Objective To clarify the views of healthcare providers on the current vascular access shared decision-making model under the daytime chemotherapy mode, and to determine improvement measures to promote the conventional implementation of the daytime chemotherapy vascular access shared decision-making model. Methods Based on the SWOT model, an interview outline was developed. Using purposive sampling method, 7 doctors and 6 intravenous therapy nurses working at Tianjin Medical University Cancer Institute & Hospital from April to June 2023 were selected for semi-structured interviews, and content analysis method was used for data analysis. Results Four themes were extracted for internal advantages: alleviating the pressure of diagnosis and treatment and decision-making for doctors, ability and willingness of specialized intravenous therapy nurses to implement, promoting the rational selection of vascular pathways, enhancing the recognition of vascular pathways in daytime chemotherapy patients, and enhancing communication stickiness between nurses and patients. Four themes were extracted for internal weaknesses: increased workload, impractical decision support tools, unsmooth implementation processes, and incomplete informatization. Three themes were extracted for external opportunities: national policy support, willingness of daytime chemotherapy patients to participate in decision-making, and sufficient evidence-based evidence. Three themes were extracted for external threats: poor communication between healthcare providers under daytime chemotherapy mode, cognitive differences related to intravenous therapy among healthcare providers, and insufficient confidence in nurse leadership. Conclusions The vascular pathway shared decision-making led by intravenous therapy nurses has certain advantages in the daytime chemotherapy mode. In the future, we should seize existing opportunities, avoid our own weaknesses, face external threats, and develop a standardized vascular access shared decision-making model led by intravenous therapy nurses under the daytime chemotherapy mode, promoting the best evidence-based practice for vascular access decision-making during daytime chemotherapy.
ObjectiveTo evaluate the safety and efficacy of second central venous catheterization in tunnel cuffed dialysis catheter (TCC) dysfunction with fibrin sheath.MethodA total of 14 maintenance hemodialysis patients who required second central venous catheterization were enrolled in West China Hospital of Sichuan University from June 2016 to June 2017 and the clinical information and procedure-related complications were recorded.ResultsAll of the 14 patients were successfully performed with second central venous catheterization, of whom 4 cases had superior vena cava cannulation, 7 cases had right brachiocephalic vein cannulation, 2 cases had internal jugular vein cannulation, and 1 case had external jugular vein cannulation. No procedure-related major complication occurred. During the follow-up, catheter malfunction occurred in 2 cases, which improved by urokinase seal and catheter change, respectively. The rest patients’ catheter function remained normal.ConclusionsWith increasing difficult to construction and maintenance of vascular access, preservation of central vein resource is of high importance. For patients with TCC dysfunction with fibrin sheath, second central venous catheterization based on percutaneous brachiocephalic vein or superior vena cava cannulation is a safe and effective method to establish the lifeline for hemodialysis patients.
Objective To preliminarily evaluate the feasibility and safety of percutaneous sharp recanalization of the superior vena cava (SVC) with puncture instruments assistance followed by catheter placement in hemodialysis patients with exhausted central venous access resources. Methods A retrospective analysis was conducted on clinical data of hemodialysis patients who underwent RUPS-100-assisted sharp recanalization at West China Hospital, Sichuan University between March 2019 and August 2024. All patients were diagnosed with SVC occlusion via digital subtraction angiography or computed tomographic angiography and conventional guidewires and catheters failed to traverse the occlusive lesions as judged by operators. The technical success rate, perioperative complications, post-procedure blood flow volume, and catheter patency rate were recorded. Results A total of 17 patients were enrolled, among whom sharp recanalization was successfully performed in 14 cases, corresponding to a technical success rate of 82.4%. The mean length of recanalized occlusive segment was (2.2±0.5) cm, and the mean procedural time was (73.4±9.5) minutes. One patient developed intraoperative hemopericardium (Society of Interventional Radiology adverse event grade C), which improved under close monitoring and conservative management without progression to cardiac tamponade. The post-procedure blood flow was maintained above 240 mL/min in all successfully recanalized patients. The primary patency rates at 6 months and 12 months were 92.9% and 66.7%, respectively. Conclusions RUPS-100-assisted sharp recanalization is an effective and acceptably safe salvage procedure for the treatment of SVC occlusion in hemodialysis patients, offering a novel therapeutic option for patients with refractory vascular access dysfunction. Given the limitations of its retrospective, single-center and small-sample design, further large-scale studies are required to validate these findings.
Objective To analyze the results of the 2024 annual competency assessment of the Hemodialysis Vascular Access Intervention Technique Specialized Training Program, evaluate trainees’ current operational competence, identify weaknesses in the training system, and provide evidence for optimizing the training curriculum. Methods From August to September 2024, trainees underwent offline practical ultrasound examinations at two sites: Chongqing (southern region) and Shijiazhuang (northern region). The examination assessed functional evaluation of arteriovenous fistulas in real maintenance hemodialysis patients, including physical examination and ultrasound evaluation. domestic mainstream ultrasound systems were used, and faculty members conducted one-on-one proctoring. Anonymous questionnaires were administered to examiners and trainees after the examination. Common problems and learning needs were ranked and scored according to severity. Results A total of 223 trainees actually participated in the offline examination, with 17 faculty members supervising the test. Among the 223 trainees, 209 passed the examination, with a pass rate of 93.7%. Examiner survey results indicated that the most prominent common problem was poor ultrasound image quality (score ratio 80.15%), followed by failure to detect clinically significant stenosis during physical examination (69.12%) and unfamiliarity with ultrasound probe manipulation (64.71%). Enhanced practical ultrasound training was identified as the most urgent learning need. Trainee survey results revealed that the most difficult examination item was visualization and diameter measurement of the anastomosis (score ratio 67.94%), while the most significant adverse factor was unfamiliarity with the ultrasound machine brand and operating interface (91.03%). A total of 76.47% of examiners and 80.92% of trainees agreed that standardized operating procedures for arteriovenous fistula physical examination and ultrasound assessment should be established as soon as possible. Conclusions Notable deficiencies were observed in ultrasound image acquisition, accuracy of physical examination, and proficiency in equipment operation. It is recommended to establish standardized operating procedures promptly, strengthen practical ultrasound training and physical examination education, refine scoring criteria, and unify training materials to improve training quality and assessment uniformity.