Infections Controlling exit site infections: Does it decrease the incidence of catheter‐related bacteremia in children on hemodialysis?

The most common complication of tunneled‐cuffed hemodialysis catheters is catheter‐related bacteremia (CRB), which contributes to patient morbidity and loss of vascular access. Gram positive microorganisms are the most common etiologic agents; coagulase negative staphylococcus and corynebacterium species are the two most prevalent strains in our center. These are the common inhabitants of skin flora, suggesting that infection of catheters occur through the exit site. The Biopatch is a chlorhexidine impregnated dressing designed to keep the exit site from colonization with skin flora. This may decrease the incidence of CRB due to organisms from the skin. Objective:  To investigate whether the application of the biopatch at the exit site has any effect on the incidence and the etiology of CRB. Methods:  Chart review of 63 pediatric chronic hemodialysis patients who were dialysed between January 1999 and December 2003 was performed. The mean age at start of hemodialysis was 13.9 ± 4.6 years. The pre‐Biopatch era started in January 1999 till the end of June 2001, and the Biopatch era started in July 2001 to December 2003. Biopatch was applied at the beginning of every dialysis week after Betadine cleansing of the exit site, which was then covered with a transparent dressing. In the pre‐Biopatch era, the exit site was cleansed with Betadine at every dialysis session and then covered with a transparent dressing. Results:  The use of the Biopatch at the exit site caused a significant decrease in the exit site infections. However, contrary to what was expected, there was no decrease in the incidence of CRB.  

     

Effective interventions with chlorhexidine gluconate (CHG) to decrease hemodialysis (HD) tunneled catheter‐related infections

Purpose:  Identify practices to reduce HD catheter access related bacteremias (ARB). Methods:  Data was collected per the CDC Dialysis Surveillance Network protocol. ARB was defined as a patient with a positive blood culture with no apparent source other than the vascular access catheter. ARB's were calculated in events per 100 patient months with 3 cohorts. Cohort 1 was observed for 12 months, Cohort 2 for the subsequent 10 months, and Cohort 3 for the final 10 months. Cohort 1 had weekly transparent dressing changes, cleansing of the skin and 5 minute soaking of the connection lines with 10% povidone‐iodine (PI) solution, and HCW use of clean gloves and face shield without a mask. Cohort 2 changes consisted of thrice weekly gauze dressing changes, skin cleansing with ChloraPrep, a 2% CHG/70% isopropyl alcohol applicator, masks on the patients, adding a face mask to the shield, and application of 10% PI ointment to the exit site. Cohort 3 changes included weekly application of BioPatch (BioP), an antimicrobial dressing with CHG, sterile glove use, and replacing the PI line soaks with 4% CHG. Results:  The catheter‐associated ARB rate per 100 patient months was 7.9 (17ARB/216 patient months) in Cohort 1 , 8.6 (13/151) in Cohort 2 , and 4.7 (5/107) in Cohort 3 (p = 0.31 compared with Cohorts 1 and 2 combined). During the last 2 months, in Cohort 3 , 9 catheter lumen cracks occurred, with one of the patients having a bacteremia. Conclusions:  Addition of CHG line soaks and BioP reduced tunneled catheter infections, although this is not statistically significant. The increased number of catheter lumen cracks raises concern with the use of CHG line soaks. Further investigation with use of CHG line soaks and the BioP for decreasing ARB is needed.     

Hemodialysis Central Venous Catheter-Related Bacteremia: Time to Onset

Bacteremia (B) is a well-known complication of an indwelling central venous catheter (CVC). Although prophylactic measures such as topical and catheter lock antibiotics have been demonstrated to decrease the risk of B in hemodialysis (HD) in patients with a CVC, there are concerns about the development of resistance to these agents when used for long periods of time.
Objective:  We wondered if we could limit the use of these agents by identifying the period when B was most common after CVC placement.
Method: We prospectively noted all patients with a CVC who developed B in any of our 3 units in CT, U.S.A.; 62 episodes of B occurred between 1/1/03 and 9/18/03. 35% of all of the HD patients had a CVC for access during the study period.
Results: Staphylococcus aureus accounted for 22 (35.5%) episodes; Gram-negative organisms for 21 (33.8%) and other staphylococcal species for 14 (22.6%). The other 3 episodes were other Gram-positive organisms and 6 patients developed B with more than 1 organism. 3 (4.8%) patients expired while being treated for the B. The average time to onset of B was 96 ± 98 CVC days with a range of 1–365 days. There was no difference in time to onset based on organism. 43.5% of the episodes of B occurred less than 60 days after the CVC was inserted, but 27.4% occurred greater than 100 days after CVC insertion.
Conclusion:  The time to onset of CVC-related B was variable among the patients developing B in this study. Preventative strategies aimed at reducing the risk of B in patients with a CVC must be used for the life of the CVC.     

Extrapulmonary tuberculosis with multiple localizations in a patient with end‐stage renal disease

Bacteremia is a common complication for hemodialysis (HD) patients (pts) with an indwelling central venous catheter (CVC). We studied our experience with CAB and noted that CAB occurred at an average of 96 ± 98 days after CVC insertion. We wondered what percentage of CAB occurred in the first 21 days after CVC insertion and the spectrum of organisms. We prospectively collected data on all HD pts from 3 centers with a CVC who developed bacteremia between 1/1/03 and 8/31/04. Pts who developed CAB with an identifiable source of bacteremia were excluded. 131 episodes of CAB were identified; 34 (25.95%) occurred in ≤21 days. The mean ± SDEV age of the pts developing CAB > 21 days and ≤21 days was 63 ± 17 and 61.5 ± 15.4 years, respectively. Table 1 outlines the spectrum of organisms. There was a significantly greater incidence of CAB with Staphylococcus aureus (SA) and a significantly lower incidence of Staphylococcus epidermidis (SE) in the pts in whom a CAB developed ≤21 days after insertion.  

  Table 1     

5.

