Catheter-based closure of the patent ductus arteriosus in lower weight infants.

Science.gov (United States)

Pavlek, Leeann R; Slaughter, Jonathan L; Berman, Darren P; Backes, Carl H

2018-06-13

Risks associated with drug therapy and surgical ligation have led health care providers to consider alternative strategies for patent ductus arteriosus (PDA) closure. Catheter-based PDA closure is the procedure of choice for ductal closure in adults, children, and infants ≥6kg. Given evidence among older counterparts, interest in catheter-based closure of the PDA in lower weight (closure devices; (3) review the technical success (feasibility); (4) review the risks (safety profile); (5) discuss the quality of evidence on procedural efficacy; (6) consider areas for future research. The review provided herein suggests that catheter-based PDA closure is technically feasible, but the lack of comparative trials precludes determination of the optimal strategy for ductal closure in this subgroup of infants. Copyright © 2018 Elsevier Inc. All rights reserved.

Impact of short-term hemodialysis catheters on the central veins: a catheter venographic study

Energy Technology Data Exchange (ETDEWEB)

Oguzkurt, Levent E-mail: loguzkurt@yahoo.com; Tercan, Fahri; Torun, Dilek; Yildirim, Tuelin; Zuemruetdal, Ayseguel; Kizilkilic, Osman

2004-12-01

defect and BCV stenosis when patients were grouped according to age, dwell time of the catheter, number of catheters inserted, and diameter of the SVC. Forty-two of the fifty-seven patients had had only right IJV (n=16) or right SCV (n=26) catheters. There were no differences between these groups with respect to rates of pericatheter sleeve formation, thrombus formation, or BCV stenosis. Conclusion: This study showed that even short-term catheters result in significantly high rates of pericatheter sleeve and thrombus formation which are two of the important causes of catheter malfunction. The IJV route is known to be much safer than the SCV route with respect to stenosis formation in the vein in which the catheter is inserted; however, the result showed no differences between the two routes with respect to frequencies of pericatheter sleeve formation, thrombus formation, and BCV stenosis. These findings remind us again that we should avoid unnecessary catheter insertion even for short-term in these chronically ill patients.

Suicide by severing the arterio-venous subclavian dialysis catheter.

Science.gov (United States)

Edirisinghe, P A S; Busuttil, A

2006-02-01

Haemodialysis access is an essential requirement for haemodialysis treatment in end-stage renal disease. The common forms are arteriovenous fistula (AVF) and arteriovenous grafts in ante-cubital fossa, forearm and upper thigh. Sometimes temporary or immediate access is created via a subclavian catheter or internal jugular catheter. This report is on a 79-year-old man who was suffering from chronic renal failure with a non-functional peripheral AVF; he was being dialysed through a permanent subclavian catheter and he became depressed due to continuing deterioration of his health. He used the easily accessible haemodialysis site as the method of suicide by cutting the tube that connected with the main vessel in his chest and bled to death. This highlights the requirement to assess carefully the patient's mental state in those on chronic haemodialysis, even though very few similar fatal cases have been previously reported.

Vessel bifurcation localization based on intraoperative three-dimensional ultrasound and catheter path for image-guided catheter intervention of oral cancers.

Science.gov (United States)

Luan, Kuan; Ohya, Takashi; Liao, Hongen; Kobayashi, Etsuko; Sakuma, Ichiro

2013-03-01

We present a method to localize intraoperative target vessel bifurcations under bones for ultrasound (US) image-guided catheter interventions. A catheter path is recorded to acquire skeletons for the target vessel bifurcations that cannot be imaged by intraoperative US. The catheter path is combined with the centerlines of the three-dimensional (3D) US image to construct a preliminary skeleton. Based on the preliminary skeleton, the orientations of target vessels are determined by registration with the preoperative image and the bifurcations were localized by computing the vessel length. An accurate intraoperative vessel skeleton is obtained for correcting the preoperative image to compensate for vessel deformation. A reality check of the proposed method was performed in a phantom experiment. Reasonable results were obtained. The in vivo experiment verified the clinical workflow of the proposed method in an in vivo environment. The accuracy of the centerline length of the vessel for localizing the target artery bifurcation was 2.4mm. These results suggest that the proposed method can allow the catheter tip to stop at the target artery bifurcations and enter into the target arteries. This method can be applied for virtual reality-enhanced image-guided catheter intervention of oral cancers. Copyright © 2013 Elsevier Ltd. All rights reserved.

Balloon-tipped flow-directed catheters

International Nuclear Information System (INIS)

Ganz, P.; Swan, H.J.C.; Ganz, W.

1986-01-01

Diagnostic catheterization of the right side of the heart with semirigid cardiac catheters requires fluoroscopic guidance and substantial skill. Abnormal positions of the heart chambers and of the great vessels associated with cardiac dilatation or with congenital malformation present difficulties even to experienced laboratory cardiologists. These problems have been largely overcome by the introduction of balloon tipped flow directed catheters, which allow for rapid and relatively safe catheterization of the pulmonary artery without fluoroscopy. It was through the application of these catheters in the intensive care unit that the many pitfalls in the clinical assessment of hemodynamic disturbances became apparent. Although S3 gallop sounds may be useful in the clinical recognition of chronic ventricular failure, their presence or absence has limited predictive value in estimating left ventricular filling pressure in myocardial infarction. Information derived from right heart catheterization is often pivotal in the evaluation of hemodynamic disorders, in directing treatment, and in monitoring the results of therapy in critically ill patients

Chronic Obstructive Pulmonary Disease in Patients with Catheter ...

African Journals Online (AJOL)

of COPD in CAD patients. Methods: A cross sectional study that included consecutive adults with catheter diagnosed CAD recruited from two cardiac centers. Patients completed a COPD diagnosis validated questionnaire and performed spirometry using an electronic spirometer. COPD was diagnosed if patient score placed ...

Use of real time three-dimensional transesophageal echocardiography in intracardiac catheter based interventions.

Science.gov (United States)

Perk, Gila; Lang, Roberto M; Garcia-Fernandez, Miguel Angel; Lodato, Joe; Sugeng, Lissa; Lopez, John; Knight, Brad P; Messika-Zeitoun, David; Shah, Sanjiv; Slater, James; Brochet, Eric; Varkey, Mathew; Hijazi, Ziyad; Marino, Nino; Ruiz, Carlos; Kronzon, Itzhak

2009-08-01

Real-time three-dimensional (RT3D) echocardiography is a recently developed technique that is being increasingly used in echocardiography laboratories. Over the past several years, improvements in transducer technologies have allowed development of a full matrix-array transducer that allows acquisition of pyramidal-shaped data sets. These data sets can be processed online and offline to allow accurate evaluation of cardiac structures, volumes, and mass. More recently, a transesophageal transducer with RT3D capabilities has been developed. This allows acquisition of high-quality RT3D images on transesophageal echocardiography (TEE). Percutaneous catheter-based procedures have gained growing acceptance in the cardiac procedural armamentarium. Advances in technology and technical skills allow increasingly complex procedures to be performed using a catheter-based approach, thus obviating the need for open-heart surgery. The authors used RT3D TEE to guide 72 catheter-based cardiac interventions. The procedures included the occlusion of atrial septal defects or patent foramen ovales (n=25), percutaneous mitral valve repair (e-valve clipping; n=3), mitral balloon valvuloplasty for mitral stenosis (n=10), left atrial appendage obliteration (n=11), left atrial or pulmonary vein ablation for atrial fibrillation (n=5), percutaneous closures of prosthetic valve dehiscence (n=10), percutaneous aortic valve replacement (n=6), and percutaneous closures of ventricular septal defects (n=2). In this review, the authors describe their experience with this technique, the added value over multiplanar two-dimensional TEE, and the pitfalls that were encountered. The main advantages found for the use RT3D TEE during catheter-based interventions were (1) the ability to visualize the entire lengths of intracardiac catheters, including the tips of all catheters and the balloons or devices they carry, along with a clear depiction of their positions in relation to other cardiac structures, and

A cost-effectiveness analysis of long-term intermittent catheterisation with hydrophilic and uncoated catheters

DEFF Research Database (Denmark)

Clark, J F; Mealing, S J; Scott, D A

2016-01-01

includes the long-term sequelae of impaired renal function and urinary tract infection (UTI). SETTING: Analysis based on a UK perspective. METHODS: A probabilistic Markov decision model was constructed, to compare lifetime costs and quality-adjusted life years, taking renal and UTI health states...... into consideration, as well as other catheter-related events. UTI event rates for the primary data set were based on data from hospital settings to ensure controlled and accurate reporting. A sensitivity analysis was applied to evaluate best- and worst-case scenarios. RESULTS: The model predicts that a 36-year......-old SCI patient with chronic urinary retention will live an additional 1.4 years if using HC catheters compared with UC catheters, at an incremental cost of £2100. Moreover, the lifetime number of UTI events will be reduced by 16%. All best- and worst-case estimates were within the UK threshold of being...

Obstruction of peritoneal dialysis catheter is associated with catheter type and independent of omentectomy: A comparative data analysis from a transplant surgical and a pediatric surgical department.

