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 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.