Although a serious impediment in haemophilia patients, difficulty accessing peripheral veins has received little attention in clinical studies. New peripheral vein visualization devices could potentially ameliorate difficult venous access (DVA), but their utility remains unproved. The study aim was to survey the frequency, causes and clinical manifestations of DVA and evaluate the clinical utility of a near-infrared (NIR) vein visualizer. In this multicentre prospective study, methods, difficulties and outcomes of venous access were assessed for a single venipuncture in consecutive patients. The impact of an NIR vein visualizer on vein localization, the number of venipuncture attempts and patient stress and pain was determined. Among 450 total patients enrolled, venous access was judged to be difficult in 165 (36.7%), most often because of poor vein condition, young patient age, overweight and difficulty in finding veins. Of the patients with DVA, difficulty in locating veins was encountered in 82.4%, and more than one venipuncture attempt was required in 24.8%. Veins were difficult to locate in significantly fewer DVA patients (P = 0.002) when the NIR vein visualizer was used (76.0%) than not used (92.3%). Pain during venipuncture in DVA patients was also significantly less common (P = 0.019) with use of the NIR vein visualizer (34.0% vs. 55.4%). No effect was observed on venipuncture attempts. DVA affects more than one-third of patients at haemophilia treatment centres. An NIR vein visualizer showed significant promise for facilitating vein location and mitigating patient pain in those patients.
This study reports on 15 years of experience, in a single haemophilia care centre in France, with central venous access devices (VADs) in children with haemophilia. Following the insertion of a central VAD, patients were requested to return to the hospital on a quarterly basis for a multidisciplinary appointment which included clinical examination, chest X-ray, cardiac and major vessels ultrasound and preventive fibrinolysis. The family was urged to return to the Haemophilia Care Centre if complications or problems occurred. The follow-up comprised 50 patients. Data were collected prospectively. The total number of days with a VAD was 86 461 days and the total number of times the VAD was used was 41 192 (approximately every other day). Mean duration of VAD placement was 1269 days (range 113-2794 days). There were 25 complications, of which 9 haematomas and 5 systemic infections. Two VADs, infected with Staphylococcus aureus, had to be replaced. The infection rate was calculated as 0.0578 infections/1000 catheter days. There were no cases of thrombosis. This study concluded that most VAD infections in children can be avoided, even in patients requiring intense, prolonged treatment. The very low infection rate was achieved through the efforts of a multidisciplinary team, combined with extensive training for all individuals involved, adherence to written protocols and specific monitoring measures.
ObjectivesTo investigate predictive factors for good outcome of ultrasound intra-articular glucocorticoids in knee osteoarthritis (OA).MethodsWe conducted a prospective monocenter cohort study including 116 patients with knee OA, after failure to standard treatments, with pain >4 (numerical rating scale NRS 0–10). Patients received an ultrasound-guided injection of 40 mg triamcinolone acetonide in their most painful knee. We exhaustively collected demographic and clinical data at inclusion, as well as lab, radiographs and ultrasound parameters of the included knees. WOMAC score was calculated at inclusion and after 4 weeks. Responders were defined as patients with at least 40% improvement of their WOMAC score. Univariate analysis was performed in order to select possible predictive factors, and stepwise multiple logistic regression analyses were conducted to identify predictors of response.ResultsAmong the 116 patients, 101 were females. Median age was 64 years (40–85) and mean duration of the disease was 14.1±14,8 years. Mean BMI was 29.9±3.8 Kg/m2. Mean NRS of pain was 8.4±1.2 and mean WOMAC was 73.3±11,8 at inclusion. 70.0% of the knees were grade 3 or 4 of Kellgren-Lawrence. 98% of knees expressed ultrasound synovial effusion and/or hypertrophy at inclusion. After 4 weeks, 61.2% of patients were responders. Regression analysis showed that patients with a BMI <30 Kg/m2 (OR=0.38, 95% CI 0.16–0.89) and an ESR <20 mm (OR=0.27, 95% CI 0.08–0.90) were more likely to respond to ultrasound-guided glucocorticoids injection. Having both predictive factors of good response increases the response rate to 73.5%, whereas having no predictive factor decreases the response rate to 25.0%.ConclusionsOur study is the largest study evaluating predictive factors of response for intra-articular glucocorticoids injections in knee OA. Also, it is the first study of predictive factors for ultrasound-guided injections. Patients with high BMIs and high ESR seem less likely to respond to intra-articular injections.Disclosure of InterestNone declared
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