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Ajello E, Arresta A, Rutili R, Aronica S, Lorenzo R, Monti E, Galletti M, Cannizzo L, Giannini L, Lucchini A, Pieruzzi F, Elli S. PICC insertion and veins of the arm size variation during dialysis treatment: A prospective observational study. J Vasc Access 2024:11297298241238455. [PMID: 38515354 DOI: 10.1177/11297298241238455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Peripherally Inserted Central Catheters play an increasingly important role in Central Venous Access Devices. However, the use of these devices should be carefully considered in specific situations such as central catheterisation in patients with chronic kidney disease. When evaluating the feasibility of placement for a patient undergoing dialysis, the relationship between changes in circulating volume before and after dialysis treatment, and potential variations in the size of deep veins in the upper limbs, should be considered. MATERIALS Upper limb veins, specifically the basilic or brachial veins, were identified and measured before and after dialysis treatment. Patient data and weight loss data during dialysis treatment were also collected. Linear regression analysis was performed to assess the correlation between the variables. RESULTS The average variation in vein size for the entire sample was +0.17 ± 0.43 mm. The mean volume removed was 2.2 ± 0.8 l. In subgroup 1 (fluid volume loss <2000 ml), the population experienced a decrease in the measured vein size after dialysis. In subgroup 2 (fluid volume loss ⩾2000 ml), the population experienced an increase in the measured vein size after dialysis. CONCLUSIONS Upper arm vascular access placement in dialysed patients with fluid removal of less than 2000 ml should be performed after the dialysis session. Conversely, in dialysed patients with fluid removal of more than 2000 ml, where a significant increase in vein size was observed, vascular access placement should be performed before the dialysis session when the veins are smaller. Additionally, it should be noted that in patients with chronic kidney disease, the venous system of the upper limbs should be preserved as much as possible to prevent thrombosis and stenosis in potential arteriovenous fistula creation.
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Affiliation(s)
- Elena Ajello
- IRCCS S. Gerardo dei Tintori Foundation, Monza (MB), Lombardia, Italy
| | - Antonio Arresta
- Santa Chiara Hospital, Trento (TN), Trentino-Alto Adige, Italy
| | | | - Salvatore Aronica
- IRCCS S. Gerardo dei Tintori Foundation, Monza (MB), Lombardia, Italy
| | | | - Elia Monti
- IRCCS Istituto Ortopedico Rizzoli, Bologna, Emilia-Romagna, Italy
| | | | - Luigi Cannizzo
- IRCCS S. Gerardo dei Tintori Foundation, Monza (MB), Lombardia, Italy
| | - Luciano Giannini
- IRCCS S. Gerardo dei Tintori Foundation, Monza (MB), Lombardia, Italy
| | - Alberto Lucchini
- IRCCS S. Gerardo dei Tintori Foundation, Healthcare Professions Department, University of Milan-Bicocca, Monza (MB), Italy
| | - Federico Pieruzzi
- University of Milan-Bicocca, IRCCS S. Gerardo dei Tintori Foundation, Monza (MB), Lombardia, Italy
| | - Stefano Elli
- IRCCS S. Gerardo dei Tintori Foundation, Healthcare Professions Department, University of Milan-Bicocca, Monza (MB), Italy
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Tran MH, Tajonera E. Peripheral blood stem cell collection: Are midline catheters a viable alternative to central venous catheters? Transfusion 2024; 64:424-427. [PMID: 38240488 DOI: 10.1111/trf.17727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 03/16/2024]
Abstract
BACKGROUND Vascular access is a rate-limiting step for peripheral blood stem cell collection. In the absence of readily accessible superficial veins, placement of tunnelled or non-tunnelled central venous catheters (CVCs) is common. These invasive access routes create medical risks for patients and are associated with logistical challenges, thus prompting a search for alternatives. One such option is the off-label use of midline catheters. STUDY DESIGN AND METHODS We carried out a literature search for published experience with the use of midline catheters for peripheral blood stem cell collection. Data extracted included whether collections were allogeneic or autologous, donor sex, age and weight, inlet flow rate, total blood volumes (TBV) processed, collection duration, number of collections per donor, and achievement of collection targets. RESULTS The search produced three reports (one in abstract form) comprising 19 patients and 26 collection events. Donor sex and status were provided for 18 patients; 10 were female, 8 were male, 12 were allogeneic, and 6 autologous. Median (range) for: donor age was 28 (12-59); donor body weight (kg) was 77.5 (45.4-113.4); inlet flow rate (in mL/min) was 66 (28-80); TBV processed (in mL) was 15,880 (6178-21,871); collection duration (in hours) was 5.0 (3.2-7.0); and CD34 × 106/kg collection yield was 5.9 (3.6-23.0). Target CD34 yields were achieved in 14/19 (74%) of donors with 7/19 (37%) requiring two collections days. DISCUSSION Peripheral blood stem cell collection does appear to be viable via midline-based catheter access, particularly for allogeneic donors and shorter collection courses. Development of institution-specific guidelines and care pathways are recommended.