Efficacy of Tissue Plasminogen Activator for Thrombolysis in Central Venous Dialysis Catheters     

Neeta B. O'Mara  Samina Ali  Kathleen Bivens  Richard A. Sherman  Toros Kapoian 《Hemodialysis international. International Symposium on Home Hemodialysis》2003,7(2):130-134

Background:  Low blood flow is a frequent complication of central‐vein (CV) dialysis catheters. Since thrombotic occlusion accounts for many cases of reduced blood flow, it is common practice to administer empiric thrombolytic therapy in an attempt to restore catheter patency and improve function.
Methods:  We prepared tissue plasminogen activator (tPA) from 50 mg lyophilized powder, which was diluted (1 mg/mL) in sterile water for injection. A volume of 1 mL was frozen in 3 cc polystyrene syringes at −20 °C and thawed at room temperature when needed. tPA was then administered into the arterial and venous ports of the central venous catheter in a volume equal to the manufacturer's stated luminal volume and was allowed to dwell for 30 minutes.
Results:  tPA was administered 62 times in 25 patients with 30 catheters (11 Tesio, 17 PermCath, 2 Shiley) for treatment of low blood flow (pump speed < 250 mL/min). Complete restoration of patency was achieved in 23 episodes (mean blood flow pre‐tPA 130 mL/min; post‐tPA 320 mL/min); partial restoration of patency was achieved in 20 episodes (mean blood flow pre‐tPA 69 mL/min; post‐tPA 233 mL/min). tPA was just as likely to be effective in patients with complete catheter occlusion (i.e., no blood flow) as it was when some initial blood flow was present. Nineteen episodes failed to respond to tPA. These episodes occurred in 13 catheters, 12 of which ultimately underwent radiologic evaluation; an extraluminal cause for low blood flow was found in all 12 catheters (6 malpositioned, 6 fibrin sheaths).
Conclusions:  tPA at a dose of 1 mg/mL is effective for restoring patency in CV dialysis catheters. Failure to respond to tPA strongly suggests an extraluminal cause of catheter malfunction.     

6.

多分配枢纽站最大覆盖选址问题     

翁克瑞  杨超 《工业工程与管理》2007,12(1):40-44

讨论了多分配枢纽站最大覆盖选址问题(MAHMCP),即要求每一条被服务的O-D流能够在规定的时间、费用或距离内从起点任意经过一个或两个枢纽站后到达终点,如何选择个枢纽站以使被服务的O-D流达到最大.由于是强NP困难问题,一般难以在满意时间内求解30个节点规模的问题.通过建立MAHMCP的改进模型,设计了求解该问题的禁忌搜索算法,经过基于澳大利亚邮政(AP)枢纽中心选址数据包计算实验,发现禁忌搜索算法在求解MAHMCP时具有很好的计算效果,并且相比分枝定界算法能够节约大量的计算时间.经计算,这一算法可以用来求解82个节点规模的中国航空枢纽港选址问题.     

7.

An effect of strength of railway axle steels on fatigue resistance under press fit     

V. Linhart  I. ?erný 《Engineering Fracture Mechanics》2011,78(5):731-741

High-cycle fatigue tests with an evaluation of fatigue limit were carried out on large model components of bars with press fitted hubs of diameter 63/59 mm. Bars were made of three railway axle steels EA1N, EA4T and 34CrNiMo6 with considerable different strength from 586 MPa to 1041 MPa, respectively. Detection and measurement of crack growth under hubs by ultrasonic method was performed during the tests. In spite of the differences in strength and alloying of tested bars, differences in mean value of fatigue limit were not significant. This result was connected with specific damage mechanism and microcracks initiation under hubs with fretting effects. Short fatigue crack growth under hubs occurred at stress intensity factor range ΔK considerably bellow threshold value ΔK_th of long cracks. Simultaneous growth of main cracks from more than one point of surface circumferential area under hub was quite frequently observed.     

8.

Vascular access‐related infection in nocturnal home hemodialysis     

Wesley N. Hayes  Karthik Tennankore  Marisa Battistella  Christopher T. Chan 《Hemodialysis international. International Symposium on Home Hemodialysis》2014,18(2):481-487

Frequent hemodialysis is associated with increased vascular access adverse events. We hypothesized that bacteremia would be more frequent in patients with central venous catheter (CVC) than arteriovenous fistula or arteriovenous graft (AVF/AVG) in nocturnal home hemodialysis (NHHD). We reviewed blood culture reports and concurrent clinical data for a cohort of one hundred eighty‐seven NHHD patients between January 1, 2006 and June 30, 2012. The primary outcome was time to first bacteremia, technique failure, or death after commencing NHHD. Types of bacteremia and clinical consequences were analyzed. Analyses were adjusted for a priori defined confounders. One hundred eighty‐seven patients were included with a total follow up of six hundred five patient years. Initial vascular access was AVF in seventy‐eight (42%) patients, AVG in eleven (6%) patients, and CVC in ninety‐eight (52%) patients. A total of 79.3% of patients with a CVC reached the composite endpoint of bacteremia, technique failure, or death in the study period; 44.5% of patients with an AVF or AVG reached this composite endpoint. Adjusted time to first bacteremia, technique failure, or death was significantly shorter in patients with initial CVC access (hazard ratio 2.42, 95% confidence interval 1.50–3.90, p < 0.001). Risk factors for bacteremia were comorbid status quantified by the Charlson Comorbidity Index (p < 0.001) and diabetes (p < 0.001). Coagulase negative staphylococcus was the commonest organism cultured accounting for 51.4% bacteremias. The second commonest organism was staphylococcus aureus (20.3% bacteremias). Patients undergoing NHHD with a CVC have a shorter duration to first infection, technique failure, or death than those with permanent vascular access.     

9.

Air-Bubble Method of Locking Central-Vein Catheters for Prevention of Hub Colonization: A Pilot Study     

Zbylut J. Twardowski  Garry Reams  Barbara F. Prowant  Harold L. Moore  John C. Van Stone 《Hemodialysis international. International Symposium on Home Hemodialysis》2003,7(4):320-325

Background: The major source of catheter‐associated bacteremia is contamination of the catheter hub during connection–disconnection procedures. A new method of catheter locking has been developed wherein anticoagulant is injected first, followed by a 0.1‐mL air bubble and 0.9 mL of bactericidal solution. The anticoagulant is then located at the catheter tip and the bactericidal solution is located at the catheter hub. The air bubble prevents mixing of the two solutions. The bactericidal solution was acidified concentrated saline (ACS). The 27% saline solution has a pH of 2.0. ACS was chosen because it is theoretically harmless if injected in the amount used to lock the catheter lumens. The goals of this pilot study were to determine whether the new method of catheter locking is easy to perform with available syringes and whether eventual injection of the experimental solution is well tolerated. Methods: Ten patients were randomly assigned, either to heparin lock (5 patients, 62 treatments) or air‐bubble method (5 patients, 56 treatments). In the control group, the catheters were locked with heparin, 5000 U/mL. In the experimental group, the catheters were locked with heparin, air bubble, and ACS. Altogether, the lumens were overfilled by 0.2 mL. Results: Compared to the routine method, the experimental method required a 1‐ to 2‐min‐longer procedure time. There were no errors in proper sequence of injections into the lumina. There were no episodes of bacteremia related to hub contamination in either group. In the air‐bubble group, there was one case of bacteremia associated with purulent drainage from the exit and the same organism in both cultures. In three instances in each group, the locking solution could not be aspirated and was injected without any subjective symptoms or objective signs. Conclusion: We conclude that the air‐bubble method of locking central‐vein catheters is easy to perform. In three instances of air‐bubble and ACS injection, there were no adverse effects. A full‐scale prospective randomized study is feasible and warranted.     

