Central line-associated bloodstream infections (CLABSIs) are responsible for 100,000 patient deaths per year, creating a critical need for prevention of these deadly infections that occur with central venous lines (CVLs). Alternative forms of IV access such as midline catheters (MLCs) may offer lower rates of infection than those seen with CVLs. MLCs were implemented at the practice setting in 2016; however, no evaluation of their effectiveness had been conducted. The purpose of this project was to evaluate the effectiveness of MLCs using a retrospective, pre- post- comparison of CLABSI rates and device utilization rates (DUR) obtained from the practice setting before and after implementation of MLCs. Infection control and Lewin's change theories were used to provide a foundation for the project. This retrospective, pre-post comparison of CLABSI and DUR 6 months before and after introduction of MLCs sought to determine if MLC use affected either rate. Results of a Wilcoxon signed-rank test showed no statistical differences (p > .05) in CLABSI rates and DUR when comparing the rates from the specified 6 month periods. A secondary purpose was to identify the characteristics and conditions in which MLCs were used. Patients with cardiovascular, neuro, and infection diagnoses constituted 43% of the 262 MLC placements. No statistically significant improvement in infection rates was demonstrated by this project; however, these findings illuminate the types of patients or conditions where MLCs are a viable alternative for IV access, and this knowledge may assist providers in options for patient care. This project promotes positive social change by raising awareness of potential strategies for reducing infections in patients when they are at their most vulnerable.

Personer som drabbas av kronisk njursjukdom och startar behandling med hemodialys får en förändrad livssituation. Kärlaccess är en förutsättning för behandling och är personens framtida livlina. Sjuksköterskans uppgift är att ge stöd och stärka personens förmåga att uppleva hälsa trots sjukdom. Möjlighet att nå delaktighet och ökad egenvård är olika för varje enskild person och sjuksköterskan behöver bred kunskap för att möta detta behov. Syftet med studien, som utfördes som en litteraturöversikt, var att utifrån patientperspektivet belysa erfarenheter av hur kärlaccess kan påverka hälsan hos personer i hemodialys. Resultatet visade att tillit till sjuksköterskan och till sig själv, kunskap om sig själv och sin sjukdom, viljan att inte känna sig annorlunda och stöd från personer i sin omgivning påverkade hälsan. Tillit till sjuksköterskan behövs för att, trots rädsla vid placering av nålar, kunna vara delaktig i behandling. Stöd och kunskap har betydelse för personens väg mot egenvård. Mer forskning är önskvärd inom området för att belysa upplevelser hos personer med dialys och kärlaccessens betydelse för självständig behandling. / The life situation changes for individuals suffering from Chronic Kidney Disease who starts treatment with Hemodialysis. A vascular access is a prerequisite and is the individual’s future lifeline. The nurse’s task is to support and reinforce the individual’s ability to experience health despite disease. The possibility to achieve involvement and increased self-care varies for each individual and the nurse requires extensive knowledge to meet this need. The study was carried out as a literature overview. The purpose was, from a patient perspective, to highlight experience of how vascular access can influence the health of people with hemodialysis.The result showed that trust in the nurse and themselves, knowledge about themselves and their illness, willingness not to feel different and support from the people around them influenced the health. Trust in the nurse is needed to facilitate involvement in the treatment, despite fear when inserting the needles. Support and knowledge is of value in order for the individual towards self-care. More research on this subject is desirable to highlight the experiences of individuals in dialysis and the significance of the vascular access in order to achieve independent treatment.

