No abstract

Objectives Little is known how calibre and length of needles affect the stability of sclerosing foam. Methods Foams were made of 0.5%, 1%, 2% and 3% polidocanol, and 0.2%, 0.5%, 1% and 3% sodium tetradecyl sulfate (STS), which were mixed with air in the proportion of 4:1. These foams were ejected through needles with the length of: 4 mm, 6 mm and 13 mm, and diameter of: 0.26 mm, 0.3 mm and 0.4 mm. Results Foams made of more concentrated polidocanol were more stable. Regarding STS an opposite relationship was revealed. Foams made of polidocanol were more stable if ejected through a longer needle, while the length of needle did not significantly affect stability of STS foams. Foams ejected through 0.26 mm diameter needles were very unstable. In the case of 0.5% polidocanol, 0.3x6mm needle provided atypically stable foam. Conclusion In order to inject maximally stable foam, calibre and length of needle should be taken into account.

Despite all efforts, still many end-stage kidney disease (ESKD) patients are dialysed using a central tunnelled catheter (CTC) as vascular access. When the CTC blood flow becomes ineffective, a number of protocols are advised. However, all of them are time-and cost-consuming. The manoeuvre of a noninvasive tunnelled catheter reposition (NTCR) was introduced to restore the CTC function. NTCR was based on gentle movements of the CTC, with or without a simultaneous flushing of the CTC lines, which resulted in a quick reposition of the CTC tip. This study comprises the analysis of a total of 297 NTCRs, which were performed in 114 patients, thus enabling an effective blood flow after 133 procedures (44.7%).Partially effective blood flow followed 123 procedures (41.4%), and it failed altogether in 41 cases (13.9%). Overall, 86% of conducted NTCRs improved the CTC patency to perform a haemodialysis session. The procedure could be successfully repeated, with a similar result after the first and the second attempt. Complications were observed only after 3.4% of all interventions. The novel NTCR manoeuvre was safe and effective in the majority of the CTC dysfunction episodes. It seemed to reduce fibrinolytic usage, allowed an immediate haemodialysis session commencement, therefore, it might save both the costs and the nursing staff time. According to registries data, CTCs were used in 68% of the incident and 32% of the prevalent haemodialysis patients in Europe 1. The 2018 Annual Data Report of the United States Renal Data System (USRDS) showed that over 80% of the US patients started haemodialysis with a CTC, and in 69% of them the catheter was still in use after 90 days 2. After comparing dialysis patients from 20 countries, catheter usage ranged from 1% in Japan to 45% in Canada 3. CTC dysfunction was a leading non-infectious complication of this type of vascular access for haemodialysis 4,5. The recent Canadian Observational Study reported one year and two year episodes, in which CTC dysfunction occurred in 15% and 18% of patients, respectively 6. It was generally defined as a failure to aspirate the locking solution from the CTC lines, blood flow rate (QB) through the lines of less than 300 ml/min., arterial pressure of less than 250 mmHg, high venous pressure greater than 250 mmHg, as well as the necessity for the CTC lines reversal 7-9. When this complication occurs repeatedly, it may lead to an ineffectiveness of renal replacement therapy (RRT) with low urea clearance (Kt/V < 1.2 or urea reduction ratio <65%) 7-9. A number of conservative measures and medical management protocols were established to solve the problem. Firstly, it is advised to flush the CTC lines with normal saline solution, place the patient in the Trendelenburg position, on a patient's sides or adjustment of a head position, and finally one can connect the CTC lines in a reversed way 7,8. However, repeated attempts, sometimes performed in an inappropriate way, increase the risk of complications, i.e. the CTC damage or a catheter-related infection...

We would like to present a case of a young male patient with fulminant myocarditis and multi-organ failure treated in our intensive care unit. In the early phase of the treatment, we simultaneously applied mechanical circulatory support (MCS) devices, including veno-arterial extracorporeal membrane oxygenation (ECMO). The use of short-term MCS devices in fulminant myocarditis and in other forms of severe heart failure has increased in recent years [1]. The results of some clinical trials indicate that this mode of treatment, when applied in the early phase of cardiogenic shock, yields promising final results [2,3].A 27-year old, previously healthy man was admitted to the Emergency Department with dyspnea, chest pain, and arterial hypotension. He had been suffering from flu-like syndrome for a week prior to admission. Upon hospital arrival, his mean arterial pressure was 50 mm Hg, and the heart rate was 120 beats per minute. Transthoracic echocardiogram (TTE) revealed severe dysfunction of both ventricles with 15% left ventricular (LV) ejection fraction (EF), 8 cm s -1 velocity-time integral of the left ventricle outflow track (LVOT VTI), and 12 mm tricuspid annular plane systolic excursion (TAPSE). Laboratory tests showed troponin above

Background: Optimal care of patients treated with a central tunneled catheter (CTC) as vascular access for hemodialysis requires a number of procedures. One of them is CTC removal, usually carried out using mostly the cut-down method (CDM) and the traction method (TM). The procedure seems to be simple and safe; however, occasionally, serious complications may occur. To eliminate the risk of such events, we have introduced a modified cut-down method (MCDM). Methods: The study included the analysis of retrospective results of 143 CTC removal procedures, 76 of which were performed using the standard cut-down method (CDM), and in 67 cases, the modified cut-down method (MCDM) was applied. Results: As minor side effects occurred in patients treated with both methods with comparable frequency, serious complications were observed only in the CDM patients group. Conclusions: In our opinion, the new MCDM procedure is the simplest and safest method of CTC removal.