10.

Developing a multi-quality characteristic analysis model to measure the quality of quick-release bicycle hubs     

Chun-Ming Yang  Chang-Hsien Hsu 《中国工程学刊》2019,42(4):309-318

To reduce the pollution caused by the carbon emissions of automobiles and locomotive vehicles, many countries around the world have encouraged citizens to use bicycles for short-distance trips in recent years. Bicycles are comprised of many parts, and quick-release hubs are highly important for the fixtures on the front and rear wheel axles of a bicycle. The quick-release hub is a multi-quality characteristic product, including two larger-the-better quality characteristics (quick-release stroke and tensile strength) and three nominal-the-best quality characteristics (axis size, assembly distance, and the outer diameter of the spindle). To improve the quality of quick-release hubs, this study proposes a multi-quality characteristic analysis table (MQCAT) and a multi-quality characteristic analysis model (MQCAM). The proposed method can provide a valuable reference by which to guide efforts aimed at improvement for quick-release hub manufacturers. A quick-release hub manufacturer in central Taiwan is presented to illustrate the feasibility of the proposed method. In addition, a comparison with recent methods is provided to demonstrate the advantages of the proposed method. Finally, conclusions are made based on the research study findings.     

11.

Approach to prophylactic measures for central venous catheter‐related infections in hemodialysis: A critical review     

Tricya N. V. Silva  Daniel de Marchi  Marcela L. Mendes  Pasqual Barretti  Daniela Ponce 《Hemodialysis international. International Symposium on Home Hemodialysis》2014,18(1):15-23

Vascular access is the major risk factor for bacteremia, hospitalization, and mortality among hemodialysis (HD) patients. The type of vascular access most associated with bloodstream infection is central venous catheter (CVC). The incidence of catheter‐related bacteremia ranges between 0.6 and 6.5 episodes per 1000 catheter days and increases linearly with the duration of catheter use. Given the high prevalence of CVC use and its direct association with catheter‐related bacteremia, which adversely impacts morbidity and mortality rates and costs among HD patients, several prevention measures aimed at reducing the rates of CVC‐related infections have been proposed and implemented. As a result, a large number of clinical trials, systematic reviews, and meta‐analyses have been conducted in order to assess the effectiveness, clinical applicability, and long‐term adverse effects of such measures. In the following article, prophylactic measures against CVC‐related infections in HD patients and their possible advantages and limitations will be discussed, and the more recent literature on clinical experience with prophylactic antimicrobial lock therapy in HD CVCs will be reviewed.     

12.

机场容量限制下的多重分派枢纽航线网络设计   总被引：1，自引：0，他引：1  

冯乾  乐美龙  韩晓龙 《工业工程》2015,18(4):146-151

为了探索枢纽航线网络的设计,提出了机场容量限制下的多重分派枢纽航线网络的设计方法。以航空客运O-D流为基础,将枢纽选择和航线设计两个阶段综合考虑,用机场吞吐量衡量机场容量限制,建立多商品网络流模型,量化成本折扣因子、枢纽数目对枢纽航线网络总成本的影响程度。中国航空客运吞吐量排名前20的城市组成算例,用IBM ILOG CPLEX12.2计算出设计方案的时间不超过14.87 s。算例证明,机场容量限制会增加枢纽航线网络的总成本,但O-D流分布过度密集的现象减轻,抗拥堵性增强。枢纽间成本折扣因子的减小和枢纽数目的适当增加都能够降低枢纽航线网络的总成本。最后,绘制枢纽航线网络结构图,为枢纽航线网络的设计提供指导。     

13.

Hemodialysis catheter infection with unusual presentation and grave outcome     

Gabaldon D  Xu Z  Sun Y  Servilla KS  Hartshorne MF  Tzamaloukas AH 《Hemodialysis international. International Symposium on Home Hemodialysis》2011,15(4):568-572

Bacteremia from central venous catheter (CVC) infection causes morbidity and mortality in patients on hemodialysis (HD). Diagnosis of the infection can be difficult and may require special imaging. A 70-year-old man with diabetic nephropathy was on HD for 11 months through a permanent CVC. Because of symptomatic osteoporosis, he had kyphoplasty in three lumbar vertebrae (L2, L3, L4) 6 months after starting HD. Severe back pain persisted after kyphoplasty. Throughout the HD period, the exit site of the CVC had a clean appearance, there was no fever, and blood leukocyte counts were normal. During the 11th month of HD, he complained of subjective fever at home. Blood count revealed normal leukocyte count with neutrophilic predominance and blood cultures grew methicillin-resistant Staphylococcus aureus (MRSA). Echocardiogram revealed no heart valve vegetations, but irregular thickening of the CVC wall. Fluorodeoxyglucose positron-emission tomography-computed tomography (FDG-PET-CT) revealed severe inflammation of the CVC wall and a picture consistent with osteomyelitis and severe destruction of the body of the 11th thoracic vertebra. He was treated with intravenous vancomycin and removal of the CVC, the wall of which was grossly inflamed and grew in culture MRSA. Three weeks later, he discontinued HD because of persistent severe back pain. CVC infection with bacteremia and remote infectious foci having grave sequelae can develop in HD patients with paucity of clinical manifestations. FDG-PET-CT is a useful imaging tool in establishing the presence and extent of both the CVC infection and remote metastatic infectious foci.     

14.