Science.gov (United States)

Radtke, Josephine; Schild, Raphael; Reismann, Marc; Ridwelski, Robert-Richard; Kempf, Caroline; Nashan, Bjoern; Rothe, Karin; Koch, Martina

2018-04-01

Peritoneal dialysis (PD) catheter occlusion is a common complication with up to 36% of catheter obstructions described in the literature. We present a comparison of complications and outcome after implantation of PD catheters in a transplant surgical and a pediatric surgical department. We retrospectively analyzed 154 PD catheters, which were implanted during 2009-2015 by transplant surgeons (TS, University Medical Center Hamburg-Eppendorf, Germany, n=85 catheters) and pediatric surgeons (PS, Charité University Medicine Berlin, Germany, n=69 catheters) in 122 children (median (range) age 3.0 (0.01-17.1) years) for acute (n=65) or chronic (n=89) renal failure. All catheters were one-cuffed or double-cuffed curled catheters, except that straight catheters were implanted into smaller children (n=19) by TS in Hamburg. Patient characteristics and operation technique did not differ between the departments. Peritonitis was the most common complication (33 catheters, 21.4%). Leakage (n=18 catheters, 11.7%) occurred more often in children weighing <10kg (p<0.001). The incidence of obstruction and dysfunction was significantly higher in catheters used in PS than catheters used in TS (30.4% vs. 11.8%, p=0.004). Omentectomy did not reduce the incidence of catheter obstruction (p=1.0). Perforation at the catheter tips was larger and appeared to be rougher in catheters used in PS than the catheters in TS. The type of catheter and presumably the type of perforation at the catheter tip may influence the incidence of peritoneal dialysis catheter obstruction. Copyright © 2017 Elsevier Inc. All rights reserved.

Anatomical and procedural determinants of catheter-based renal denervation

NARCIS (Netherlands)

Ewen, Sebastian; Ukena, Christian; Lüscher, Thomas Felix; Bergmann, Martin; Blankestijn, Peter J; Blessing, Erwin; Cremers, Bodo; Dörr, Oliver; Hering, Dagmara; Kaiser, Lukas; Nef, Holger; Noory, Elias; Schlaich, Markus; Sharif, Faisal; Sudano, Isabella; Vogel, Britta; Voskuil, Michiel; Zeller, Thomas; Tzafriri, Abraham R; Edelman, Elazer R; Lauder, Lucas; Scheller, Bruno; Böhm, Michael; Mahfoud, Felix

2016-01-01

BACKGROUND/PURPOSE: Catheter-based renal sympathetic denervation (RDN) can reduce blood pressure (BP) and sympathetic activity in certain patients with uncontrolled hypertension. Less is known about the impact of renal anatomy and procedural parameters on subsequent BP response. METHODS/MATERIALS: A

Malfunctioning and infected tunneled infusion catheters: over-the-wire catheter exchange versus catheter removal and replacement.

Science.gov (United States)

Guttmann, David M; Trerotola, Scott O; Clark, Timothy W; Dagli, Mandeep; Shlansky-Goldberg, Richard D; Itkin, Maxim; Soulen, Michael C; Mondschein, Jeffrey I; Stavropoulos, S William

2011-05-01

To compare the safety and effectiveness of over-the-wire catheter exchange (catheter-exchange) with catheter removal and replacement (removal-replacement) at a new site for infected or malfunctioning tunneled infusion catheters. Using a quality assurance database, 61 patients with tunneled infusion catheters placed during the period July 2001 to June 2009 were included in this study. Patients receiving hemodialysis catheters were excluded. Catheter-exchange was performed in 25 patients, and same-day removal-replacement was performed in 36 patients. Data collected included demographic information, indication for initial catheter placement and replacement, dwell time for the new catheter, and ultimate fate of the new device. Statistical comparisons between the two cohorts were analyzed using the Kaplan-Meier technique and Fisher exact test. Catheters exchanged over the wire remained functional without infection for a median of 102 days (range, 2-570 days), whereas catheters removed and replaced were functional for a median 238 days (range, 1-292 days, P = .12). After catheter replacement, there were 11 instances of subsequent infection in the catheter-exchange group and 7 instances in the removal-replacement cohort, accounting for infection rates of 4.4 and 2.3 per 1,000 catheter days (P = .049). Patients in the catheter-exchange group had 3.2 greater odds of infection compared with patients in the removal-replacement group. Five malfunction events occurred in each group, accounting for 2.0 and 1.7 malfunctions per 1,000 catheter days in the catheter-exchange and removal-replacement groups (P = .73). Catheter-exchange of tunneled infusion catheters results in a higher infection rate compared with removal-replacement at a new site. The rate of catheter malfunction is not significantly different between the two groups. Catheter-exchange is an alternative for patients with tunneled infusion catheters who have limited venous access, but this technique should not be

Previous PICC Placement May Be Associated With Catheter-Related Infections in Hemodialysis Patients

International Nuclear Information System (INIS)

Butler, Philip J.; Sood, Shreya; Mojibian, Hamid; Tal, Michael G.

2011-01-01

Background: Catheter-related infections (CRIs) are a significant source of morbidity and mortality in hemodialysis patients. The identification of novel, modifiable risk factors for CRIs may lead to improved outcomes in this population. Peripherally inserted central catheters (PICCs) have been hypothesized to compromise vascular access due to vascular damage and venous thrombosis, whereas venous thrombosis has been linked to the development of CRIs. Here we examine the association between PICC placement and CRIs. Methods: A retrospective review was performed of all chronic hemodialysis catheter placements and exchanges performed at a large university hospital from September 2003 to September 2008. History of PICC line use was determined by examining hospital radiologic records from December 1993 to September 2008. Catheter-related complications were assessed and correlated with PICC line history. Results: One hundred eighty-five patients with 713 chronic tunneled hemodialysis catheter placements were identified. Thirty-eight of those patients (20.5%) had a history of PICC placement; these patients were more likely to have CRIs (odds ratio = 2.46, 95% confidence interval = 1.71–3.53, p < .001) compared with patients without a history of PICC placement. There was no difference between the two groups in age or number of catheters placed. Conclusion: Previous PICC placement may be associated with catheter-related infections in hemodialysis patients.

Catheter Angiography

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Full Text Available ... News Physician Resources Professions Site Index A-Z Catheter Angiography Catheter angiography uses a catheter, x-ray ... are the limitations of Catheter Angiography? What is Catheter Angiography? Angiography is a minimally invasive medical test ...

Correction of rotational distortion for catheter-based en face OCT and OCT angiography

Science.gov (United States)

Ahsen, Osman O.; Lee, Hsiang-Chieh; Giacomelli, Michael G.; Wang, Zhao; Liang, Kaicheng; Tsai, Tsung-Han; Potsaid, Benjamin; Mashimo, Hiroshi; Fujimoto, James G.

2015-01-01

We demonstrate a computationally efficient method for correcting the nonuniform rotational distortion (NURD) in catheter-based imaging systems to improve endoscopic en face optical coherence tomography (OCT) and OCT angiography. The method performs nonrigid registration using fiducial markers on the catheter to correct rotational speed variations. Algorithm performance is investigated with an ultrahigh-speed endoscopic OCT system and micromotor catheter. Scan nonuniformity is quantitatively characterized, and artifacts from rotational speed variations are significantly reduced. Furthermore, we present endoscopic en face OCT and OCT angiography images of human gastrointestinal tract in vivo to demonstrate the image quality improvement using the correction algorithm. PMID:25361133

Urinary catheters

Science.gov (United States)

Catheter - urine; Foley catheter; Indwelling catheter; Suprapubic catheters ... stones Blood infections ( septicemia ) Blood in the urine (hematuria) Kidney damage (usually only with long-term, indwelling ...

Total parenteral alimentation via indwelling umbilical catheters in the newborn period.

Science.gov (United States)

Hall, R T; Rhodes, P G

1976-01-01

Total parenteral alimentation (TPA) was delivered to 80 infants via indwelling umbilical artery and to 9 via indwelling umbilical venous catheters. The primary indication for catheter placement and maintenance was monitoring of arterial blood gases (umbilical venous catheter tip in left atrium) in a group of sick neonates requiring increased inspired oxygen or assisted ventilation. Results were compared with those from 23 infants who had tunnelled jugular catheters for a variety of chronic medical and surgical problems preventing gastric or intestinal feeding. A mean weight gain was achieved in both groups. Mortality and morbidity rates were similar in both groups. The most common complications were infection and thrombotic phenomena. Metabolic complications were few. It is concluded that infusing TPA solutions via indwelling umbilical catheters presents no greater risk than infusion via tunnelled jugular catheters, and provides a method for supplying adequate caloric intake for growth during the acute stage of illness. PMID:827978

Catheter-based intervention for pulmonary vein stenosis due to fibrosing mediastinitis: The Mayo Clinic experience

Directory of Open Access Journals (Sweden)

Shiva P. Ponamgi

2015-09-01

Conclusions: We describe the largest reported case series of catheter-based intervention for PV stenosis in FM. Although catheter-based therapy improved hemodynamics, short-term vascular patency, and patient symptoms, the rate of life-threatening complications, restenosis, and mortality associated with these interventions was found to be high. Despite these associated risks, catheter-based intervention is the only palliative option available to improve quality of life in severely symptomatic patients with PV stenosis and FM. Patients with PV stenosis and FM (especially those with bilateral disease have an overall poor prognosis in spite of undergoing these interventions due to the progressive and recalcitrant nature of the disease. This underscores the need for further innovative approaches to manage this disease.

Initial experience with the Europass: a new ultra-low profile monorail balloon catheter.

Science.gov (United States)

Zimarino, M; Corcos, T; Favereau, X; Tamburino, C; Toussaint, M; Spaulding, C; Guérin, Y

1994-09-01

One of the causes for percutaneous transluminal coronary angioplasty (PTCA) failure is the inability to cross the lesion with the balloon catheter after guidewire positioning. The Europass coronary angioplasty catheter is a monorail Duralyn balloon catheter developed to enhance lesion crossability and to overcome this limitation. This system was evaluated in 50 patients in which target lesions were chronic total coronary occlusions (12 cases) or stenoses that could not be reached or crossed by other new monorail balloon catheters. Overall procedural success was obtained in 49/50 patients (98%), using a single Europass balloon catheter in 46/50 patients (92%), with no in-hospital complications. Its low profile, small distal shaft, and excellent trackability allowed successful angioplasty in cases where other catheters failed. This balloon catheter represents a significant advance in angioplasty technology and can be considered as a first-choice device for a safe and expeditious single-operator procedure.