Vascular access (VA) is one of the most important determinants of outcomes in haemodialysis (HD). Poor VA outcomes have a significant adverse impact on patient experience, morbidity and mortality and also result in significant burden on the health economy. An arteriovenous fistula (AVF) is accepted as the best HD vascular access. However AVF prevalence is variable and AVFs are associated with a high early failure rate. A small but significant number of AVFs experience late failure further down the line. The purpose of this project, broadly, was to understand VA outcomes, focusing specifically on AVFs. This project involved a series of clinical studies that were specifically designed by the student researcher to investigate various time points in the life cycle of AVFs – from creation and maturation - to its use and subsequent failure. The MANVAS, OPEN and Coil embolisation studies focus on the early phase of AVF development and maturation, whilst, the VA in Home HD study investigates the impact of intensive self-use in a non-healthcare setting. It is followed by the prospective thrombosed vascular access study focusing on the late phase of VA failure. The MANVAS study, a prospective cohort study, was set up with an aim to follow up patients undergoing AVF formation with a view to defining the natural history and maturation process of AVFs, and determine factors which affect outcomes – demographic, clinical, and biological. The OPEN study was designed to investigate poor maturation due to anastomotic failure by the intervention of the OptiflowTM device. The results suggest high maturation rates that were significantly better than those reported in the literature. The coil embolisation study demonstrated that the intervention of coil embolisation is a safe and effective treatment option for failing AVFs with accessory draining veins. The Vascular Access in Home Haemodialysis (HHD) study demonstrated that VA outcomes are significantly better in HHD patients and unadjusted patient survival in the HHD cohort was associated with incident VA. The thrombosed access study is a prospective longitudinal study designed to assess the effectiveness of endovascular access salvage and investigation of factors that impact longer-term access survival. One of the major aims of the study was to analyse outcomes related to prompt restoration of flow for patients presenting with acute failure of fistulae and grafts. The study showed that timely endovascular salvage is highly effective in restoring immediate patency but long-term outcomes remain poor. It also confirms poor outcomes of grafts as compared to AVFs and demonstrates that progression to thrombosis in AVFs portends poorer prognosis. The endovascular technique of balloon maceration, compared to outcomes reported in the literature, appears to be equally safe and effective with no increased risk of clinically significant pulmonary embolism. The clinical studies in this thesis provide a unique insight into the different aspects of the lifecycle of an AVF, and pave the way for an improvement in our fundamental understanding of the natural history and biology of AVFs.

No description available.

O uso de dispositivos para infusões intravasculares representa um desafio, principalmente, pela possibilidade da dispersão microbiana do local de inserção até a ponta do cateter. O procedimento de desinfecção poderá reduzir a colonização no sítio de inserção desses dispositivos, entretanto instiga uma série de questionamentos acerca da possibilidade de dispersão para o interior do lúmen, espectro de ação do antimicrobiano, e a técnica do procedimento de desinfecção. O objetivo deste estudo foi avaliar in vitro o procedimento de desinfecção das dânulas/torneiras de três vias contaminadas propositalmente com Staphylococcus aureus e Pseudomonas aeruginosa, bem como a dispersão de soluções para o interior dos lúmens. Trata-se de um experimento laboratorial in vitro, controlado e desenvolvido em duas etapas: avaliação da dispersão bacteriana por meio da contaminação intencional com cepas padrão: S. aureus (ATCC 25923) e P. aeruginosa (ATCC 27853), e a dispersão de líquidos para o interior do conector por meio do corante cristal violeta a 1%, após a fricção com solução fisiológica ou álcool etílico a 70%, visando simular o processo de desinfecção. Todos os experimentos foram realizados em triplicata por três pesquisadores distintos. A