CathAway fistula vascular access program achieves improved outcomes and sets a new standard of treatment for end‐stage renal disease     

Steven M. Wilson  Tracy J. Mayne  Mahesh Krishnan  Janet Holland  Abbe Volz  Lori S. Good  Allen R. Nissenson 《Hemodialysis international. International Symposium on Home Hemodialysis》2013,17(1):86-93

Hemodialysis patients using central venous catheters (CVCs) for vascular access are at greater risk of infection and death vs. arterial venous fistula (AVF). In 2008, DaVita initiated the CathAway quality improvement initiative, a multidisciplinary program to reduce CVC use in favor of AVF. Our retrospective analysis examined CVC use for incident (≤90 days) and prevalent (>90 days) patients receiving hemodialysis in the years 2006 to 2010. Outcomes included annual mean percentage of patients with CVCs, new CVC placements per 100 patient years, CVC survival, and percentage patient days with CVC. Over 152,000 patient records were reviewed. Between 76.2% and 79.7% of incident patients used a CVC annually, but for prevalent patients, the proportion decreased from 41.1% in 2006 to 33.5% in 2010. The number of new CVC placements per 100 patient years increased slightly for incident patients but fell annually from 64.8 in 2006 to 55.2 in 2010 for prevalent patients. The percentage of treatment days with CVCs was stable among incident patients (70.4%–74.3%) but fell among prevalent patients from 26.1% in 2006 to 16.5% in 2010. The mean duration of CVC use in incident patients was between 53.0 days (SD, 27.8) in 2006 and 54.1 days (SD, 28.1) in 2009, and for prevalent patients between 158.9 days (SD, 123.0) in 2006 and 128.1 days (SD, 112.0) in 2010. CathAway significantly decreased CVC use in prevalent hemodialysis patients. Decreasing incident patient use will require improvements in predialysis care.     

15.

Selective Carbon Fiber Reinforced Nylon 66 Spur Gears: Development and Performance     

S. Senthilvelan  R. Gnanamoorthy 《Applied Composite Materials》2006,13(1):43-56

A new design methodology is developed to mold the polymer spur gears with high strength fiber reinforcement only in the highly stressed region. High performance high cost short carbon fiber reinforced Nylon 66 is used in the highly stressed tooth region and low cost unreinforced Nylon 66 is used in the hub region. Two different geometries, circular and spline shaped hubs were used for developing the selective reinforced gears by multi-shot injection-molding process. Joint strength of the selectively reinforced gear was estimated using shear tests. Clear hub and tooth region separation without any distortion was observed in joint shear tests. A molten material due to fusion bonding was observed at the interfaces. The joint strength was also evaluated by conducting gear fatigue tests using a power absorption test rig at various torque levels and at a constant gear rotational speed. Monolithic reinforced gear and selective reinforced gears with spline hub exhibited similar fatigue behavior. The failure mode depends upon the test torque level. The selective reinforced gears with circular hub showed joint failures at high-test torque levels. Absence of mechanical interlocking feature in the circular hub geometry contributes to the joint failure. Thermal bond, part interference and mechanical interlocking feature provide sufficient joint strength to the selective reinforced gear with spline hub.     

16.

可靠的不完全轴辐网络设计模型          下载免费PDF全文

李婷婷  张永波 《工业工程》2023,26(1):153-161

不完全轴辐网络的枢纽被毁坏将导致网络运输成本大量增加，研究可靠的不完全轴辐网络设计模型有利于减少枢纽毁坏带来的不利影响。在不完全轴辐网络设计模型基础上，针对枢纽毁坏后需求分配的两种模式 (single backup/multiple backup，SB/MB) ，构建可靠的不完全轴辐网络设计问题 (reliable incomplete hub-and-spoke network design problem，RIHNDP) 模型并线性化，通过算例验证了模型的有效性。结果表明，需求最多的节点总被选为枢纽。不同模式下的后补枢纽、分配方案可能不同：从管理者角度，为了降低管理难度，可采用SB模式；从出行者角度，为了更低的运输成本，宜采用MB模式。因为正常情况下可靠的不完全网络运输成本比不考虑枢纽毁坏的不完全网络高 (不超过5%，网络越密相差越小) ，有必要考虑枢纽毁坏设计可靠的网络，但当枢纽毁坏发生后RIHNDP能避免枢纽毁坏后网络不连通的情况，其运输成本比不考虑枢纽毁坏的不完全网络低。     

17.

Construction and investigation of breast‐cancer‐specific ceRNA network based on the mRNA and miRNA expression data     

Xionghui Zhou  Juan Liu  Wei Wang 《IET systems biology》2014,8(3):96

It has been proved and widely acknowledged that messenger RNAs can talk to each other by competing for a limited pool of miRNAs. The competing endogenous RNAs are called as ceRNAs. Although some researchers have recently used ceRNAs to do biological function annotations, few of them have investigated the ceRNA network on specific disease systematically. In this work, using both miRNA expression data and mRNA expression data of breast cancer patient as well as the miRNA target relations, the authors proposed a computational method to construct a breast‐cancer‐specific ceRNA network by checking whether the shared miRNA sponges between the gene pairs are significant. The ceRNA network is shown to be scale‐free, thus the topological characters such as hub nodes and communities may provide important clues for the biological mechanism. Through investigation on the communities (the dense clusters) in the network, it was found that they are related to cancer hallmarks. In addition, through function annotation of the hub genes in the network, it was found that they are related to breast cancer. Moreover, classifiers based on the discriminative hubs can significantly distinguish breast cancer patients’ risks of distant metastasis in all the three independent data sets.Inspec keywords: cancer, genetics, medical computing, molecular biophysics, RNAOther keywords: breast‐cancer specific ceRNA network construction, miRNA expression data, mRNA expression data, gene pairs, computational method, dense clusters, cancer hallmarks, biological mechanism, discriminative hub genes     

18.

The Air-Bubble Method of Locking Central-Vein Catheters with Acidified, Concentrated Sodium Chloride as a Bactericidal Agent: In Vitro Studies     

Harold L. Moore  Zbylut J. Twardowski 《Hemodialysis international. International Symposium on Home Hemodialysis》2003,7(4):311-319

Background:  Soft, cuffed indwelling catheters are used for hemodialysis access and intravenous infusions. The majority of these catheters are removed as a result of infection caused by contamination of the catheter hub during the connection/disconnection procedures. To prevent clot formation in the lumen, these catheters are routinely "locked" with heparin or some other anticoagulant. None of the anticoagulants commonly used as locking solutions demonstrates any significant bactericidal properties. The primary goal of this study was the development of a catheter locking method that retains anticoagulant properties at the catheter tip and bactericidal properties at the catheter hub. The second goal was to find a solution that possesses excellent bactericidal properties but is not detrimental in the event of injection into the patient's blood stream. The bactericidal properties of acidified, concentrated saline (ACS) were compared to concentrated trisodium citrate and to commonly used bactericidal agents such as povidone iodine, sodium hypochlorite, and chlorhexidine.
Methods:  In preliminary studies, the rate of diffusion of solutes was measured in glass tubes. In another set of experiments, the mixing of two solutions (anticoagulant and bactericide) separated by an air bubble ("air-bubble method") was observed in stationary and moving systems. The final series of studies compared the bactericidal properties of ACS to other bactericidal solutions mentioned above.
Results:  The solutions diffused swiftly in the glass tubes, and by the third day, both solutions were mixed. The air-bubble method prevented mixing in both stationary and moving systems. The bactericidal properties of ACS were superior to all other tested solutions.
Conclusions:  The proposed method of catheter locking with anticoagulant at the catheter tip and ACS at the catheter hub separated by an air bubble is a promising technique and clinical studies are warranted.     