Central venous catheters: detection of catheter complications and therapeutical options

International Nuclear Information System (INIS)

Gebauer, B.; Beck, A.; Wagner, H.J.; Vivantes-Kliniken, Hellersdorf und Prenzlauer Berg

2008-01-01

For modern medicine central venous catheters play an important role for diagnostic and therapeutic options. Catheter implantation, complication detection and therapy of catheter complications are an increasing demand for the radiologist. The review article provides an overview of different catheter types, their indications, advantages and disadvantages. Catheter malpositions are usually detectable in conventional X-ray. Most malpositions are correctable using interventional-radiological techniques. In addition therapeutical options for thrombotic complications (venous thrombosis, catheter occlusion, fibrin sheath) are discussed. In case of an infectious catheter complication, usually a catheter extraction and re-implantation is necessary

Catheter Angiography

Medline Plus

Full Text Available ... Z Catheter Angiography Catheter angiography uses a catheter, x-ray imaging guidance and an injection of contrast material ... vessels in the body. Angiography is performed using: x-rays with catheters computed tomography (CT) magnetic resonance imaging ( ...

Urinary catheter - infants

Science.gov (United States)

Bladder catheter - infants; Foley catheter - infants; Urinary catheter - neonatal ... A urinary catheter is a small, soft tube placed in the bladder. This article addresses urinary catheters in babies. WHY IS ...

Penile gangrene following condom catheter urinary drainage : A case report

Directory of Open Access Journals (Sweden)

Sandhya Gupta

2016-04-01

Full Text Available External urine collecting devices have been a boon to patients of urinary incontinence since their invention in late 90s. They have replaced the need for uncomfortable indwelling catheters in these patients. As safe as they may be, ghastly complications have occurred infrequently, mostly due to their inappropriate application. Such penile and urethral complications add to the morbidity of the patients significantly. They can be easily avoided by following few simple steps of catheter care, thus emphasizing the need to aware clinicians and health care workers about the correct application methods. Here we discuss a case of 60 year old male who developed penile skin necrosis and urethral fistula due to chronic use of condom catheter.

[The role of the uretral catheter in the development of catheter- related urinary tract infection].

Science.gov (United States)

Vasilyev, A O; Govorov, A V; Shiryaev, A A; Pushkar, D Yu

2017-12-01

The most common source of nosocomial infection is the urinary tract, especially if they it is drained with a urethral catheter. Catheter-associated urinary tract infections account for at least 80% of all complicated urinary tract infections and are the most common type of hospital-acquired infection. Intestinal microflora plays the leading role in the pathogenesis of catheter-associated urinary tract infections, whereas the most important risk factor for their development is the long duration of urinary catheter drainage. In the case of short-term and intermittent catheterization, routine antibiotic prophylaxis is not required, but if a patient develops clinically significant infection, antibiotic therapy is required followed by definitive therapy based on culture. Urethral catheters coated with antimicrobial substances and anti-inflammatory agents can significantly reduce the adhesion and migration of bacteria, thereby reducing the incidence of urinary tract infections. Despite this, the incidence of catheter-associated infection remains high. We have reviewed recent literature related to catheter-associated urinary tract infections and the best means of preventing this condition.

Deep venous thrombosis in the lower extremity: catheter-directed thrombolysis

Energy Technology Data Exchange (ETDEWEB)

Roh, Byung Suk; Kim, En A; Park, Ki Han; Yoon, Kwon Ha; So, Byung Jun; Juhng, Seon Kwan; Won, Jin Jong [School of Medicine, Wonkwang University, Iksan (Korea, Republic of)

2000-09-01

To evaluate the efficacy of catheter-directed thrombolysis in treating symptomatic deep venous thrombosis (DVT) in lower limbs. Twenty-six consecutive patients (16 male and 10 female; mean age, 55 years) with lower extremity DVT underwent thrombolytic therapy. The duration of symptoms was 1-90 (mean, 17) days: 20 days or less in 16 cases (acute DVT) and less than 20 days in ten (chronic DVT). Catheter-directed infusions of urokinase were administered via ipsilateral popliteal veins, and angioplasty or stent placement was performed after the thrombolytic procedure. Oral medication of warfarin continued for six months, and for the evaluation of venous patency, follow-up ultrasonography was performed. The total dose of infused urokinase was 1,750,000-10,000,000 (mean 4,84,000) IU, and the total procedural time was 25-115 (mean, 64) hours. Lysis was complete in 16 cases (62%, all acute DVT), partial in five (19%, chronic DVT), and failed in five (19%, chronic DVT). Eight patients with venous stenosis and two with occlusion were treated by means of angioplasty (n=3D4) or Wallstent placement (n=3D6). Minor bleeding occurred in six cases and major complications in two (one of pulmonary embolism, and one of multiorgan failure). Catheter-directed thrombolysis with urokinase is effective for the treatment of DVT in lower limbs. (author)

Deep venous thrombosis in the lower extremity: catheter-directed thrombolysis

International Nuclear Information System (INIS)

Roh, Byung Suk; Kim, En A; Park, Ki Han; Yoon, Kwon Ha; So, Byung Jun; Juhng, Seon Kwan; Won, Jin Jong

2000-01-01

To evaluate the efficacy of catheter-directed thrombolysis in treating symptomatic deep venous thrombosis (DVT) in lower limbs. Twenty-six consecutive patients (16 male and 10 female; mean age, 55 years) with lower extremity DVT underwent thrombolytic therapy. The duration of symptoms was 1-90 (mean, 17) days: 20 days or less in 16 cases (acute DVT) and less than 20 days in ten (chronic DVT). Catheter-directed infusions of urokinase were administered via ipsilateral popliteal veins, and angioplasty or stent placement was performed after the thrombolytic procedure. Oral medication of warfarin continued for six months, and for the evaluation of venous patency, follow-up ultrasonography was performed. The total dose of infused urokinase was 1,750,000-10,000,000 (mean 4,84,000) IU, and the total procedural time was 25-115 (mean, 64) hours. Lysis was complete in 16 cases (62%, all acute DVT), partial in five (19%, chronic DVT), and failed in five (19%, chronic DVT). Eight patients with venous stenosis and two with occlusion were treated by means of angioplasty (n=3D4) or Wallstent placement (n=3D6). Minor bleeding occurred in six cases and major complications in two (one of pulmonary embolism, and one of multiorgan failure). Catheter-directed thrombolysis with urokinase is effective for the treatment of DVT in lower limbs. (author)

A hospital-acquired outbreak of catheter-related nontuberculous mycobacterial infection in children on peritoneal dialysis

OpenAIRE

Yamada, Takuji; Ushijima, Katsumi; Uemura, Osamu

2014-01-01

Catheter-related nontuberculous mycobacterial infection in children with chronic renal failure on peritoneal dialysis (PD) is rare. However, there have been five such infections in infants among PD patients at our center. Although the patients were treated with antibiotics to which the organisms showed in vitro sensitivity, they were clinically drug resistant. Hence, all PD catheters needed to be removed. Thereafter, following hemodialysis treatment for approximately 1 month, the PD catheters...

Correction of malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance

International Nuclear Information System (INIS)

Lee, Seung Ryong; Baek, Kyong Hee; Jung, Gyoo Sik; Huh, Jin Do; Joh, Young Duk; Rim, Hark

1997-01-01

To determine the efficacy of correction of a malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance. Between November 1994 and March 1997, we performed 15 manipulations in 12 patients in whom a dual-cuff, straight Tenckhoff peritoneal dialysis catheter had been implanted due to chronic renal failure. The causes of catheter malfunctioning were inadequate drainage of the dialysate(n=14) and painful dialysis(n=1). Under fluoroscopic guidance, adhesiolysis and repositioning of the malfunctioning catheter were performed with an Amplatz Super Stiff guidewire and the stiffener from a biliary drainage catheter. The results of procedures were categorized as either immediate or durable success, this latter being defined as adequate catheter function for at least one month after the procedure. Immediate success was achieved in 14 of 15 procedures (93%), and durable success in 7 of 15(47%). The mean duration of catheter function was 157 (range, 30 to 578) days. After manipulation, abdominal pain developed in eight patients and peritonitis in two, but with conservative treatment, these symptoms improved. The correction of a malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance is an effective means of restoring catheter function and may be an effective alternative to surgical reimplantation of the catheter, or hemodialysis

Correction of malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance

Energy Technology Data Exchange (ETDEWEB)

Lee, Seung Ryong; Baek, Kyong Hee; Jung, Gyoo Sik; Huh, Jin Do; Joh, Young Duk; Rim, Hark [Kosin Medical College, Pusan (Korea, Republic of)

1997-11-01

To determine the efficacy of correction of a malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance. Between November 1994 and March 1997, we performed 15 manipulations in 12 patients in whom a dual-cuff, straight Tenckhoff peritoneal dialysis catheter had been implanted due to chronic renal failure. The causes of catheter malfunctioning were inadequate drainage of the dialysate(n=14) and painful dialysis(n=1). Under fluoroscopic guidance, adhesiolysis and repositioning of the malfunctioning catheter were performed with an Amplatz Super Stiff guidewire and the stiffener from a biliary drainage catheter. The results of procedures were categorized as either immediate or durable success, this latter being defined as adequate catheter function for at least one month after the procedure. Immediate success was achieved in 14 of 15 procedures (93%), and durable success in 7 of 15(47%). The mean duration of catheter function was 157 (range, 30 to 578) days. After manipulation, abdominal pain developed in eight patients and peritonitis in two, but with conservative treatment, these symptoms improved. The correction of a malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance is an effective means of restoring catheter function and may be an effective alternative to surgical reimplantation of the catheter, or hemodialysis.