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Affiliation(s)
- Minh-Ha Tran
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Irvine, California, USA
| | - Eduardo Tajonera
- University of California, Irvine Medical Center, Orange, California, USA
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Zhou G, Chen Y, Chien C, Revatta L, Ferdous J, Chen M, Deb S, De Leon Cruz S, Wang A, Lee B, Sabuncu MR, Browne W, Wun H, Mosadegh B. Deep learning analysis of blood flow sounds to detect arteriovenous fistula stenosis. NPJ Digit Med 2023; 6:163. [PMID: 37658233 PMCID: PMC10474109 DOI: 10.1038/s41746-023-00894-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/03/2023] [Indexed: 09/03/2023] Open
Abstract
For hemodialysis patients, arteriovenous fistula (AVF) patency determines whether adequate hemofiltration can be achieved, and directly influences clinical outcomes. Here, we report the development and performance of a deep learning model for automated AVF stenosis screening based on the sound of AVF blood flow using supervised learning with data validated by ultrasound. We demonstrate the importance of contextualizing the sound with location metadata as the characteristics of the blood flow sound varies significantly along the AVF. We found the best model to be a vision transformer trained on spectrogram images. Our model can screen for stenosis at a performance level comparable to that of a nephrologist performing a physical exam, but with the advantage of being automated and scalable. In a high-volume, resource-limited clinical setting, automated AVF stenosis screening can help ensure patient safety via early detection of at-risk vascular access, streamline the dialysis workflow, and serve as a patient-facing tool to allow for at-home, self-screening.
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Affiliation(s)
- George Zhou
- Weill Cornell Medicine, New York, NY, 10021, USA.
| | - Yunchan Chen
- Weill Cornell Medicine, New York, NY, 10021, USA
| | | | - Leslie Revatta
- City University of New York, Hunter College, New York, NY, 10021, USA
| | - Jannatul Ferdous
- City University of New York, Hunter College, New York, NY, 10021, USA
| | - Michelle Chen
- City University of New York, Hunter College, New York, NY, 10021, USA
| | - Shourov Deb
- City University of New York, Hunter College, New York, NY, 10021, USA
| | - Sol De Leon Cruz
- City University of New York, Hunter College, New York, NY, 10021, USA
| | - Alan Wang
- School of Electrical and Computer Engineering, Cornell University and Cornell Tech, New York, NY, 10044, USA
| | - Benjamin Lee
- Department of Radiology, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Mert R Sabuncu
- School of Electrical and Computer Engineering, Cornell University and Cornell Tech, New York, NY, 10044, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY, 10021, USA
| | - William Browne
- Department of Interventional Radiology, NewYork-Presbyterian Hospital, New York, NY, 10021, USA
| | - Herrick Wun
- Department of Vascular Surgery, NewYork-Presbyterian Hospital, New York, NY, 10021, USA.
| | - Bobak Mosadegh
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, Weill Cornell Medicine, New York, NY, 10021, USA.
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