19.

基于方差分析的轮毂造型特征显著性研究     

魏君  韩颖  苏畅  张英朝 《包装工程》2022,43(10):115-120

目的 探讨差异化的轮毂造型、受试者年龄、感知意象的显著程度,确定符合目标人群的电动车轮毂造型方案。方法 完成各有5组轮辐的8种不同风格的轮毂造型方案。获取与电动车整体造型风格一致的8个感知意象词汇,采用5段语义差分法对102名目标人群进行感知意象实验。采用单因素方差分析法,对主成分分析确定的“个性的”等6个重要的感知意象词汇进行比较分析,分别求得8种轮毂造型,以及高中低3个年龄层次的目标人群对电动车轮毂造型特征的感知意象的显著结果。结果 获得不同感知意象对差异化的电动车轮毂造型显著性的影响程度,掌握具有倾向性的感知意象对特定年龄层次人群的敏感程度,总结市场细分条件下的电动车轮毂造型特征的倾向性,并呈现各轮毂造型显著性的影响程度。结论 通过方差分析找到指定感知意象词汇中最敏感的受试者年龄层次,以及造型特征显著性最强、感知意象最突出的轮毂造型,为确保轮毂与整车造型风格的统一性,提供科学依据。     

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Evaluating safety of tunneled small bore central venous catheters in chronic kidney disease population: A quality improvement initiative          下载免费PDF全文

Gauri Bhutani  Mireille El Ters  Walter K Kremers  Joe L Klunder  Sandra J. Taler  Amy W. Williams  Andrew H. Stockland  Marie C. Hogan 《Hemodialysis international. International Symposium on Home Hemodialysis》2017,21(2):284-293

Introduction: Peripherally inserted central venous catheters (PICCs) may adversely impact future successful arteriovenous fistulae (AVF). As part of a quality improvement project, the performance of tunneled small bore tunneled central venous catheters (TSB‐CVCs), as alternatives to PICCs, was evaluated. Methods: A retrospective observational study, involving individuals ≥18 years of age who underwent TSB‐CVC placement by Interventional Radiology at Mayo Clinic, Rochester, MN between 1/1/2010 and 8/30/2013. Findings: The study cohort included 92 patients with a median age of 55 (46–67) years, who underwent 108 TSB‐CVC placements. Baseline renal disease was present in 71% (77/108). Most TSB‐CVCs were placed in hospitalized patients (94%; 102/108); five French in diameter (61%; 66/108) and located in an internal jugular vein (84%; 91/108). Median catheter indwelling time was 20 (11–43) days (n = 84). TSB‐CVC‐related bloodstream infection, deep venous thrombosis (DVT), and superficial venous thrombosis (SpVT) rates per line were 0.009 (1/108), 0.018 (2/108), and 0.009 (1/108), respectively. Venous outcomes in a subgroup of 54 patients, who had documented PICC placements (n = 161) in addition to TSB‐CVC (n = 58) were compared. TSB‐CVC‐DVT rate was lower than the PICC‐DVT rate (0.017 [1/58] vs. 0.106 per line [17/161]; P = 0.04). The TSB‐CVC‐SpVT rate was not different from the PICC‐SpVT rate (0 [0/58] vs. 0.037 [6/161] per line; P = 0.14). Discussion: TSB‐CVCs demonstrated an excellent safety profile in our study. These catheters should be preferentially utilized for arm vein preservation in advanced kidney disease. Their impact on future AVF success needs further evaluation.     

Efficacy of Tissue Plasminogen Activator for Thrombolysis in Central Venous Dialysis Catheters

Background:  Low blood flow is a frequent complication of central‐vein (CV) dialysis catheters. Since thrombotic occlusion accounts for many cases of reduced blood flow, it is common practice to administer empiric thrombolytic therapy in an attempt to restore catheter patency and improve function.
Methods:  We prepared tissue plasminogen activator (tPA) from 50 mg lyophilized powder, which was diluted (1 mg/mL) in sterile water for injection. A volume of 1 mL was frozen in 3 cc polystyrene syringes at −20 °C and thawed at room temperature when needed. tPA was then administered into the arterial and venous ports of the central venous catheter in a volume equal to the manufacturer's stated luminal volume and was allowed to dwell for 30 minutes.
Results:  tPA was administered 62 times in 25 patients with 30 catheters (11 Tesio, 17 PermCath, 2 Shiley) for treatment of low blood flow (pump speed < 250 mL/min). Complete restoration of patency was achieved in 23 episodes (mean blood flow pre‐tPA 130 mL/min; post‐tPA 320 mL/min); partial restoration of patency was achieved in 20 episodes (mean blood flow pre‐tPA 69 mL/min; post‐tPA 233 mL/min). tPA was just as likely to be effective in patients with complete catheter occlusion (i.e., no blood flow) as it was when some initial blood flow was present. Nineteen episodes failed to respond to tPA. These episodes occurred in 13 catheters, 12 of which ultimately underwent radiologic evaluation; an extraluminal cause for low blood flow was found in all 12 catheters (6 malpositioned, 6 fibrin sheaths).
Conclusions:  tPA at a dose of 1 mg/mL is effective for restoring patency in CV dialysis catheters. Failure to respond to tPA strongly suggests an extraluminal cause of catheter malfunction.     