Catheter Angiography

Medline Plus

Full Text Available ... of a catheter makes it possible to combine diagnosis and treatment in a single procedure. Catheter angiography ... of a catheter makes it possible to combine diagnosis and treatment in a single procedure. An example ...

Catheter Angiography

Medline Plus

Full Text Available ... few millimeters) in the skin where the catheter can be inserted into an artery. The catheter is ... need for surgery. If surgery remains necessary, it can be performed more accurately. Catheter angiography presents a ...

Catheter Angiography

Medline Plus

Full Text Available ... resonance imaging (MRI) In catheter angiography, a thin plastic tube, called a catheter , is inserted into an ... The catheter used in angiography is a long plastic tube about as thick as a strand of ...

Catheter Angiography

Medline Plus

Full Text Available ... using: x-rays with catheters computed tomography (CT) magnetic resonance imaging (MRI) In catheter angiography, a thin plastic ... called superselective angiography. Unlike computed tomography (CT) or magnetic resonance (MR) angiography , use of a catheter makes it ...

SURVIVAL OF CONTINUOUS AMBULATORY PERITONEAL DIALYSIS CATHETERS: AN EVALUATION OF SURGICAL AND NON-SURGICAL FACTORS (SINGLE CENTER STUDY

Directory of Open Access Journals (Sweden)

A. Keshvari

2006-06-01

Full Text Available Peritoneal dialysis is an established form of renal replacement therapy used in many patients with end-stage renal disease. The key to a successful chronic peritoneal dialysis is a permanent and safe access to the peritoneal cavity. This study was conducted in order to evaluate the catheter survival and its related factors in Imam Khomeini Hospital. A total of 80 catheters were inserted into 69 patients (52 men and 28 women with end-stage chronic renal failure during a period of 84 months. Retrospectively the correlation between catheter survival (overall and event free with demographic factors (sex and age, surgical factors (surgeons and surgical methods, nephrologic factors (the causes of peritoneal dialysis selection and the history of hemodialysis and peritonitis factors (the history and number of peritonitis has been evaluated. The mean age of the patients was 48.35 years (16 to 79 years. The overall survival of catheters or the probability of having a functioning catheter after one, two and three years was 53%, 41%, 22%, respectively. The event free survival of the catheter or the probability of having a functioning catheter without any problems after one year was 14%. It has been found out that among all factors in this study only history of hemodialysis had statistically significant effect on the overall survival of continuous ambulatory peritoneal dialysis catheter (P = 0.04. It seems that the overall survival of catheters is better when CAPD is started before any other attempts for hemodialysis.

Infraclavicular versus axillary nerve catheters: A retrospective comparison of early catheter failure rate.

Science.gov (United States)

Quast, Michaela B; Sviggum, Hans P; Hanson, Andrew C; Stoike, David E; Martin, David P; Niesen, Adam D

2018-05-01

Continuous brachial plexus catheters are often used to decrease pain following elbow surgery. This investigation aimed to assess the rate of early failure of infraclavicular (IC) and axillary (AX) nerve catheters following elbow surgery. Retrospective study. Postoperative recovery unit and inpatient hospital floor. 328 patients who received IC or AX nerve catheters and underwent elbow surgery were identified by retrospective query of our institution's database. Data collected included unplanned catheter dislodgement, catheter replacement rate, postoperative pain scores, and opioid administration on postoperative day 1. Catheter failure was defined as unplanned dislodging within 24 h of placement or requirement for catheter replacement and evaluated using a covariate adjusted model. 119 IC catheters and 209 AX catheters were evaluated. There were 8 (6.7%) failed IC catheters versus 13 (6.2%) failed AX catheters. After adjusting for age, BMI, and gender there was no difference in catheter failure rate between IC and AX nerve catheters (p = 0.449). These results suggest that IC and AX nerve catheters do not differ in the rate of early catheter failure, despite differences in anatomic location and catheter placement techniques. Both techniques provided effective postoperative analgesia with median pain scores < 3/10 for patients following elbow surgery. Reasons other than rate of early catheter failure should dictate which approach is performed. Copyright © 2018. Published by Elsevier Inc.

A Cognitive Neuroscience Perspective on Skill Acquisition in Catheter-based Interventions

NARCIS (Netherlands)

Paul, Katja; Cnossen, Fokeltje; Lanzer, Peter

2018-01-01

Catheter-based cardiovascular interventions (CBCVI) provide a fascinating context to study skill acquisition. In CBCVI, multiple cognitive skills are crucial; technical, perceptual, and decision-making skills are all used at the same time and often depend on each other. In order to be able to

Catheter Angiography

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Full Text Available ... lessen your anxiety during the procedure. The area of the groin or arm where the catheter will be inserted is shaved, ... contrast material is injected through the catheter and reaches the blood vessels being studied, several sets of x-rays are taken. Then the catheter is ...

Thrombectomy approach using pediatric Foley catheter in lateral sinus thrombosis developed as a complication of chronic otitis media in a patient with sickle cell anemia

Directory of Open Access Journals (Sweden)

Ercan Akbay

2014-04-01

Full Text Available Lateral sinus thrombophlebitis (LST is a rarely seen intracranial complication of chronic otitis media. Even single case report may guide in this entity given the lack of larger series. In the present manuscript, we will discuss removal of infected thrombus localized in transverse sinus via Foley catheter in a 46-years old man with sickle cell anemia underwent surgery due to LST.

Questionable validity of the catheter-associated urinary tract infection metric used for value-based purchasing.

Science.gov (United States)

Calderon, Lindsay E; Kavanagh, Kevin T; Rice, Mara K

2015-10-01

Catheter-associated urinary tract infections (CAUTIs) occur in 290,000 US hospital patients annually, with an estimated cost of $290 million. Two different measurement systems are being used to track the US health care system's performance in lowering the rate of CAUTIs. Since 2010, the Agency for Healthcare Research and Quality (AHRQ) metric has shown a 28.2% decrease in CAUTI, whereas the Centers for Disease Control and Prevention metric has shown a 3%-6% increase in CAUTI since 2009. Differences in data acquisition and the definition of the denominator may explain this discrepancy. The AHRQ metric analyzes chart-audited data and reflects both catheter use and care. The Centers for Disease Control and Prevention metric analyzes self-reported data and primarily reflects catheter care. Because analysis of the AHRQ metric showed a progressive change in performance over time and the scientific literature supports the importance of catheter use in the prevention of CAUTI, it is suggested that risk-adjusted catheter-use data be incorporated into metrics that are used for determining facility performance and for value-based purchasing initiatives. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Incidence of catheter-related complications in patients with central venous or hemodialysis catheters: a health care claims database analysis.

Science.gov (United States)

Napalkov, Pavel; Felici, Diana M; Chu, Laura K; Jacobs, Joan R; Begelman, Susan M

2013-10-16

Central venous catheter (CVC) and hemodialysis (HD) catheter usage are associated with complications that occur during catheter insertion, dwell period, and removal. This study aims to identify and describe the incidence rates of catheter-related complications in a large patient population in a United States-based health care claims database after CVC or HD catheter placement. Patients in the i3 InVision DataMart® health care claims database with at least 1 CVC or HD catheter insertion claim were categorized into CVC or HD cohorts using diagnostic and procedural codes from the US Renal Data System, American College of Surgeons, and American Medical Association's Physician Performance Measures. Catheter-related complications were identified using published diagnostic and procedural codes. Incidence rates (IRs)/1000 catheter-days were calculated for complications including catheter-related bloodstream infections (CRBSIs), thrombosis, embolism, intracranial hemorrhage (ICH), major bleeding (MB), and mechanical catheter-related complications (MCRCs). Thirty percent of the CVC cohort and 54% of the HD cohort had catheter placements lasting <90 days. Catheter-related complications occurred most often during the first 90 days of catheter placement. IRs were highest for CRBSIs in both cohorts (4.0 [95% CI, 3.7-4.3] and 5.1 [95% CI, 4.7-5.6], respectively). Other IRs in CVC and HD cohorts, respectively, were thrombosis, 1.3 and 0.8; MCRCs, 0.6 and 0.7; embolism, 0.4 and 0.5; MB, 0.1 and 0.3; and ICH, 0.1 in both cohorts. Patients with cancer at baseline had significantly higher IRs for CRBSIs and thrombosis than non-cancer patients. CVC or HD catheter-related complications were most frequently seen in patients 16 years or younger. The risk of catheter-related complications is highest during the first 90 days of catheter placement in patients with CVCs and HD catheters and in younger patients (≤16 years of age) with HD catheters. Data provided in this study can be applied

Reducing catheter-related thrombosis using a risk reduction tool centered on catheter to vessel ratio.

