No abstract available.
Vascular Access Devices*

No abstract available.
Child ; Humans ; Vascular Access Devices

Introduction: Accurate and reliable glucose level measurements are essential for ensuring safe and effective glycemic control among diabetic patients undergoing hemodialysis (HD). Capillary blood glucose (CBG) monitoring is the standard of care of glycemic control assessment in patients with diabetes on maintenance HD. In the Philippines, glucose monitoring during HD involves either standard finger stick (CBG) or blood sample from the arterial line (AL) of extracorporeal circuit of HD machine. However, anecdotal observations noted over the years have shown discrepancies in the glucose values from the two sites. This study aimed to determine the accuracy of blood glucose measurements of capillary and AL of extracorporeal circuit of HD machine using point-of-care (POC) glucose meter in comparison to central laboratory venous plasma among diabetic patients undergoing outpatient HD in a private tertiary hospital in the Philippines. Determining the most accurate and reliable method of glucose level measurement is vital in helping patients attain glycemic control. To date, there is limited published data regarding the accuracy of blood glucose values obtained through CBG and AL of extracorporeal circuit of HD machine while patients are undergoing dialysis. Methods: This is a prospective, cross-sectional, analytical study involving thirty patients. Forty blood samples from 30 patients obtained through CBG, AL and the peripheral venous plasma of the opposite arm were simultaneously analyzed. Specifically, StatStrip was utilized as the POC glucose meter. Accuracy of AL of extracorporeal circuit and CBG were determined and assessed in accordance with International Organization for Standardization (ISO) 15197:2013 minimum accuracy criteria for glucose meters. Regression analysis was used to determine whether AL and CBG significantly predict peripheral venous blood glucose levels. Results: Analysis showed that there is a statistically significant difference in the glucose values obtained from AL and CBG (p-values 0.005 and <0.0001) when compared to venous plasma glucose. However, this may not pose clinical significance in routine practice. It is noteworthy that both AL (concordance rate (CR)=100%) and CBG (CR=96.5%) satisfied the revised ISO 15197:2013 accuracy criteria for glucose value greater than or equal to 100mg/dL. Conclusion Both CBG and AL blood glucose measurement significantly predict venous plasma blood glucose level. POC blood glucose value from both AL of extracorporeal circuit during HD and CBG satisfied the accuracy criteria set by ISO 15197: 2013 for glucose value greater than or equal to 100mg/dL. Thus, confirming the glucose level by CBG monitoring is not necessary in patients with arterial glucose value of greater than or equal to 100 mg/dL during HD.
Vascular Access Devices ; Renal Dialysis

BACKGROUND/AIMS: Fragmented care in nephrology can cause treatment delays. Nephrologists are qualified to perform vascular access-related procedures because they understand the pathophysiology of renal disease and perform physical examination for vascular access. We compared treatment delays associated with tunneled hemodialysis catheter (TDC) placement between interventional radiologists and nephrologists. METHODS: We collected data by radiologists from January 1, 2011 through December 31, 2011 and by nephrologists from since July 1, 2012 through June 30, 2013. We compared the duration from the hemodialysis decision to TDC placement (D-P duration) and hemodialysis initiation (D-H duration), catheter success and the complication rate, and the frequency and the usage time of non-tunneled hemodialysis catheters (NDCs) before TDC placement. RESULTS: The study analyzed 483 placed TDCs: 280 TDCs placed by radiologists and 203 by nephrologists. The D-P durations were 319 minutes (interquartile range [IQR], 180 to 1,057) in the radiologist group and 140 minutes (IQR, 0 to 792) in the nephrologist group. Additionally, the D-H durations were 415 minutes (IQR,260 to 1,091) and 275 minutes (IQR, 123 to 598), respectively. These differences were statistically significant (p = 0.00). The TDC success rate (95.3% vs. 94.5%, respectively; p = 0.32) and complication rate (16.2% vs. 11%, respectively; p = 0.11) did not differ between the groups. The frequency (24.5 vs. 26%, respectively; p = 0.72) and the usage time of NDC (8,451 vs. 8,416 minutes, respectively; p = 0.91) before TDC placement were not statistically significant. CONCLUSIONS: Trained interventional nephrologists could perform TDC placement safely, minimizing treatment delays.
Catheters* ; Nephrology ; Physical Examination ; Renal Dialysis* ; Vascular Access Devices

Totally implanted vascular access devices are excellent for delivering chemotherapeutic agents and prolonged intravenous infusions in patients with cancer. Catheter disconnection and migration are rare but potentially serious complications of these widely used devices. Retrieval of the migrated fragment is generally indicated but may not be possible. We hereby report three cases of catheter disconnection and migration of totally implanted vascular access devices into the heart along with the review of literatures.
Catheters ; Heart ; Humans ; Infusions, Intravenous ; Vascular Access Devices*

The pseudoaneurysms are resulted from complication of vascular catheterization, trauma, etc. and recently, the reports on pseudoaneurysms have been increasing. Successful treatment of pseudoaneurysms have been described usingdirect compression guided by color doppler ultrasound, instead of invasive surgical treatment. Authors experienced three cases of pseudoaneurysm ; two resulted from post-catheterization and one from trauma. We successfully treated two post-catheterization cases using C-clamp compression under the color doppler US-guidance. The traumatic case was treated by embolization instead of US-guided compression. We suggest that the compression of pseudoaneurysm using C-clamp under the US-guidance is more useful than hand or probe compression method.
Aneurysm, False* ; Arteries* ; Hand ; Ultrasonography ; Vascular Access Devices