fricção dos conectores com solução fisiológica demonstrou crescimento bacteriano (P. aeruginosa e S. aureus) no interior de 41,7% dos lúmens, no entanto não houve crescimento bacteriano nas amostras após a desinfecção com solução alcoólica a 70% (p<0,001). Com relação aos percentuais das ausências de dispersão de soluções para o interior dos lúmens das dânulas, observou-se que a fricção com as soluções fisiológica e alcoólica foram de 81,5% e 66,7%, respectivamente (p=0,079). Assim, a ausência do crescimento bacteriano no lúmen das dânulas após a fricção com solução alcoólica a 70% está associada a uma série de variáveis controladas as quais remetem a preocupação, principalmente, na possibilidade de dispersão de soluções desinfetantes para o seu interior. Nesse sentido, infere-se sobre os riscos que ameaçam a segurança das pessoas submetidas a infusões intravenosas, especialmente, no que concerne a execução do procedimento de desinfecção das dânulas / The use of intravascular infusion devices presents a challenge, mainly, due to the possibility of microbial dispersion of insertion site up to catheter tip. Disinfection procedure can reduce colonization at insertion site of these devices, but it instigates a series of questions about the possibility of dispersion into the lumen, antimicrobial action spectrum, and the technique of the disinfection procedure. The objective of this study was to evaluate in vitro disinfection procedure of three-way taps purposely contaminated with Staphylococcus aureus and Pseudomonas aeruginosa as well as the dispersion of solutions into the lumens. This is an in vitro laboratory experiment, it was controlled and developed in two steps: evaluation of bacterial dispersion by intentional contamination with standard strains: S. aureus (ATCC 25923) and P. aeruginosa (ATCC 27853), and liquid dispersion into the connector through 1% violet crystal dye, after friction with physiological solution or 70% ethyl alcohol, in order to simulate disinfection process. All experiments were performed in triplicate by three distinct researchers. The friction of connectors with physiological solution showed bacterial growth (P. aeruginosa and S. aureus) within 41.7% of the lumens, but there was no bacterial growth in the samples after disinfection with 70% alcoholic solution (p<0.001). Regarding the absence of dispersion percentages of solutions into the lumens from three-way taps, it was observed that the friction with physiological and alcoholic solutions were 81.5% and 66.7%, respectively (p=0.079). Thus, the absence of bacterial growth in the lumen from three-way taps after the friction with 70% alcoholic solution is associated to a series of controlled variables which refer, mainly, to the possibility of dispersion of disinfectant solutions to its interior. In that sense, it is inferred about risks that threaten the safety of people undergoing intravenous infusion, especially, concerning the disinfecting procedure execution for three-way taps

Introdução: A hemodiálise (HD) requer um acesso vascular funcionante para sua realização. A fístula arteriovenosa nativa (FAV) constitui-se no acesso ideal para essa prática, com menores índices de morbidade e trombose e melhor qualidade de vida. A estenose da FAV é a maior causa de trombose e perda do acesso vascular. A monitorização continuada dos acessos através de diferentes métodos pode reduzir a incidência de trombose da FAV, conforme indicado por estudos com controle histórico e não-randomizados. Objetivos: Avaliar se uma estratégia intervencionista através de ecografia com Doppler (ED), angiografia digital (AD) e angioplastia (ATP) reduz a incidência de trombose e necessidade do uso de cateter em veia central temporário (CVC) em relação ao manejo conservador em pacientes com FAV em programa de HD. Métodos: Estudo prospectivo randomizado controlado de 108 pacientes e 111 FAV em programa de HD durante 11 meses. No grupo controle, foram realizadas mensurações quinzenais de parâmetros hemodinâmicos durante sessões de HD. No grupo intervenção, além da mensuração dos parâmetros hemodinâmicos, foi realizada ED a cada três meses, seguido de AD em casos de disfunção do acesso, definida pela ocorrência de pelo menos 1 dos seguintes critérios: redução do frêmito da FAV, aumento das pressões venosas, pobre fluxo arterial ou formação de hematoma ou edema no membro superior recorrentes durante HD, e/ ou pela