82 per 1,000 days); 17 organisms, most commonly Gram-positive pathogens, were isolated; 87% of CVC infections were treated by systemic antibiotics associated with lock therapy. tCVC cumulative survival was 91% at 1 year, 88% at 2 years and 85% at 4 years. Conclusions Our data show a high survival rate of tCVCs in hemodialysis patients, with low incidence of catheter dysfunction and CRBS events. These data justify tCVC use for hemodialysis vascular access, also as first choice, especially in patients with exhausted peripheral access and limited life expectancy.
Peripherally Inserted Central Catheter (PICC)-Related Thrombosis in Critically Ill Patients
Authors: Zochios Vasileios , Umar Imraan , Simpson Nicola , Jones Nicola 
Published: May 2014

Background Peripherally inserted central catheters (PICC) are being increasingly used in critical care setting. However, PICCs are associated with a number of complications, particularly upper extremity venous thrombosis (UEVT), leading to post-thrombotic syndrome, pulmonary embolism and increased risk of catheter-related infection. Objective To review the literature surrounding PICCs and highlight the epidemiology, pathophysiology, diagnosis and management of PICC-related thrombosis in critically ill patients. Data sources and extraction We performed an electronic literature search of the databases PubMed, EMBASE and Google scholar using set search terms, from their commencement date to the end of January 2014. Summary of review It has been shown that PICCs may double the risk of deep venous thrombosis compared with centrally inserted venous catheters, in critically ill patients. However, the incidence of PICC-related thrombosis in critically ill patients has not been quantified. Ultrasonography is the preferred diagnostic imaging modality. There are no randomized controlled trials (RCTs) on the best treatment of PICC-related thrombosis in the intensive care unit (ICU) setting and in most cohort studies, anticoagulation strategies with or without PICC removal have been used. Conclusions Decision to insert a PICC should be taken after careful risk stratification. There is lack of high-quality evidence assessing prevention strategies and management of PICC-related thrombosis in the ICU. Well-designed RCTs are required to estimate the prevalence of UEVT in ICU patients with PICCs and evaluate the efficacy and magnitude of clinical benefit and cost-effectiveness of therapeutic strategies.
“Am I That Name?” Feminism, Feminist Criticism, and Gender Studies
Authors: Filipowicz Halina 
Published: May 2014

Abstract
This article takes up three overlapping sets of issues. The first set brings into sharper relief current debates about work–family balance and persistent gender inequality. The second set traces the emergence of women’s studies as a scholarly discipline, examines a shift from women’s studies to gender studies, and considers the reception of Western feminist discourse in Poland. The final set builds on the first two by addressing assumptions about the history of Polish women and their supposedly benighted sisters in the West, by questioning the presupposition that archives are passive depositories, and by exploring prospects for future work.