多分配枢纽站最大覆盖选址问题

讨论了多分配枢纽站最大覆盖选址问题(MAHMCP),即要求每一条被服务的O-D流能够在规定的时间、费用或距离内从起点任意经过一个或两个枢纽站后到达终点,如何选择个枢纽站以使被服务的O-D流达到最大.由于是强NP困难问题,一般难以在满意时间内求解30个节点规模的问题.通过建立MAHMCP的改进模型,设计了求解该问题的禁忌搜索算法,经过基于澳大利亚邮政(AP)枢纽中心选址数据包计算实验,发现禁忌搜索算法在求解MAHMCP时具有很好的计算效果,并且相比分枝定界算法能够节约大量的计算时间.经计算,这一算法可以用来求解82个节点规模的中国航空枢纽港选址问题.     

An effect of strength of railway axle steels on fatigue resistance under press fit

High-cycle fatigue tests with an evaluation of fatigue limit were carried out on large model components of bars with press fitted hubs of diameter 63/59 mm. Bars were made of three railway axle steels EA1N, EA4T and 34CrNiMo6 with considerable different strength from 586 MPa to 1041 MPa, respectively. Detection and measurement of crack growth under hubs by ultrasonic method was performed during the tests. In spite of the differences in strength and alloying of tested bars, differences in mean value of fatigue limit were not significant. This result was connected with specific damage mechanism and microcracks initiation under hubs with fretting effects. Short fatigue crack growth under hubs occurred at stress intensity factor range ΔK considerably bellow threshold value ΔK_th of long cracks. Simultaneous growth of main cracks from more than one point of surface circumferential area under hub was quite frequently observed.     

Vascular access‐related infection in nocturnal home hemodialysis

Frequent hemodialysis is associated with increased vascular access adverse events. We hypothesized that bacteremia would be more frequent in patients with central venous catheter (CVC) than arteriovenous fistula or arteriovenous graft (AVF/AVG) in nocturnal home hemodialysis (NHHD). We reviewed blood culture reports and concurrent clinical data for a cohort of one hundred eighty‐seven NHHD patients between January 1, 2006 and June 30, 2012. The primary outcome was time to first bacteremia, technique failure, or death after commencing NHHD. Types of bacteremia and clinical consequences were analyzed. Analyses were adjusted for a priori defined confounders. One hundred eighty‐seven patients were included with a total follow up of six hundred five patient years. Initial vascular access was AVF in seventy‐eight (42%) patients, AVG in eleven (6%) patients, and CVC in ninety‐eight (52%) patients. A total of 79.3% of patients with a CVC reached the composite endpoint of bacteremia, technique failure, or death in the study period; 44.5% of patients with an AVF or AVG reached this composite endpoint. Adjusted time to first bacteremia, technique failure, or death was significantly shorter in patients with initial CVC access (hazard ratio 2.42, 95% confidence interval 1.50–3.90, p < 0.001). Risk factors for bacteremia were comorbid status quantified by the Charlson Comorbidity Index (p < 0.001) and diabetes (p < 0.001). Coagulase negative staphylococcus was the commonest organism cultured accounting for 51.4% bacteremias. The second commonest organism was staphylococcus aureus (20.3% bacteremias). Patients undergoing NHHD with a CVC have a shorter duration to first infection, technique failure, or death than those with permanent vascular access.     

Air-Bubble Method of Locking Central-Vein Catheters for Prevention of Hub Colonization: A Pilot Study

Background: The major source of catheter‐associated bacteremia is contamination of the catheter hub during connection–disconnection procedures. A new method of catheter locking has been developed wherein anticoagulant is injected first, followed by a 0.1‐mL air bubble and 0.9 mL of bactericidal solution. The anticoagulant is then located at the catheter tip and the bactericidal solution is located at the catheter hub. The air bubble prevents mixing of the two solutions. The bactericidal solution was acidified concentrated saline (ACS). The 27% saline solution has a pH of 2.0. ACS was chosen because it is theoretically harmless if injected in the amount used to lock the catheter lumens. The goals of this pilot study were to determine whether the new method of catheter locking is easy to perform with available syringes and whether eventual injection of the experimental solution is well tolerated. Methods: Ten patients were randomly assigned, either to heparin lock (5 patients, 62 treatments) or air‐bubble method (5 patients, 56 treatments). In the control group, the catheters were locked with heparin, 5000 U/mL. In the experimental group, the catheters were locked with heparin, air bubble, and ACS. Altogether, the lumens were overfilled by 0.2 mL. Results: Compared to the routine method, the experimental method required a 1‐ to 2‐min‐longer procedure time. There were no errors in proper sequence of injections into the lumina. There were no episodes of bacteremia related to hub contamination in either group. In the air‐bubble group, there was one case of bacteremia associated with purulent drainage from the exit and the same organism in both cultures. In three instances in each group, the locking solution could not be aspirated and was injected without any subjective symptoms or objective signs. Conclusion: We conclude that the air‐bubble method of locking central‐vein catheters is easy to perform. In three instances of air‐bubble and ACS injection, there were no adverse effects. A full‐scale prospective randomized study is feasible and warranted.     

Developing a multi-quality characteristic analysis model to measure the quality of quick-release bicycle hubs

To reduce the pollution caused by the carbon emissions of automobiles and locomotive vehicles, many countries around the world have encouraged citizens to use bicycles for short-distance trips in recent years. Bicycles are comprised of many parts, and quick-release hubs are highly important for the fixtures on the front and rear wheel axles of a bicycle. The quick-release hub is a multi-quality characteristic product, including two larger-the-better quality characteristics (quick-release stroke and tensile strength) and three nominal-the-best quality characteristics (axis size, assembly distance, and the outer diameter of the spindle). To improve the quality of quick-release hubs, this study proposes a multi-quality characteristic analysis table (MQCAT) and a multi-quality characteristic analysis model (MQCAM). The proposed method can provide a valuable reference by which to guide efforts aimed at improvement for quick-release hub manufacturers. A quick-release hub manufacturer in central Taiwan is presented to illustrate the feasibility of the proposed method. In addition, a comparison with recent methods is provided to demonstrate the advantages of the proposed method. Finally, conclusions are made based on the research study findings.     

Approach to prophylactic measures for central venous catheter‐related infections in hemodialysis: A critical review

Vascular access is the major risk factor for bacteremia, hospitalization, and mortality among hemodialysis (HD) patients. The type of vascular access most associated with bloodstream infection is central venous catheter (CVC). The incidence of catheter‐related bacteremia ranges between 0.6 and 6.5 episodes per 1000 catheter days and increases linearly with the duration of catheter use. Given the high prevalence of CVC use and its direct association with catheter‐related bacteremia, which adversely impacts morbidity and mortality rates and costs among HD patients, several prevention measures aimed at reducing the rates of CVC‐related infections have been proposed and implemented. As a result, a large number of clinical trials, systematic reviews, and meta‐analyses have been conducted in order to assess the effectiveness, clinical applicability, and long‐term adverse effects of such measures. In the following article, prophylactic measures against CVC‐related infections in HD patients and their possible advantages and limitations will be discussed, and the more recent literature on clinical experience with prophylactic antimicrobial lock therapy in HD CVCs will be reviewed.     