presença de estenose vascular maior que 50% e/ou um fluxo estimado inferior à 500ml/min na ED. Em estenoses angiográficas superiores a 50% foi realizada ATP. Os desfechos avaliados foram trombose e necessidade de implantação de CVC, bem como desfecho composto, dado pela associação dos desfechos referidos. Resultados: Foram randomizadas 58 FAV para o grupo controle e 53 FAV para o grupo intervenção. Não foram observadas diferenças significativas entre os grupos em relação aos dados demográficos, comorbidades e características do acesso. O tempo médio de seguimento foi de 7,5 meses. No grupo intervenção, foram realizadas 97 ED, com média de 1,83 exame por paciente. Foram indicadas 14 AD, sendo que um paciente não compareceu ao estudo. Foi evidenciada trombose da FAV em 4 casos, e estenose não-significativa em 1. Estenose significativa foi observada em 8 pacientes, sendo então realizada ATP nesses casos. Não houve diferença significativa entre os grupos quanto à incidência de trombose (24,1% vs 17,0% p=ns). A estratégia intervencionista determinou redução significativa na incidência de necessidade de CVC (25,9% vs 7,5%, p=0,021), e na incidência do desfecho composto (44,8% vs 20,8%, p=0,033). Conclusões: A estratégia intervencionista no manejo das FAV promoveu uma redução significativa da necessidade de CVC e do desfecho composto de trombose e CVC. / Background: Hemodialysis (HD) requires a functioning vascular access in appropriate conditions. Native arteriovenous fistulae (NAF) provide the ideal access for that practice. Stenosis of the NAF is the highest cause of thrombosis and loss of the HD vascular access. The continuous monitorization of the NAF through different methods reduce the incidence of thrombosis according to non-randomized studies with historical control. Objective: To evaluate an interventionist strategy through the follow up of the NAF with Color Flow Doppler ultrasound (US), digital angiography and transluminal angioplasty (ATP), when suitable, to reduce the thrombosis and need for the use of a temporary central vein catheter (CVC) rates in relation to the conservative strategy. Methods: A prospective randomized controlled study of 108 patients and 111 permanent vascular access in an HD program. In the control group, assesment of the hemodynamic parameters of the vascular access were performed every fiftheen days. In the intervention group , besides the assesment of the hemodynamic parameters, was submitted to US every three months, as well as with angiography in cases that presented criteria for dysfunction of the access, defined by the occurrence of at least 1 of the following: reduction of the thrill; increase of the vein pressure during HD sessions; impossibility of obtaining a flow of 300 ml/min during HD; recurring hematoma or edema formation and/or the presence of larger vascular stenoses than 50% or a flow lower than 500ml/min at the US. The patients that presented angiographic evidence of hemodymically significant stenoses were submitted to ATP. The primary outcomes were need for temporary CVC during the follow up, FAV thrombosis and composite outcome. The outcomes were compared between the groups at the end of a 11 months period of follow-up. Results: Fifht eight FAV were randomized to control group and 53 FAV to interventional group. No significant differences were observed between the groups in relation to the demographic data, comorbidities and characteristics of the access. The NAF studied were followed up for a mean time of 7,5 months. In the interventional group, 97 US were performed, with an average of 1,83 exam per patient. A total of 14 digital angiography were required, and evidenced thrombosis in 4 patients and nonsignificant stenosis in 1. Significant stenosis was observed in 8 patients, and ATP was performed in those cases. No statistically significant difference was observed between the groups in thrombosis rates 24,1% vs 17,0%, p=ns). The interventional strategy showed statistically significant redution in the incidence of the need for placement of CVC (25,9% vs 7,5%, p=0,021). The differences in the composite outcome was statistically significant (44,8% vs 20,8%, p=0,033). Conclusions : The interventional strategy promoted a significant reduction rates for the need of placement of central vein catheter and of the combined outcome in the studied sample, showing benefits in patients with FAV in hemodialysis program.