Science.gov (United States)

Spencer, Timothy R; Mahoney, Keegan J

2017-11-01

In vascular access practices, the internal vessel size is considered important, and a catheter to vessel ratio (CVR) is recommended to assist clinicians in selecting the most appropriate-sized device for the vessel. In 2016, new practice recommendations stated that the CVR can increase from 33 to 45% of the vessels diameter. There has been evidence on larger diameter catheters and increased thrombosis risk in recent literature, while insufficient information established on what relationship to vessel size is appropriate for any intra-vascular device. Earlier references to clinical standards and guidelines did not clearly address vessel size in relation to the area consumed or external catheter diameter. The aim of this manuscript is to present catheter-related thrombosis evidence and develop a standardized process of ultrasound-guided vessel assessment, integrating CVR, Virchow's triad phenomenon and vessel health and preservation strategies, empowering an evidence-based approach to device placement. Through review, calculation and assessment on the areas of the 33 and 45% rule, a preliminary clinical tool was developed to assist clinicians make cognizant decisions when placing intravascular devices relating to target vessel size, focusing on potential reduction in catheter-related thrombosis. Increasing the understanding and utilization of CVRs will lead to a safer, more consistent approach to device placement, with potential thrombosis reduction strategies. The future of evidence-based data relies on the clinician to capture accurate vessel measurements and device-related outcomes. This will lead to a more dependable data pool, driving the relationship of catheter-related thrombosis and vascular assessment.

Blood flow measurements during hemodialysis vascular access interventions - Catheter-based thermodilution or Doppler ultrasound?

DEFF Research Database (Denmark)

Heerwagen, Søren T; Hansen, Marc A; Schroeder, Torben V

2012-01-01

by ultrasound dilution was determined within three days of the procedure. The methods were compared using regression analysis and tested for systematic bias. Results: Failure to position the thermodilutional catheter correctly was observed in 8 out of 46 (17%) pre-intervention measurements. Post-intervention......Purpose: To test the clinical performance of catheter-based thermodilution and Doppler ultrasound of the feeding brachial artery for blood flow measurements during hemodialysis vascular access interventions.Methods: Thirty patients with arteriovenous fistulas who underwent 46 interventions had...

Insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations

Energy Technology Data Exchange (ETDEWEB)

Kotsikoris, Ioannis, E-mail: gkotsikoris@gmail.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Zygomalas, Apollon, E-mail: azygomalas@upatras.gr [Department of General Surgery, University Hospital of Patras (Greece); Papas, Theofanis, E-mail: pfanis@otenet.gr [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Maras, Dimitris, E-mail: dimmaras@gmail.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Pavlidis, Polyvios, E-mail: polpavlidis@yahoo.gr [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Andrikopoulou, Maria, E-mail: madric@gmail.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Tsanis, Antonis, E-mail: atsanis@gmail.com [Department of Interventional Radiology, “Erythros Stauros” General Hospital (Greece); Alivizatos, Vasileios, E-mail: valiviz@hol.gr [Department of General Surgery and Artificial Nutrition Unit, “Agios Andreas” General Hospital of Patras (Greece); Bessias, Nikolaos, E-mail: bessias@otenet.gr [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece)

2012-09-15

Introduction: Central venous catheter placement is an effective alternative vascular access for dialysis in patients with chronic renal failure. The purpose of this study was to evaluate the insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations in terms of efficacy of the procedure and early complications. Materials and methods: Between 2008 and 2010, the vascular access team of our hospital placed 409 central venous catheters in patients with chronic renal failure. The procedure was performed using the Seldinger blind technique. In 18 (4.4%) cases it was impossible to advance the guidewire, and so the patients were transported to the angiography suite. Results: Using the angiographic technique, the guidewire was advanced in order to position the central venous catheter. The latter was inserted into the subclavian vein in 12 (66.6%) cases, into the internal jugular vein in 4 (22.2%) and into the femoral vein in 2 (11.1%) cases. There was only one complicated case with severe arrhythmia in 1 (5.5%) patient. Conclusion: Our results suggest that insertion of central venous catheters using angiographic techniques in hemodialysis patients with previous multiple catheterizations is a safe and effective procedure with few complications and high success rates.

Insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations

International Nuclear Information System (INIS)

Kotsikoris, Ioannis; Zygomalas, Apollon; Papas, Theofanis; Maras, Dimitris; Pavlidis, Polyvios; Andrikopoulou, Maria; Tsanis, Antonis; Alivizatos, Vasileios; Bessias, Nikolaos

2012-01-01

Introduction: Central venous catheter placement is an effective alternative vascular access for dialysis in patients with chronic renal failure. The purpose of this study was to evaluate the insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations in terms of efficacy of the procedure and early complications. Materials and methods: Between 2008 and 2010, the vascular access team of our hospital placed 409 central venous catheters in patients with chronic renal failure. The procedure was performed using the Seldinger blind technique. In 18 (4.4%) cases it was impossible to advance the guidewire, and so the patients were transported to the angiography suite. Results: Using the angiographic technique, the guidewire was advanced in order to position the central venous catheter. The latter was inserted into the subclavian vein in 12 (66.6%) cases, into the internal jugular vein in 4 (22.2%) and into the femoral vein in 2 (11.1%) cases. There was only one complicated case with severe arrhythmia in 1 (5.5%) patient. Conclusion: Our results suggest that insertion of central venous catheters using angiographic techniques in hemodialysis patients with previous multiple catheterizations is a safe and effective procedure with few complications and high success rates

Surgical complications after peritoneal dialysis catheter implantation depend on children's weight.

Science.gov (United States)

Radtke, Josephine; Lemke, Anja; Kemper, Markus J; Nashan, Bjoern; Koch, Martina

2016-08-01

Surgical complications are estimated to be as high as 30%-40% during the first 8 weeks after implantation of peritoneal dialysis (PD) catheters. 70 PD catheters which were implanted by transplant surgeons in 61 children (median age 3.3years, range 0.01-15.5years, 31 boys and 30 girls) in 2009-2014 were retrospectively reviewed. The incidence of complications and revisions during the first 6months after implantation was analyzed depending on children's weight and diagnosis. 17 out of 70 catheters needed a surgical revision within 6months after implantation (24.3%). Peritonitis was the most common complication affecting 18.6% of peritoneal dialysis catheters followed by obstruction and dislocation, which it occurred in 9 (12.9%) and 7 (10%) catheters, respectively. Leakage (n=5) only occurred in children with a weight of less than 10kg. The total proportion of complications was higher in children with less than 10kg of weight (P<0.001). PD is safe in children with acute renal failure and older children with chronic renal failure; however children with a weight of less than 10kg are more likely to develop complications. Copyright © 2016 Elsevier Inc. All rights reserved.

Dose requirements for UVC disinfection of catheter biofilms

DEFF Research Database (Denmark)

Bak, Jimmy; Ladefoged, Søren D.; Tvede, Michael

2009-01-01

Bacterial biofilms on permanent catheters are the major sources of infection. Exposure to ultraviolet-C (UVC) light has been proposed as a method for disinfecting the inner surface of catheters. Specification of a UVC-based device for in vivo disinfection is based on the knowledge of the required...... doses to kill catheter biofilm. Given these doses and the power of available UVC light sources, calculation of the necessary treatment times is then possible. To determine the required doses, contaminated urinary catheters were used as test samples and UVC treated in vitro. Patient catheters (n = 67......) were collected and cut into segments of equal size and treated with various UVC doses. After treatment, the biofilm was removed by scraping and quantified by counting colony forming units. Percentage killing rates were determined by calculating ratios between UVC-treated samples and controls (no UVC...

Decreasing dialysis catheter rates by creating a multidisciplinary dialysis access program.

Science.gov (United States)

Rosenberry, Patricia M; Niederhaus, Silke V; Schweitzer, Eugene J; Leeser, David B

2018-03-01

Centers for Medicare and Medicaid Services have determined that chronic dialysis units should have 45%. A multidisciplinary program was established with goals of decreasing catheter rates in order to decrease central line-associated bloodstream infections, decrease mortality associated with central line-associated bloodstream infection, decrease hospital days, and provide savings to the healthcare system. We collected the catheter rates within three dialysis centers served over a 5-year period. Using published data surrounding the incidence and related costs of central line-associated bloodstream infection and mortality per catheter day, the number of central line-associated bloodstream infection events, the costs, and the related mortality could be determined prior to and after the initiation of the dialysis access program. An organized dialysis access program resulted in a 82% decrease in the number of central venous catheter days which lead to a concurrent reduction in central line-associated bloodstream infection and deaths. As a result of creating an access program, central venous catheter rates decreased from an average rate of 45% to 8%. The cost savings related to the program was calculated to be over US$5 million. The decrease in the number of mortalities is estimated to be between 13 and 27 patients. We conclude that a formalized access program decreases catheter rates, central line-associated bloodstream infection, and the resultant hospitalizations, mortality, and costs. Areas with high hemodialysis catheter rates should develop access programs to better serve their patient population.

Indwelling catheter care

Science.gov (United States)

Foley catheter ... You will need to make sure your indwelling catheter is working properly. You will also need to ... not get an infection or skin irritation. Make catheter and skin care part of your daily routine. ...

Reducing catheter-associated urinary tract infections: a quality-improvement initiative.

Science.gov (United States)

Davis, Katherine Finn; Colebaugh, Ann M; Eithun, Benjamin L; Klieger, Sarah B; Meredith, Dennis J; Plachter, Natalie; Sammons, Julia Shaklee; Thompson, Allison; Coffin, Susan E

2014-09-01

Catheter-associated urinary tract infections (CAUTIs) are among the most common health care-associated infections in the United States, yet little is known about the prevention and epidemiology of pediatric CAUTIs. An observational study was conducted to assess the impact of a CAUTI quality improvement prevention bundle that included institution-wide standardization of and training on urinary catheter insertion and maintenance practices, daily review of catheter necessity, and rapid review of all CAUTIs. Poisson regression was used to determine the impact of the bundle on CAUTI rates. A retrospective cohort study was performed to describe the epidemiology of incident pediatric CAUTIs at a tertiary care children's hospital over a 3-year period (June 2009 to June 2012). Implementation of the CAUTI prevention bundle was associated with a 50% reduction in the mean monthly CAUTI rate (95% confidence interval: -1.28 to -0.12; P = .02) from 5.41 to 2.49 per 1000 catheter-days. The median monthly catheter utilization ratio remained unchanged; ∼90% of patients had an indication for urinary catheterization. Forty-four patients experienced 57 CAUTIs over the study period. Most patients with CAUTIs were female (75%), received care in the pediatric or cardiac ICUs (70%), and had at least 1 complex chronic condition (98%). Nearly 90% of patients who developed a CAUTI had a recognized indication for initial catheter placement. CAUTI is a common pediatric health care-associated infection. Implementation of a prevention bundle can significantly reduce CAUTI rates in children. Copyright © 2014 by the American Academy of Pediatrics.