机场容量限制下的多重分派枢纽航线网络设计

为了探索枢纽航线网络的设计,提出了机场容量限制下的多重分派枢纽航线网络的设计方法。以航空客运O-D流为基础,将枢纽选择和航线设计两个阶段综合考虑,用机场吞吐量衡量机场容量限制,建立多商品网络流模型,量化成本折扣因子、枢纽数目对枢纽航线网络总成本的影响程度。中国航空客运吞吐量排名前20的城市组成算例,用IBM ILOG CPLEX12.2计算出设计方案的时间不超过14.87 s。算例证明,机场容量限制会增加枢纽航线网络的总成本,但O-D流分布过度密集的现象减轻,抗拥堵性增强。枢纽间成本折扣因子的减小和枢纽数目的适当增加都能够降低枢纽航线网络的总成本。最后,绘制枢纽航线网络结构图,为枢纽航线网络的设计提供指导。     

Hemodialysis catheter infection with unusual presentation and grave outcome

Bacteremia from central venous catheter (CVC) infection causes morbidity and mortality in patients on hemodialysis (HD). Diagnosis of the infection can be difficult and may require special imaging. A 70-year-old man with diabetic nephropathy was on HD for 11 months through a permanent CVC. Because of symptomatic osteoporosis, he had kyphoplasty in three lumbar vertebrae (L2, L3, L4) 6 months after starting HD. Severe back pain persisted after kyphoplasty. Throughout the HD period, the exit site of the CVC had a clean appearance, there was no fever, and blood leukocyte counts were normal. During the 11th month of HD, he complained of subjective fever at home. Blood count revealed normal leukocyte count with neutrophilic predominance and blood cultures grew methicillin-resistant Staphylococcus aureus (MRSA). Echocardiogram revealed no heart valve vegetations, but irregular thickening of the CVC wall. Fluorodeoxyglucose positron-emission tomography-computed tomography (FDG-PET-CT) revealed severe inflammation of the CVC wall and a picture consistent with osteomyelitis and severe destruction of the body of the 11th thoracic vertebra. He was treated with intravenous vancomycin and removal of the CVC, the wall of which was grossly inflamed and grew in culture MRSA. Three weeks later, he discontinued HD because of persistent severe back pain. CVC infection with bacteremia and remote infectious foci having grave sequelae can develop in HD patients with paucity of clinical manifestations. FDG-PET-CT is a useful imaging tool in establishing the presence and extent of both the CVC infection and remote metastatic infectious foci.     

CathAway fistula vascular access program achieves improved outcomes and sets a new standard of treatment for end‐stage renal disease

Hemodialysis patients using central venous catheters (CVCs) for vascular access are at greater risk of infection and death vs. arterial venous fistula (AVF). In 2008, DaVita initiated the CathAway quality improvement initiative, a multidisciplinary program to reduce CVC use in favor of AVF. Our retrospective analysis examined CVC use for incident (≤90 days) and prevalent (>90 days) patients receiving hemodialysis in the years 2006 to 2010. Outcomes included annual mean percentage of patients with CVCs, new CVC placements per 100 patient years, CVC survival, and percentage patient days with CVC. Over 152,000 patient records were reviewed. Between 76.2% and 79.7% of incident patients used a CVC annually, but for prevalent patients, the proportion decreased from 41.1% in 2006 to 33.5% in 2010. The number of new CVC placements per 100 patient years increased slightly for incident patients but fell annually from 64.8 in 2006 to 55.2 in 2010 for prevalent patients. The percentage of treatment days with CVCs was stable among incident patients (70.4%–74.3%) but fell among prevalent patients from 26.1% in 2006 to 16.5% in 2010. The mean duration of CVC use in incident patients was between 53.0 days (SD, 27.8) in 2006 and 54.1 days (SD, 28.1) in 2009, and for prevalent patients between 158.9 days (SD, 123.0) in 2006 and 128.1 days (SD, 112.0) in 2010. CathAway significantly decreased CVC use in prevalent hemodialysis patients. Decreasing incident patient use will require improvements in predialysis care.     

Selective Carbon Fiber Reinforced Nylon 66 Spur Gears: Development and Performance

A new design methodology is developed to mold the polymer spur gears with high strength fiber reinforcement only in the highly stressed region. High performance high cost short carbon fiber reinforced Nylon 66 is used in the highly stressed tooth region and low cost unreinforced Nylon 66 is used in the hub region. Two different geometries, circular and spline shaped hubs were used for developing the selective reinforced gears by multi-shot injection-molding process. Joint strength of the selectively reinforced gear was estimated using shear tests. Clear hub and tooth region separation without any distortion was observed in joint shear tests. A molten material due to fusion bonding was observed at the interfaces. The joint strength was also evaluated by conducting gear fatigue tests using a power absorption test rig at various torque levels and at a constant gear rotational speed. Monolithic reinforced gear and selective reinforced gears with spline hub exhibited similar fatigue behavior. The failure mode depends upon the test torque level. The selective reinforced gears with circular hub showed joint failures at high-test torque levels. Absence of mechanical interlocking feature in the circular hub geometry contributes to the joint failure. Thermal bond, part interference and mechanical interlocking feature provide sufficient joint strength to the selective reinforced gear with spline hub.     

