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Background Ports have traditionally been inserted in hospitalized inpatients; however, there has been an increasing transition to outpatient placement by interventionalists in hospital imaging suites. To our knowledge, port implantation in nonhospital settings has not been reported in peer-reviewed literature. Here, we report our experience with port placement in freestanding outpatient vascular centers. Methodology The electronic medical record for 47 centers was retrospectively searched to identify port placements between January 1, 2012, and December 31, 2018. Data included indications, platelet inhibitor/anticoagulants, American Society of Anesthesiologists (ASA) classification, port type, site, tip position, peri-procedure medications, procedure time, and pain scores. Complications were determined by phone calls at 48-72 hours. Results No short-term malfunctions were reported. In total, 5,890 ports were placed for chemotherapy (n = 5,531), IV therapy (n = 77), antibiotics (n = 74), hyperalimentation (n = 19), phlebotomy (n = 7), medications (n = 4), miscellaneous (n = 74), and unknown (n = 104). Regarding ASA classifications, 1% (n = 65) were categorized as Class I, 20% (n = 1,203) as Class II, 78% (n = 4,592) as Class III, and 0.5% (n = 30) as Class IV. Overall, 3,712 were single-lumen power ports, 341 dual-lumen, 19 unknown, 7 arm, 1 other, and 1,810 were unspecified. There were 5,855 chest, 19 arm, 1 thigh, and 15 unspecified ports. Tips were positioned in the superior vena cava (n = 1,582), superior vena cava-right atrium (n = 497), right atrium (n = 272), inferior vena cava (n = 2), inferior vena cava-right atrium (n = 1), or not specified (n = 3,536). The mean procedure time was 29 minutes (range = 6-137). The mean peak pain score was 0.86 (range = 0-10). Complications (n = 33) included 16 emergency/hospital admissions <24 hours for port-site bleeding (2), infection (1), pneumothorax (1), EKG changes (1), respiratory symptoms (3), tachycardia (2), unconfirmed infection (1), fall (1), chest pain (1), syncope (1), pain (1), or other (1). Furthermore, 17 Other complications included unrelated/unconfirmed infection (4), death <30 days (1), shortness of breath (1), infection (1), reversal agent (1), hypoglycemia (1), fall (1), and other (7). No leaks were reported. Conclusions According to the study findings, port placement in outpatient centers appears to be safe and provides short-term effectiveness.

RESULTSFive decommissioning strategies were identified: disposal, donation, reuse, sale and recycling/trade-in. Substantial variability and limited formalization in these strategies were observed across and within hospitals. Economic consequences included repair costs, depreciation and resale value. Social consequences were important, yet typically secondary. Environmental consequences were recognized but rarely formalized, although indirect environmental benefits from economically driven repair activities were acknowledged.CONCLUSIONSDecommissioning strategies for hemodialysis machines in Dutch hospitals do not use formalized guidelines and are still predominantly shaped by economic drivers. The recognition that each decommissioning strategy entails distinct economic, social and environmental consequences highlights the need for more balanced decision-making. By embedding sustainability principles into hospital policies and standardizing decommissioning procedures, hospitals can move toward more circular and responsible dialysis care.BACKGROUNDThe decommissioning of hemodialysis machines, particularly in the context of transitioning from hemodialysis to hemodiafiltration, remains understudied despite its importance for sustainable healthcare. This study evaluates decommissioning strategies for hemodialysis machines used by Dutch hospitals, analyzing the economic, social and environmental consequences.METHODSA qualitative, exploratory study was conducted through semi-structured interviews with 15 professionals from 11 Dutch hospitals that retired hemodialysis machines. The analysis focused on understanding decommissioning strategies and their economic, social and environmental consequences.

RESULTSApollo captures data from January 2018 to March 2021 from 40 countries and 543,169 patients worldwide (4.6% in Asia-Pacific [AP], 13.9% in Europe, Middle East, and Africa [EMEA], 7.0% in Latin America [LA], and 74.5% in North America [NA]). It contains demographic data, 35,874,039 laboratory, and 140,016,249 treatment observations as well as frequently recorded medication information, and clinical outcomes (e.g., hospitalization and mortality). Several regional differences can be observed using these data, such as age, treatment modality, and treatment time.CONCLUSIONCreating a robust multinational dialysis database offers vast opportunities to conduct real-world research and data analytics, including the development of artificial intelligence models. These activities hold promise of advancing the understanding of kidney disease and dialysis therapies. It can serve as comparative resource for the nephrology community.INTRODUCTIONLarge amounts of data are captured during dialysis, yet multinational datasets are scarce because of challenges in harmonizing and integrating clinical data, as well as complying with data protection regulations across the world. A global kidney care provider, Fresenius Medical Care, approached this challenge and finalized the creation of an anonymized dialysis database, coined ApolloDialDb (Apollo). We report on the approach used for database creation and detail dialysis patient characteristics globally.METHODSTo create this globally distributed multinational database, data from different electronic clinical systems were extracted, covering routinely collected medical information from dialysis clinics worldwide. This data were harmonized, and then anonymized following a reidentification risk assessment conducted by the external company Privacy Analytics, Ontario, Canada. The data was consolidated and is stored in a central cloud environment and will be updated periodically.