Inhibition and Inactivation of Uropathogenic Escherichia coli Biofilms on Urinary Catheters by Sodium Selenite

Directory of Open Access Journals (Sweden)

Amoolya Narayanan

2018-06-01

Full Text Available Urinary tract infections (UTI are the most common hospital-acquired infections in humans and are caused primarily by uropathogenic Escherichia coli (UPEC. Indwelling urinary catheters become encrusted with UPEC biofilms that are resistant to common antibiotics, resulting in chronic infections. Therefore, it is important to control UPEC biofilms on catheters to reduce the risk for UTIs. This study investigated the efficacy of selenium for inhibiting and inactivating UPEC biofilms on urinary catheters. Urinary catheters were inoculated with UPEC and treated with 0 and 35 mM selenium at 37 °C for 5 days for the biofilm inhibition assay. In addition, catheters with preformed UPEC biofilms were treated with 0, 45, 60, and 85 mM selenium and incubated at 37 °C. Biofilm-associated UPEC counts on catheters were enumerated on days 0, 1, 3, and 5 of incubation. Additionally, the effect of selenium on exopolysacchride (EPS production and expression of UPEC biofilm-associated genes was evaluated. Selenium at 35 mM concentration was effective in preventing UPEC biofilm formation on catheters compared to controls (p < 0.05. Further, this inhibitory effect was associated with a reduction in EPS production and UPEC gene expression. Moreover, at higher concentrations, selenium was effective in inactivating preformed UPEC biofilms on catheters as early as day 3 of incubation. Results suggest that selenium could be potentially used in the control of UPEC biofilms on urinary catheters.

Does Guidewire Exchange Influence Infection Rate Related to Catheters Used for Vascular Access in Children on Chronic Hemodialysis?

Science.gov (United States)

Rus, Rina R; Battelino, Nina; Ponikvar, Rafael; Premru, Vladimir; Novljan, Gregor

2017-02-01

A central venous catheter (CVC) can either be inserted "de novo" or placed by guidewire exchange (GWE). From September 1998 to September 2015, 32 children (19 boys, 13 girls) were hemodialyzed in our unit by using a CVC. The mean age at CVC insertion was 12.6 ± 0.5 years. A total of 121 uncuffed catheters were placed, either "de novo" or by GWE in 64 (52.9%) and 57 (47.1%) cases, respectively. The most frequent cause for line revision was catheter dysfunction in 40/121 (33.1%) patients. The overall incidence of bacteremia was 1.5/1000 catheter-days. The incidence in newly inserted and GWE catheters was 1.4 and 1.7/1000 catheter-days, respectively. The difference did not reach statistical significance (P = 0.939). The infection rate correlated with patient age, and was higher in younger children (P = 0.006). GWE is an effective option of line revision, and did not influence the infection rate in our study. © 2016 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.

Intravenous catheter training system: computer-based education versus traditional learning methods.

Science.gov (United States)

Engum, Scott A; Jeffries, Pamela; Fisher, Lisa

2003-07-01

Virtual reality simulators allow trainees to practice techniques without consequences, reduce potential risk associated with training, minimize animal use, and help to develop standards and optimize procedures. Current intravenous (IV) catheter placement training methods utilize plastic arms, however, the lack of variability can diminish the educational stimulus for the student. This study compares the effectiveness of an interactive, multimedia, virtual reality computer IV catheter simulator with a traditional laboratory experience of teaching IV venipuncture skills to both nursing and medical students. A randomized, pretest-posttest experimental design was employed. A total of 163 participants, 70 baccalaureate nursing students and 93 third-year medical students beginning their fundamental skills training were recruited. The students ranged in age from 20 to 55 years (mean 25). Fifty-eight percent were female and 68% percent perceived themselves as having average computer skills (25% declaring excellence). The methods of IV catheter education compared included a traditional method of instruction involving a scripted self-study module which involved a 10-minute videotape, instructor demonstration, and hands-on-experience using plastic mannequin arms. The second method involved an interactive multimedia, commercially made computer catheter simulator program utilizing virtual reality (CathSim). The pretest scores were similar between the computer and the traditional laboratory group. There was a significant improvement in cognitive gains, student satisfaction, and documentation of the procedure with the traditional laboratory group compared with the computer catheter simulator group. Both groups were similar in their ability to demonstrate the skill correctly. CONCLUSIONS; This evaluation and assessment was an initial effort to assess new teaching methodologies related to intravenous catheter placement and their effects on student learning outcomes and behaviors

Catheter visualisation in MR tomography: first animal experimental experiences with field inhomogeneity catheters

International Nuclear Information System (INIS)

Adam, G.; Glowinski, A.; Neuerburg, J.; Buecker, A.; Vaals, J.J. van; Hurtak, W.; Guenther, R.W.

1997-01-01

Purpose: To assess the feasibility of a new developed field inhomogeneity catheter for interventional MR imaging in vivo. Materials and methods: Three different prototypes of a field inhomogeneity catheter were investigated in 6 pigs. The catheters were introduced in Seldinger technique via the femoral vessels over a guide wire on an interventional MR system (Philips Gyroscan NT combined with a C-arm fluoroscopy unit [Philips BV 212[). Catheters were placed in veins and arteries. The catheter position was controlled by a fast gradient echo sequence (Turbo Field Echo [TEF[). Results: Catheters were introduced over a guide wire without complications in all cases. Using the field inhomogeneity concept, catheters were easily visualised in the inferior vena cava and the aorta by the fast gradient echo technique on MR in all cases. Although aortic branches were successfully cannulated, the catheters were not displayed by the TFE technique due to the complex and tortuous anatomy. All animals survived the experiments without complications. Conclusion: MR guided visualisation of a field inhomogeneity catheter is a simple concept which can be realised on each MR scanner and may allow intravascular MR guided interventions in future. (orig.) [de

Catheter Angiography

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Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us News Physician Resources Professions Site Index A-Z Catheter Angiography Catheter angiography ...

A virtual reality-based method of decreasing transmission time of visual feedback for a tele-operative robotic catheter operating system.

Science.gov (United States)

Guo, Jin; Guo, Shuxiang; Tamiya, Takashi; Hirata, Hideyuki; Ishihara, Hidenori

2016-03-01

An Internet-based tele-operative robotic catheter operating system was designed for vascular interventional surgery, to afford unskilled surgeons the opportunity to learn basic catheter/guidewire skills, while allowing experienced physicians to perform surgeries cooperatively. Remote surgical procedures, limited by variable transmission times for visual feedback, have been associated with deterioration in operability and vascular wall damage during surgery. At the patient's location, the catheter shape/position was detected in real time and converted into three-dimensional coordinates in a world coordinate system. At the operation location, the catheter shape was reconstructed in a virtual-reality environment, based on the coordinates received. The data volume reduction significantly reduced visual feedback transmission times. Remote transmission experiments, conducted over inter-country distances, demonstrated the improved performance of the proposed prototype. The maximum error for the catheter shape reconstruction was 0.93 mm and the transmission time was reduced considerably. The results were positive and demonstrate the feasibility of remote surgery using conventional network infrastructures. Copyright © 2015 John Wiley & Sons, Ltd.

Catheter Angiography

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Full Text Available ... imaging (MRI) In catheter angiography, a thin plastic tube, called a catheter , is inserted into an artery ... examined, a contrast material is injected through the tube and images are captured using a small dose ...

Catheter Angiography

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Full Text Available ... incision in the skin. Once the catheter is guided to the area being examined, a contrast material ... inserted into an artery. The catheter is then guided through the arteries to the area to be ...

Catheter Angiography

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Full Text Available ... catheter , is inserted into an artery through a small incision in the skin. Once the catheter is ... the tube and images are captured using a small dose of ionizing radiation ( x-rays ). top of ...

Catheter Angiography

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Full Text Available ... it will make the rest of the procedure pain-free. You will not feel the catheter in ... nurse if you notice any bleeding, swelling or pain at the site where the catheter entered the ...

Catheter Angiography

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Full Text Available ... should inform the nurse if you notice any bleeding, swelling or pain at the site where the ... Rarely, the catheter punctures the artery, causing internal bleeding. It also is possible that the catheter tip ...

Catheter Angiography

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Full Text Available ... an artery through a small incision in the skin. Once the catheter is guided to the area ... small incision (usually a few millimeters) in the skin where the catheter can be inserted into an ...

Catheter Angiography

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Full Text Available ... or other procedures such as chemoembolization or selective internal radiation therapy. identify dissection or splitting in the ... days. Rarely, the catheter punctures the artery, causing internal bleeding. It also is possible that the catheter ...

Catheter Angiography

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Full Text Available ... is performed using: x-rays with catheters computed tomography (CT) magnetic resonance imaging (MRI) In catheter angiography, ... tumor; this is called superselective angiography. Unlike computed tomography (CT) or magnetic resonance (MR) angiography , use of ...