可靠的不完全轴辐网络设计模型

不完全轴辐网络的枢纽被毁坏将导致网络运输成本大量增加，研究可靠的不完全轴辐网络设计模型有利于减少枢纽毁坏带来的不利影响。在不完全轴辐网络设计模型基础上，针对枢纽毁坏后需求分配的两种模式 (single backup/multiple backup，SB/MB) ，构建可靠的不完全轴辐网络设计问题 (reliable incomplete hub-and-spoke network design problem，RIHNDP) 模型并线性化，通过算例验证了模型的有效性。结果表明，需求最多的节点总被选为枢纽。不同模式下的后补枢纽、分配方案可能不同：从管理者角度，为了降低管理难度，可采用SB模式；从出行者角度，为了更低的运输成本，宜采用MB模式。因为正常情况下可靠的不完全网络运输成本比不考虑枢纽毁坏的不完全网络高 (不超过5%，网络越密相差越小) ，有必要考虑枢纽毁坏设计可靠的网络，但当枢纽毁坏发生后RIHNDP能避免枢纽毁坏后网络不连通的情况，其运输成本比不考虑枢纽毁坏的不完全网络低。     

Construction and investigation of breast‐cancer‐specific ceRNA network based on the mRNA and miRNA expression data

It has been proved and widely acknowledged that messenger RNAs can talk to each other by competing for a limited pool of miRNAs. The competing endogenous RNAs are called as ceRNAs. Although some researchers have recently used ceRNAs to do biological function annotations, few of them have investigated the ceRNA network on specific disease systematically. In this work, using both miRNA expression data and mRNA expression data of breast cancer patient as well as the miRNA target relations, the authors proposed a computational method to construct a breast‐cancer‐specific ceRNA network by checking whether the shared miRNA sponges between the gene pairs are significant. The ceRNA network is shown to be scale‐free, thus the topological characters such as hub nodes and communities may provide important clues for the biological mechanism. Through investigation on the communities (the dense clusters) in the network, it was found that they are related to cancer hallmarks. In addition, through function annotation of the hub genes in the network, it was found that they are related to breast cancer. Moreover, classifiers based on the discriminative hubs can significantly distinguish breast cancer patients’ risks of distant metastasis in all the three independent data sets.Inspec keywords: cancer, genetics, medical computing, molecular biophysics, RNAOther keywords: breast‐cancer specific ceRNA network construction, miRNA expression data, mRNA expression data, gene pairs, computational method, dense clusters, cancer hallmarks, biological mechanism, discriminative hub genes     

The Air-Bubble Method of Locking Central-Vein Catheters with Acidified, Concentrated Sodium Chloride as a Bactericidal Agent: In Vitro Studies

Background:  Soft, cuffed indwelling catheters are used for hemodialysis access and intravenous infusions. The majority of these catheters are removed as a result of infection caused by contamination of the catheter hub during the connection/disconnection procedures. To prevent clot formation in the lumen, these catheters are routinely "locked" with heparin or some other anticoagulant. None of the anticoagulants commonly used as locking solutions demonstrates any significant bactericidal properties. The primary goal of this study was the development of a catheter locking method that retains anticoagulant properties at the catheter tip and bactericidal properties at the catheter hub. The second goal was to find a solution that possesses excellent bactericidal properties but is not detrimental in the event of injection into the patient's blood stream. The bactericidal properties of acidified, concentrated saline (ACS) were compared to concentrated trisodium citrate and to commonly used bactericidal agents such as povidone iodine, sodium hypochlorite, and chlorhexidine.
Methods:  In preliminary studies, the rate of diffusion of solutes was measured in glass tubes. In another set of experiments, the mixing of two solutions (anticoagulant and bactericide) separated by an air bubble ("air-bubble method") was observed in stationary and moving systems. The final series of studies compared the bactericidal properties of ACS to other bactericidal solutions mentioned above.
Results:  The solutions diffused swiftly in the glass tubes, and by the third day, both solutions were mixed. The air-bubble method prevented mixing in both stationary and moving systems. The bactericidal properties of ACS were superior to all other tested solutions.
Conclusions:  The proposed method of catheter locking with anticoagulant at the catheter tip and ACS at the catheter hub separated by an air bubble is a promising technique and clinical studies are warranted.     

基于方差分析的轮毂造型特征显著性研究

目的 探讨差异化的轮毂造型、受试者年龄、感知意象的显著程度,确定符合目标人群的电动车轮毂造型方案。方法 完成各有5组轮辐的8种不同风格的轮毂造型方案。获取与电动车整体造型风格一致的8个感知意象词汇,采用5段语义差分法对102名目标人群进行感知意象实验。采用单因素方差分析法,对主成分分析确定的“个性的”等6个重要的感知意象词汇进行比较分析,分别求得8种轮毂造型,以及高中低3个年龄层次的目标人群对电动车轮毂造型特征的感知意象的显著结果。结果 获得不同感知意象对差异化的电动车轮毂造型显著性的影响程度,掌握具有倾向性的感知意象对特定年龄层次人群的敏感程度,总结市场细分条件下的电动车轮毂造型特征的倾向性,并呈现各轮毂造型显著性的影响程度。结论 通过方差分析找到指定感知意象词汇中最敏感的受试者年龄层次,以及造型特征显著性最强、感知意象最突出的轮毂造型,为确保轮毂与整车造型风格的统一性,提供科学依据。     

Evaluating safety of tunneled small bore central venous catheters in chronic kidney disease population: A quality improvement initiative

Introduction: Peripherally inserted central venous catheters (PICCs) may adversely impact future successful arteriovenous fistulae (AVF). As part of a quality improvement project, the performance of tunneled small bore tunneled central venous catheters (TSB‐CVCs), as alternatives to PICCs, was evaluated. Methods: A retrospective observational study, involving individuals ≥18 years of age who underwent TSB‐CVC placement by Interventional Radiology at Mayo Clinic, Rochester, MN between 1/1/2010 and 8/30/2013. Findings: The study cohort included 92 patients with a median age of 55 (46–67) years, who underwent 108 TSB‐CVC placements. Baseline renal disease was present in 71% (77/108). Most TSB‐CVCs were placed in hospitalized patients (94%; 102/108); five French in diameter (61%; 66/108) and located in an internal jugular vein (84%; 91/108). Median catheter indwelling time was 20 (11–43) days (n = 84). TSB‐CVC‐related bloodstream infection, deep venous thrombosis (DVT), and superficial venous thrombosis (SpVT) rates per line were 0.009 (1/108), 0.018 (2/108), and 0.009 (1/108), respectively. Venous outcomes in a subgroup of 54 patients, who had documented PICC placements (n = 161) in addition to TSB‐CVC (n = 58) were compared. TSB‐CVC‐DVT rate was lower than the PICC‐DVT rate (0.017 [1/58] vs. 0.106 per line [17/161]; P = 0.04). The TSB‐CVC‐SpVT rate was not different from the PICC‐SpVT rate (0 [0/58] vs. 0.037 [6/161] per line; P = 0.14). Discussion: TSB‐CVCs demonstrated an excellent safety profile in our study. These catheters should be preferentially utilized for arm vein preservation in advanced kidney disease. Their impact on future AVF success needs further evaluation.