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Arteriovenous fistula (AVF) is still in 2010 the gold standard of vascular(2) access in haemodialysis (HD) patients. Nevertheless it may be difficult to obtain and/or to use AVF in elderly. With this prospective randomised pilot study, we compare two strategies of vascular access in 70 years old or more new HD patients. AVF were compared to tunnelled jugular vein catheters (TIJC) with taurolidine as bacterial lock solution. Results were as follow: [table: see text] The responses with the visual analogic scale of comfort was 8/10 for TIJC and 5/10 with AVF * P<0.05. In five TIJC patients, heparin was added with success to taurolidine because of partial clotting of catheters. Albuminemia was significantly lower in AVF failure patients compared to AVF success patients (24.8g/L vs 31.1g/L). This pilot study allows to conclude that TIJC is an acceptable challenge to AVF in haemodialysed patients of 70 years or more in a two years long use., (Copyright © 2011 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.)

Objective: The aim of this retrospective study was to identify the risk factors for catheter-associated bloodstream infection (CABSI) in neonates., Method and Results: Fifteen episodes of CABSI occurred in 108 central catheters over a period of one year (2002). The univariate analysis risk factors were birth weight (1.064 vs 1.413 g; P<0.001), gestation age (28 vs 31 weeks; P<0.001), blood transfusion (8/15 vs 3/34; P<0.01), corticosteroids (7/15 vs 3/34; P<0.01), nasal CPAP duration (13.6 vs 2 days; P<0.01). Nasal CPAP duration was the only risk factor independently associated with CASBI (OR=1.2, 95% confidence interval=1.09-1.5) in the multivariate logistic regression analysis., Conclusions: The risk of infection associated with low birth weight is multifactorial suggesting that host-related factors are important. Prevention remains difficult and a policy of strict aseptic catheter care must be promoted.

Since 1982, we realized 2538 apheresis sessions in 142 different patients. We analyzed the vascular access of these patients. According to the estimate number of sessions we divided this population in 6 groups: group I: less than 5 sessions = femoral vein catheter, group II: subclavian vein catheter less than 5 sessions; group III: 6 to 21 sessions with same catheter, group IV: internal jugular vein catheter (IJVC) for same session number, group V: patients on IJVC undergoins more than 21 session or treated during more than 3 months, group VI long term treated patients with arterio-venous fistula. We analyse the number of patients in each groups, the mean number of session and the absolute number of recorded adverse events such as local of systemic infection, clotting, catheter dysfunction. Results are as follow: [table: see text] Our study shows clearly the advantage of IJVC compared to either subclavian way in middle duration apheresis as in long term when compared to arterio venous fistula.

Blind deep venous puncture is an invasive procedure with risks of serious complications compromising the availability of veins for future punctures or endangering the patient's life. We designed a new hand-held pulsed Doppler probe for coaxial guidance of the puncture needle and a dedicated pulsed Doppler device displaying the depth of the measurement volume. We used this technique prospectively in two independent centers (the nephrology department and the intensive care unit) involving senior as well as junior staff members. Either the non-Doppler or the Doppler method were randomly selected for subclavian vein catheterization in 100 patients and for internal jugular vein catheterization in 30 patients. The success rate on the first attempt was 86.2% for the non-Doppler method versus 96.8% for the Doppler method (p = 0.03). The failure rate of the non-Doppler method used by junior staff members was 9.2%, reduced to 1.5% (p = 0.05) by secondary use of the Doppler method and/or help from a senior staff member (rescue procedure). Pulsed Doppler guidance reduced significantly the failure rate of venous punctures especially when used by seniors or by juniors after a training period.

Serious complications may occur after "blind" profound venous puncture in intensive care units. To secure these punctures, we designed a new fingertip pulsed Doppler (FPD) 5 MHz probe with a lateral to center indentation to guide the needle into the ultrasonic flux. A specific ultrasound analyzer indicating depth and diameter of the vessel was made for this use. The material was first tested in an experimental animal study. Results of animal venous punctures were successful 20/21. This material was then tested on patients with previous failure of "blind" punctures: results of 4 FPD punctures were successful in all 12 cases but one (catheterization not completed). We started a prospective multi-unit randomized study with various operators (junior residents, senior staff members), compared the success rate and type, the procedure duration of blind standard versus FPD punctures. We conclude in the safety and easy use of the FPD for central venous punctures.

Since 1984, internal jugular vein cannulation (I.J.V.C.) was performed in our Center for ESRD patients. 202 catheters were implanted in 79 patients. Our population was divided in 2 groups: group I corresponding to a rescue procedure for the chronic vascular access failure, group II corresponding to chronic implantation. Outcome analysis indicate the follows results: in both groups, the first I.J.V.C. withdrawal cause was a functional AV fistula. Infections were observed only in group II. Thrombosis is not infrequent requiring fibrinolytic drugs with a 54 FF per patient year additive cost. A special nurse training protocol is also required to reduce the thrombosis incidence. Accidental withdrawal occurred in 11% cases of group II. This observation underlines the need of better fixation devices.