Catheter Angiography

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Full Text Available ... Catheter angiography uses a catheter, x-ray imaging guidance and an injection of contrast material to examine ... removable dental appliances, eye glasses and any metal objects or clothing that might interfere with the x- ...

Catheter Angiography

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Full Text Available ... most cases, the kidneys will regain their normal function within five to seven days. Rarely, the catheter ... limitations of Catheter Angiography? Patients with impaired kidney function, especially those who also have diabetes, are not ...

Catheter Angiography

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Full Text Available ... lies. The catheter used in angiography is a long plastic tube about as thick as a strand of spaghetti. top of page How does the procedure work? Catheter angiography works much the same as a ...

A prospective interventional study to examine the effect of a silver alloy and hydrogel-coated catheter on the incidence of catheter-associated urinary tract infection.

Science.gov (United States)

Chung, P Hy; Wong, C Wy; Lai, C Kc; Siu, H K; Tsang, D Nc; Yeung, K Y; Ip, D Km; Tam, P Kh

2017-06-01

Catheter-associated urinary tract infection is a major hospital-acquired infection. This study aimed to analyse the effect of a silver alloy and hydrogel-coated catheter on the occurrence of catheter-associated urinary tract infection. This was a 1-year prospective study conducted at a single centre in Hong Kong. Adult patients with an indwelling urinary catheter for longer than 24 hours were recruited. The incidence of catheter-associated urinary tract infection in patients with a conventional latex Foley catheter without hydrogel was compared with that in patients with a silver alloy and hydrogel-coated catheter. The most recent definition of urinary tract infection was based on the latest surveillance definition of the National Healthcare Safety Network managed by Centers for Disease Control and Prevention. A total of 306 patients were recruited with a similar ratio between males and females. The mean (standard deviation) age was 81.1 (10.5) years. The total numbers of catheter-days were 4352 and 7474 in the silver-coated and conventional groups, respectively. The incidences of catheter-associated urinary tract infection per 1000 catheter-days were 6.4 and 9.4, respectively (P=0.095). There was a 31% reduction in the incidence of catheter-associated urinary tract infection per 1000 catheter-days in the silver-coated group. Escherichia coli was the most commonly involved pathogen (36.7%) of all cases. Subgroup analysis revealed that the protective effect of silver-coated catheter was more pronounced in long-term users as well as female patients with a respective 48% (P=0.027) and 42% (P=0.108) reduction in incidence of catheter-associated urinary tract infection. The mean catheterisation time per person was the longest in patients using a silver-coated catheter (17.0 days) compared with those using a conventional (10.8 days) or both types of catheter (13.6 days) [P=0.01]. Silver alloy and hydrogel-coated catheters appear to be effective in preventing catheter

Catheter Angiography

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Full Text Available ... is performed using: x-rays with catheters computed tomography (CT) magnetic resonance imaging (MRI) In catheter angiography, a ... tumor; this is called superselective angiography. Unlike computed tomography (CT) or magnetic resonance (MR) angiography , use of a ...

Implantable electrolyte conductance-based pressure sensing catheter, II. Device construction and testing.

Science.gov (United States)

Tan, Robert; Benharash, Peyman; Schulam, Peter; Schmidt, Jacob J

2013-12-01

Direct measurements of arterial blood pressure most commonly use bulky external instrumentation containing a pressure transducer connected to an ex vivo fluid-filled arterial line, which is subject to several sensing artifacts. In situ blood pressure sensors, typically solid state piezoresistive, capacitive, and interferometric sensors, are unaffected by these artifacts, but can be expensive to produce and miniaturize. We have developed an alternative approach to blood pressure measurement based on deformation of an elastic tube filled with electrolyte solution. Simple measurement of the electrical conductance of this solution as the tube dimensions change allows determination of the external pressure. The sensor is made from inexpensive materials and its miniaturization is straightforward. In vitro static testing of initial sensor prototypes mounted on a catheter tip showed a linear response with applied pressure and a resolution of 1 mmHg. In vivo sensing followed catheterization of the sensor into the femoral artery of a porcine model through a 7F catheter port. The sensor performed comparably to a commercial pressure transducer also connected to the catheter port. Due to its scalability and cost, this sensor has the potential for use in a range of pressure sensing applications, such as measurement of intracranial, spinal, or interstitial pressures.

A central venous catheter coated with benzalkonium chloride for the prevention of catheter-related microbial colonization.

Science.gov (United States)

Moss, H A; Tebbs, S E; Faroqui, M H; Herbst, T; Isaac, J L; Brown, J; Elliott, T S

2000-11-01

In an attempt to overcome infections associated with central venous catheters, a new antiseptic central venous catheter coated with benzalkonium chloride on the internal and external surfaces has been developed and evaluated in a clinical trial. Patients (235) randomly received either a triple-lumen central venous catheter coated with benzalkonium chloride (117) or a polyurethane non-antiseptic catheter (118). The incidence of microbial colonization of both catheters and retained antiseptic activity of the benzalkonium chloride device following removal were determined. The benzalkonium chloride resulted in a significant reduction of the incidence of microbial colonization on both the internal and external catheter surfaces. The reduction in colonization was detected at both the intradermal (21 benzalkonium chloride catheters vs. 38 controls, P = 0.0016) and distal segments of the antiseptic-coated catheters. Following catheter removal retained activity was demonstrated in benzalkonium chloride catheters which had been in place for up to 12 days. No patients developed adverse reactions to the benzalkonium chloride catheters. The findings demonstrate that the benzalkonium chloride catheter significantly reduced the incidence of catheter-associated colonization.

Biological safety evaluation of the modified urinary catheter

Energy Technology Data Exchange (ETDEWEB)

Kowalczuk, Dorota, E-mail: dorota.kowalczuk@umlub.pl [Department of Medicinal Chemistry, Medical University of Lublin, Jaczewskiego 4, 20-090 Lublin (Poland); Przekora, Agata; Ginalska, Grazyna [Department of Biochemistry and Biotechnology, Medical University of Lublin, Chodzki 1, 20-093 Lublin (Poland)

2015-04-01

The purpose of this study was to evaluate in vitro safety of the novel tosufloxacin (TOS)-treated catheters with the prolonged antimicrobial activity. The test samples of silicone latex catheter were prepared by the immobilization of TOS on chitosan (CHIT)-coated catheter by means of covalent bonds and non-covalent interactions. Each step of the modification process of catheter surface was observed using ATR–Fourier transform infrared spectroscopy. In vitro cytotoxicity of the modified and unmodified catheters was assessed by direct and indirect tests in accordance with ISO standards using green monkey kidney (GMK) cell line. The MTT, lactate dehydrogenase activity (LDH), WST-8, Sulforhodamine B (SRB) test results and microscopic observation clearly indicated that unmodified silicone latex catheters decrease cell metabolic activity, act as a cytotoxic agent causing cell lysis and induce cell death through necrotic or apoptotic process. We suggest that chitosan coat with TOS immobilized limits leaching of harmful agents from silicone latex material, which significantly enhances survivability of GMK cells and therefore is quite a good protection against the cytotoxic effect of this material. - Highlights: • Characterization of the novel antimicrobial urinary catheters • Monitoring of the catheter modification by FTIR analysis • Confirmation of high cytotoxicity of latex-based catheter used in urological practice • Chitosan-coated and tosufloxacin-treated catheter is less toxic than the untreated one. • The proposed surface modification protects cells against latex-induced death.

High dose urokinase for restoration of patency of occluded permanent central venous catheters in hemodialysis patients.

Science.gov (United States)

Shavit, L; Lifschitz, M; Plaksin, J; Grenader, T; Slotki, I

2010-10-01

Catheter thrombosis is common and results in inadequate dialysis treatment and, frequently, in catheter loss. Since dialysis treatment runs on a strict schedule, occluded catheters need to be restored in a timely and cost effective manner. We present a new shortened protocol of urokinase infusion that allows hemodialysis to be performed within 90 minutes. To chronic hemodialysis patients, who developed complete catheter occlusion, urokinase was infused simultaneously through both lumens of the catheter (125,000 units to each lumen) over 90 minutes. Technical success was defined as restoring blood pump speed to at least 250 ml/min. We determined the average time from catheter placement to first clot event (primary patency PP), recurrent clot event after urokinase treatment (secondary patency SP), catheter salvage rate and cause for removal. 37 catheters developed total thrombosis and urokinase was used to restore patency one or more times (total 47 treatments). Catheter salvage rate was 97 %. The average time of PP was 152 ± 56 days (7 - 784 days). Nine patients (30%) developed recurrent occlusion and the average time of SP was 64 ± 34 days (2 - 364 days). One catheter was removed because of dysfunction due to thrombosis. Other catheters were removed due to infection, fistula maturation or fell out spontaneously. Hemodialysis was performed immediately after treatment with blood speed of 250 ml/min in all patients. Our protocol is highly effective, short, and allows to restore patency of totally occluded central venous catheters with minimal disruption of the dialysis session.

Culture-dependent and -independent investigations of microbial diversity on urinary catheters

DEFF Research Database (Denmark)

Xu, Yijuan; Moser, Claus Ernst; Abu Al-Soud, Waleed

2012-01-01

Catheter-associated urinary tract infection is caused by bacteria, which ascend the catheter along its external or internal surface to the bladder and subsequently develop into biofilms on the catheter and uroepithelium. Antibiotic-treated bacteria and bacteria residing in biofilm can be difficult...... to culture. In this study we used culture-based and 16S rRNA gene-based culture-independent methods (fingerprinting, cloning, and pyrosequencing) to determine the microbial diversity of biofilms on 24 urinary catheters. Most of the patients were catheterized for...