Introdução: A hemodiálise (HD) requer um acesso vascular funcionante para sua realização. A fístula arteriovenosa nativa (FAV) constitui-se no acesso ideal para essa prática, com menores índices de morbidade e trombose e melhor qualidade de vida. A estenose da FAV é a maior causa de trombose e perda do acesso vascular. A monitorização continuada dos acessos através de diferentes métodos pode reduzir a incidência de trombose da FAV, conforme indicado por estudos com controle histórico e não-randomizados. Objetivos: Avaliar se uma estratégia intervencionista através de ecografia com Doppler (ED), angiografia digital (AD) e angioplastia (ATP) reduz a incidência de trombose e necessidade do uso de cateter em veia central temporário (CVC) em relação ao manejo conservador em pacientes com FAV em programa de HD. Métodos: Estudo prospectivo randomizado controlado de 108 pacientes e 111 FAV em programa de HD durante 11 meses. No grupo controle, foram realizadas mensurações quinzenais de parâmetros hemodinâmicos durante sessões de HD. No grupo intervenção, além da mensuração dos parâmetros hemodinâmicos, foi realizada ED a cada três meses, seguido de AD em casos de disfunção do acesso, definida pela ocorrência de pelo menos 1 dos seguintes critérios: redução do frêmito da FAV, aumento das pressões venosas, pobre fluxo arterial ou formação de hematoma ou edema no membro superior recorrentes durante HD, e/ ou pela presença de estenose vascular maior que 50% e/ou um fluxo estimado inferior à 500ml/min na ED. Em estenoses angiográficas superiores a 50% foi realizada ATP. Os desfechos avaliados foram trombose e necessidade de implantação de CVC, bem como desfecho composto, dado pela associação dos desfechos referidos. Resultados: Foram randomizadas 58 FAV para o grupo controle e 53 FAV para o grupo intervenção. Não foram observadas diferenças significativas entre os grupos em relação aos dados demográficos, comorbidades e características do acesso. O tempo médio de seguimento foi de 7,5 meses. No grupo intervenção, foram realizadas 97 ED, com média de 1,83 exame por paciente. Foram indicadas 14 AD, sendo que um paciente não compareceu ao estudo. Foi evidenciada trombose da FAV em 4 casos, e estenose não-significativa em 1. Estenose significativa foi observada em 8 pacientes, sendo então realizada ATP nesses casos. Não houve diferença significativa entre os grupos quanto à incidência de trombose (24,1% vs 17,0% p=ns). A estratégia intervencionista determinou redução significativa na incidência de necessidade de CVC (25,9% vs 7,5%, p=0,021), e na incidência do desfecho composto (44,8% vs 20,8%, p=0,033). Conclusões: A estratégia intervencionista no manejo das FAV promoveu uma redução significativa da necessidade de CVC e do desfecho composto de trombose e CVC. / Background: Hemodialysis (HD) requires a functioning vascular access in appropriate conditions. Native arteriovenous fistulae (NAF) provide the ideal access for that practice. Stenosis of the NAF is the highest cause of thrombosis and loss of the HD vascular access. The continuous monitorization of the NAF through different methods reduce the incidence of thrombosis according to non-randomized studies with historical control. Objective: To evaluate an interventionist strategy through the follow up of the NAF with Color Flow Doppler ultrasound (US), digital angiography and transluminal angioplasty (ATP), when suitable, to reduce the thrombosis and need for the use of a temporary central vein catheter (CVC) rates in relation to the conservative strategy. Methods: A prospective randomized controlled study of 108 patients and 111 permanent vascular access in an HD program. In the control group, assesment of the hemodynamic parameters of the vascular access were performed every fiftheen days. In the intervention group , besides the assesment of the hemodynamic parameters, was submitted to US every three months, as well as with angiography in cases that presented criteria for dysfunction of the access, defined by the occurrence of at least 1 of the following: reduction of the thrill; increase of the vein pressure during HD sessions; impossibility of obtaining a flow of 300 ml/min during HD; recurring hematoma or edema formation and/or the presence of larger vascular stenoses than 50% or a flow lower than 500ml/min at the US. The patients that presented angiographic evidence of hemodymically significant stenoses were submitted to ATP. The primary outcomes were need for temporary CVC during the follow up, FAV thrombosis and composite outcome. The outcomes were compared between the groups at the end of a 11 months period of follow-up. Results: Fifht eight FAV were randomized to control group and 53 FAV to interventional group. No significant differences were observed between the groups in relation to the demographic data, comorbidities and characteristics of the access. The NAF studied were followed up for a mean time of 7,5 months. In the interventional group, 97 US were performed, with an average of 1,83 exam per patient. A total of 14 digital angiography were required, and evidenced thrombosis in 4 patients and nonsignificant stenosis in 1. Significant stenosis was observed in 8 patients, and ATP was performed in those cases. No statistically significant difference was observed between the groups in thrombosis rates 24,1% vs 17,0%, p=ns). The interventional strategy showed statistically significant redution in the incidence of the need for placement of CVC (25,9% vs 7,5%, p=0,021). The differences in the composite outcome was statistically significant (44,8% vs 20,8%, p=0,033). Conclusions : The interventional strategy promoted a significant reduction rates for the need of placement of central vein catheter and of the combined outcome in the studied sample, showing benefits in patients with FAV in hemodialysis program.