The purpose of this study was to compare direct and three indirect blood pressure measurements in adults and to compare among three indirect blood pressure measurements in adults. One direct(intraarterial) and three indirect(using a mercery sphygmomanometer, a aneroid type sphygmomanometer and an automatic auscultatory device) methods of blood pressure measurement were compared in adult patients who had an arterial line. The subjects for this study consisted of 29 patients in K medical center, B medical center, B hospital and M hospital in Pusan. The data was collected from October 1, 1992 to June 30, 1993. The collected data was analysed with the SPSS program, frequency, percentage, mean, S. D., t-test, ANOVA The results of this study were as follows : 1) There was a significant difference in the systolic BP when using the direct and three indirect measurements(P<0.05). 2) There was no overall significant difference in the diastolic BP when using the direct and three indirect measurements. 3) There was no significant difference in the SBP and DBP among the three indirect measurements.
Adult ; Blood Pressure* ; Busan ; Humans ; Sphygmomanometers ; Vascular Access Devices

OBJECTIVE: The purpose of this study was to identify differences in measurement methods for blood pressure (Direct measurement, HP automatic indirect measurement, and SE 7000 Korean made indirect measurement), and to evaluate the clinical trial of the Korean made automatic indirect blood pressure measurement. MATERIAL & METHODS: From June, 1999 to February, 2000, fifty five consecutive patients were randomized into hypertension group (n=20), normotension group (n=20), and hypotension group (n=15). Measuring blood pressure by indirect methods (HP NIBP M 1008B and SE 7000 NIBP Korean made) was done simultaneously in the same arm with arterial line for direct blood pressure measurement (HP M1006A). The procedures were repeated ten times at intervals of 2 minutes. Statistical analysis was performed using SPSS (version 8.0 for windows) software package. Values were expressed as means and standard deviation and means were compared using t-test. Statistical significance was considered present with a p value less than 0.05. RESULTS: In the hypertension group and noromotension group, the disparity between HP direct measurement and indirect SE 7000 NIBP did not show any differences compared to the disparity between HP direct measurement and indirect HP NIBP. In the hypotension group, the disparity in the diastolic pressure between HP direct measurement and indirect SE 7000 NIBP was significantly different compared to the disparity between HP direct measurement and indirect HP NIBP (p<0.001), however, disparities in systolic pressure did not showed any differences. CONCLUSION: Direct blood pressure measurement (HP M1006A) can be replaced with indirect blood pressure measurements (HP NIBP M 1008B & SE 7000 NIBP) in normotension and hypertension patients. Korean made indirect measurement was found to be more accurate compared to HP indirect measurement in hypotension patients, but more study is needed.
Arm ; Blood Pressure* ; Humans ; Hypertension ; Hypotension ; Vascular Access Devices

BACKGROUND: Arterial pressure measured in a peripheral artery sometimes underestimates central arterial pressure after discontinuation of cardiopulmonary bypass (CPB) for reasons that are still unclear. Therefore, the sideport of the aortic cannula is often used for measurement of central pressure because it is accessible and is near the ascending aorta. This study was designed to assess whether blood pressure measured at the sideport of the aortic cannula mirrors blood pressure measured within the ascending aorta. METHODS: Blood pressure was compared in 21 patients 5 minute after discontinuation of CPB at two sites: at the tip of the 23-gauge needle that points distally at a 25degrees to 30degrees angle to the blood flow within the ascending aorta and at the sideport of the aortic cannula. The effects on the sideport-to-aorta pressure differences and wave contour were tested by placing a clamp at the proximal and distal end of the arterial line (aortic cannula sideport-oxygenator tube) of the CPB circuit. RESULTS: There were no statistical differences between systolic, diastolic and mean blood pressure measured at the sideport and ascending aorta when the clamp was applied to the proximal end. The average sideport-to-aorta systolic pressure differences (0.3+/-3.1 mmHg ranged from -5 to 6 mmHg), diastolic pressure differences (-0.9+/-2.1 mmHg ranged from -4 to 4 mmHg) and mean pressure differences (-0.5+/-1.0 mmHg ranged from -2 to 2 mmHg) were not significantly different. No statistical differences were noted between pressures measured at the two sites when the clamp was applied to the distal end of the arterial line. CONCLUSIONS: It is concluded that the pressure measured at the sideport of the aortic cannula reflects the pressure in the ascending aorta after discontinuation of CPB.
Aorta* ; Arterial Pressure ; Arteries ; Blood Pressure* ; Cardiopulmonary Bypass* ; Catheters* ; Humans ; Needles ; Vascular Access Devices

Renal papillary necrosis(RPN) is a 4bointerstitial nephropathy accompanied by compromised medullary blood flow that ultimately results in a focal or diffuse ischemic necrosis of segments of the renal medulla. Renal papillary necrosis is infrequently reported as complication of fungal infections. Underlying condi- tions such as prematurity, immunosuppressive therapy, neoplastic disease, previous antibiotic therapy, diabetes mellitus, extensive burn and indwelling vascular catheters were found in candidal RPN. Candidal renal papillary necrosis is a extremely rare and fatal disease. Only 20 cases were reported over the past. There were only three survivors which were diagnosed were treated with antifugal agents early in the clinical course. As far as we know, this case is the first case of candidal RPN treated with bilateral nephrectomy. We report a case of candidal renal papillary necrosis in a 66-year-old diabetic woman treated with bilateral nephrectomy, along with review of the literatures.
Aged ; Burns ; Candida tropicalis ; Candidiasis ; Diabetes Mellitus ; Female ; Humans ; Necrosis* ; Nephrectomy ; Survivors ; Vascular Access Devices