Introdução: A hemodiálise (HD) requer um acesso vascular funcionante para sua realização. A fístula arteriovenosa nativa (FAV) constitui-se no acesso ideal para essa prática, com menores índices de morbidade e trombose e melhor qualidade de vida. A estenose da FAV é a maior causa de trombose e perda do acesso vascular. A monitorização continuada dos acessos através de diferentes métodos pode reduzir a incidência de trombose da FAV, conforme indicado por estudos com controle histórico e não-randomizados. Objetivos: Avaliar se uma estratégia intervencionista através de ecografia com Doppler (ED), angiografia digital (AD) e angioplastia (ATP) reduz a incidência de trombose e necessidade do uso de cateter em veia central temporário (CVC) em relação ao manejo conservador em pacientes com FAV em programa de HD. Métodos: Estudo prospectivo randomizado controlado de 108 pacientes e 111 FAV em programa de HD durante 11 meses. No grupo controle, foram realizadas mensurações quinzenais de parâmetros hemodinâmicos durante sessões de HD. No grupo intervenção, além da mensuração dos parâmetros hemodinâmicos, foi realizada ED a cada três meses, seguido de AD em casos de disfunção do acesso, definida pela ocorrência de pelo menos 1 dos seguintes critérios: redução do frêmito da FAV, aumento das pressões venosas, pobre fluxo arterial ou formação de hematoma ou edema no membro superior recorrentes durante HD, e/ ou pela presença de estenose vascular maior que 50% e/ou um fluxo estimado inferior à 500ml/min na ED. Em estenoses angiográficas superiores a 50% foi realizada ATP. Os desfechos avaliados foram trombose e necessidade de implantação de CVC, bem como desfecho composto, dado pela associação dos desfechos referidos. Resultados: Foram randomizadas 58 FAV para o grupo controle e 53 FAV para o grupo intervenção. Não foram observadas diferenças significativas entre os grupos em relação aos dados demográficos, comorbidades e características do acesso. O tempo médio de seguimento foi de 7,5 meses. No grupo intervenção, foram realizadas 97 ED, com média de 1,83 exame por paciente. Foram indicadas 14 AD, sendo que um paciente não compareceu ao estudo. Foi evidenciada trombose da FAV em 4 casos, e estenose não-significativa em 1. Estenose significativa foi observada em 8 pacientes, sendo então realizada ATP nesses casos. Não houve diferença significativa entre os grupos quanto à incidência de trombose (24,1% vs 17,0% p=ns). A estratégia intervencionista determinou redução significativa na incidência de necessidade de CVC (25,9% vs 7,5%, p=0,021), e na incidência do desfecho composto (44,8% vs 20,8%, p=0,033). Conclusões: A estratégia intervencionista no manejo das FAV promoveu uma redução significativa da necessidade de CVC e do desfecho composto de trombose e CVC. / Background: Hemodialysis (HD) requires a functioning vascular access in appropriate conditions. Native arteriovenous fistulae (NAF) provide the ideal access for that practice. Stenosis of the NAF is the highest cause of thrombosis and loss of the HD vascular access. The continuous monitorization of the NAF through different methods reduce the incidence of thrombosis according to non-randomized studies with historical control. Objective: To evaluate an interventionist strategy through the follow up of the NAF with Color Flow Doppler ultrasound (US), digital angiography and transluminal angioplasty (ATP), when suitable, to reduce the thrombosis and need for the use of a temporary central vein catheter (CVC) rates in relation to the conservative strategy. Methods: A prospective randomized controlled study of 108 patients and 111 permanent vascular access in an HD program. In the control group, assesment of the hemodynamic parameters of the vascular access were performed every fiftheen days. In the intervention group , besides the assesment of the hemodynamic parameters, was submitted to US every three months, as well as with angiography in cases that presented criteria for dysfunction of the access, defined by the occurrence of at least 1 of the following: reduction of the thrill; increase of the vein pressure during HD sessions; impossibility of obtaining a flow of 300 ml/min during HD; recurring hematoma or edema formation and/or the presence of larger vascular stenoses than 50% or a flow lower than 500ml/min at the US. The patients that presented angiographic evidence of hemodymically significant stenoses were submitted to ATP. The primary outcomes were need for temporary CVC during the follow up, FAV thrombosis and composite outcome. The outcomes were compared between the groups at the end of a 11 months period of follow-up. Results: Fifht eight FAV were randomized to control group and 53 FAV to interventional group. No significant differences were observed between the groups in relation to the demographic data, comorbidities and characteristics of the access. The NAF studied were followed up for a mean time of 7,5 months. In the interventional group, 97 US were performed, with an average of 1,83 exam per patient. A total of 14 digital angiography were required, and evidenced thrombosis in 4 patients and nonsignificant stenosis in 1. Significant stenosis was observed in 8 patients, and ATP was performed in those cases. No statistically significant difference was observed between the groups in thrombosis rates 24,1% vs 17,0%, p=ns). The interventional strategy showed statistically significant redution in the incidence of the need for placement of CVC (25,9% vs 7,5%, p=0,021). The differences in the composite outcome was statistically significant (44,8% vs 20,8%, p=0,033). Conclusions : The interventional strategy promoted a significant reduction rates for the need of placement of central vein catheter and of the combined outcome in the studied sample, showing benefits in patients with FAV in hemodialysis program.

This study sought to evaluate a new method that uses injection of fibrin sealant under simultaneous balloon occlusion for the treatment of postinterventional access site bleeding complications. With the rising complexity of interventional procedures, iatrogenic false aneurysms and active bleeding has become more common. In general, these complications are associated with increased morbidity and mortality, especially if surgical repair is required. Although high success rates are reported for ultrasound‐guided compression and ultrasound‐guided thrombin injection, these methods are not always feasible. All procedures of fibrin sealant injection under simultaneous balloon occlusion for the treatment of postinterventional access site bleeding complications or pseudoaneurysm were prospectively collected. Additional data were retrospectively obtained and analyzed for all patients treated by this new method. In total, 53 patients were included from 2018 to 2021. Most of the access site complications were related to transcatheter aortic valve replacement (40%) or percutaneous coronary intervention (21%), but also to a wide variety of other procedures. Of the 53 patients, 30 had to be treated for false aneurysms and 23 for active bleeding. A high primary success rate of 94% was achieved. Recurrences of false aneurysms occurred in six patients, of which only one needed open surgical repair. Regarding complications, two peripheral embolisms, thereof one requiring additional stent implantation occurred. Balloon‐assisted thrombin injection seems to be feasible and safe. It provides a new alternative to prevent surgery for patients where common techniques are unavailable or have failed.

No description available.