Clinical usefulness of catheter-drawn blood samples and catheter tip cultures for the diagnosis of catheter-related bloodstream infections in neonatology: A systematic review.

Science.gov (United States)

Ferreira, Janita; Camargos, Paulo Augusto Moreira; Clemente, Wanessa Trindade; Romanelli, Roberta Maia de Castro

2018-01-01

Neonatal sepsis is the most frequent health care-associated infection in neonatal units. This study aimed to analyze articles on the clinical usefulness of catheter-drawn blood samples and catheter tip cultures for the diagnosis of intravascular catheter-related bloodstream infection (CRBSI) in neonates. A systematic search was performed for studies published from 1987-2017, without language restriction. Observational studies carried out in neonates with CRBSI diagnosed using catheter-drawn blood samples or catheter tip cultures were included. A total of 412 articles were identified in the databases and 10 articles were included. The 7 studies that evaluated central venous catheter tip cultures and cultures of catheter fragments presented sensitivities ranging from 58.5%-100% and specificities ranging from 60%-95.7%. Three studies that evaluated catheter-drawn blood cultures, paired with peripheral blood cultures, reported sensitivity and specificity of 94% and 71% when evaluated for the differential time to positivity. When quantitative evaluation was performed, the sensitivity and specificity were 80% and 99.4%. Most of the studies analyzed cultures from the central venous catheter tip and catheter fragments for the diagnosis of CRBSI in neonatal populations. The results of this review suggest that the analysis of the catheter-drawn blood samples and catheter tip cultures, paired with peripheral blood cultures, are efficient methods for the diagnosis of CRBSI in neonates. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Dedicated radial ventriculography pigtail catheter

Energy Technology Data Exchange (ETDEWEB)

Vidovich, Mladen I., E-mail: miv@uic.edu

2013-05-15

A new dedicated cardiac ventriculography catheter was specifically designed for radial and upper arm arterial access approach. Two catheter configurations have been developed to facilitate retrograde crossing of the aortic valve and to conform to various subclavian, ascending aortic and left ventricular anatomies. The “short” dedicated radial ventriculography catheter is suited for horizontal ascending aortas, obese body habitus, short stature and small ventricular cavities. The “long” dedicated radial ventriculography catheter is suited for vertical ascending aortas, thin body habitus, tall stature and larger ventricular cavities. This new design allows for improved performance, faster and simpler insertion in the left ventricle which can reduce procedure time, radiation exposure and propensity for radial artery spasm due to excessive catheter manipulation. Two different catheter configurations allow for optimal catheter selection in a broad range of patient anatomies. The catheter is exceptionally stable during contrast power injection and provides equivalent cavity opacification to traditional femoral ventriculography catheter designs.

Cryo-balloon catheter localization in fluoroscopic images

Science.gov (United States)

Kurzendorfer, Tanja; Brost, Alexander; Jakob, Carolin; Mewes, Philip W.; Bourier, Felix; Koch, Martin; Kurzidim, Klaus; Hornegger, Joachim; Strobel, Norbert

2013-03-01

Minimally invasive catheter ablation has become the preferred treatment option for atrial fibrillation. Although the standard ablation procedure involves ablation points set by radio-frequency catheters, cryo-balloon catheters have even been reported to be more advantageous in certain cases. As electro-anatomical mapping systems do not support cryo-balloon ablation procedures, X-ray guidance is needed. However, current methods to provide support for cryo-balloon catheters in fluoroscopically guided ablation procedures rely heavily on manual user interaction. To improve this, we propose a first method for automatic cryo-balloon catheter localization in fluoroscopic images based on a blob detection algorithm. Our method is evaluated on 24 clinical images from 17 patients. The method successfully detected the cryoballoon in 22 out of 24 images, yielding a success rate of 91.6 %. The successful localization achieved an accuracy of 1.00 mm +/- 0.44 mm. Even though our methods currently fails in 8.4 % of the images available, it still offers a significant improvement over manual methods. Furthermore, detecting a landmark point along the cryo-balloon catheter can be a very important step for additional post-processing operations.

Catheter Angiography

Medline Plus

Full Text Available ... is injected through the catheter and reaches the blood vessels being studied, several sets of x-rays are taken. Then the catheter is removed and the incision site is closed by applying pressure on the area for approximately 10 to 20 ...

FACTORS AND COMPLICATIONS AFFECTING CATHETER AND TECHNIQUE SURVIVAL WITH PERMANENT SINGLE-LUMEN DIALYSIS CATHETERS

NARCIS (Netherlands)

DEMEESTER, J; VANHOLDER, R; DEROOSE, J; RINGOIR, S

1994-01-01

This long-term study on the outcome of permanent silicone single-lumen dialysis catheters consisted of 43 surgically inserted catheters in 33 patients. All catheters were attached to a pressure-pressure single-cannula dialysis system. Technique and catheter survival were 80 and 59% at 1 year, and 63

Feedforward Coordinate Control of a Robotic Cell Injection Catheter.

Science.gov (United States)

Cheng, Weyland; Law, Peter K

2017-08-01

Remote and robotically actuated catheters are the stepping-stones toward autonomous catheters, where complex intravascular procedures may be performed with minimal intervention from a physician. This article proposes a concept for the positional, feedforward control of a robotically actuated cell injection catheter used for the injection of myogenic or undifferentiated stem cells into the myocardial infarct boundary zones of the left ventricle. The prototype for the catheter system was built upon a needle-based catheter with a single degree of deflection, a 3-D printed handle combined with actuators, and the Arduino microcontroller platform. A bench setup was used to mimic a left ventricle catheter procedure starting from the femoral artery. Using Matlab and the open-source video modeling tool Tracker, the planar coordinates ( y, z) of the catheter position were analyzed, and a feedforward control system was developed based on empirical models. Using the Student's t test with a sample size of 26, it was determined that for both the y- and z-axes, the mean discrepancy between the calibrated and theoretical coordinate values had no significant difference compared to the hypothetical value of µ = 0. The root mean square error of the calibrated coordinates also showed an 88% improvement in the z-axis and 31% improvement in the y-axis compared to the unmodified trial run. This proof of concept investigation leads to the possibility of further developing a feedfoward control system in vivo using catheters with omnidirectional deflection. Feedforward positional control allows for more flexibility in the design of an automated catheter system where problems such as systemic time delay may be a hindrance in instances requiring an immediate reaction.

PR Interval Associated Genes, Atrial Remodeling and Rhythm Outcome of Catheter Ablation of Atrial Fibrillation—A Gene-Based Analysis of GWAS Data

Directory of Open Access Journals (Sweden)

Daniela Husser

2017-12-01

Full Text Available Background: PR interval prolongation has recently been shown to associate with advanced left atrial remodeling and atrial fibrillation (AF recurrence after catheter ablation. While different genome-wide association studies (GWAS have implicated 13 loci to associate with the PR interval as an AF endophenotype their subsequent associations with AF remodeling and response to catheter ablation are unknown. Here, we perform a gene-based analysis of GWAS data to test the hypothesis that PR interval candidate genes also associate with left atrial remodeling and arrhythmia recurrence following AF catheter ablation.Methods and Results: Samples from 660 patients with paroxysmal (n = 370 or persistent AF (n = 290 undergoing AF catheter ablation were genotyped for ~1,000,000 SNPs. Gene-based association was investigated using VEGAS (versatile gene-based association study. Among the 13 candidate genes, SLC8A1, MEIS1, ITGA9, SCN5A, and SOX5 associated with the PR interval. Of those, ITGA9 and SOX5 were significantly associated with left atrial low voltage areas and left atrial diameter and subsequently with AF recurrence after radiofrequency catheter ablation.Conclusion: This study suggests contributions of ITGA9 and SOX5 to AF remodeling expressed as PR interval prolongation, low voltage areas and left atrial dilatation and subsequently to response to catheter ablation. Future and larger studies are necessary to replicate and apply these findings with the aim of designing AF pathophysiology-based multi-locus risk scores.

Catheter versus non-catheter angiography in isolated third nerve palsy

International Nuclear Information System (INIS)

Lee, A.G.

2007-01-01

To discuss the controversies surrounding the indications for catheter angiography versus non-catheter and less invasive angiography techniques (e.g. magnetic resonance angiography (MRA) and computerized tomography angiography (CTA)) in the evaluation of patients with a third nerve palsy. Clinical opinion-perspective and literature review. The patient with an isolated third nerve palsy might have a vasculopathic (and typically benign, self limited course) etiology or a life threatening intracranial posterior communicating artery aneurysm. Although it is clear that non-isolated third nerve palsies require imaging directed at the topographical localization of the clinical findings, the evaluation of the neurologically isolated third nerve palsy remains controversial. The completeness of the external (i.e. somatic) motor dysfunction and the presence or absence of internal (i.e. pupillary) dysfunction are generally used to guide the choice of initial neuroimaging. Advances in MRA and CTA technology have reduced but not eliminated our dependence upon catheter angiography in this setting. A properly performed and interpreted MRA or CTA probably will be able to detect greater than 95 % of aneurysms producing a third nerve palsy. The issues surrounding the use of catheter angiography in third nerve palsy are reviewed. If the clinician is highly confident in the capability, availability, and reliability of the neuroradiologist and of their institutional experience and quality of less invasive non-catheter MRA and CTA and if the risk of aneurysm is low or if the risk of angiography is high (e.g. elderly, renal failure, iodinated contrast allergy, risk of stroke) then MRI and MRA (or CTA) may be a reasonable alternative to catheter angiography. Patients with a moderate or uncertain risk of aneurysm and a lower risk for catheter angiography or if there is a low confidence in the quality or the interpretation of the institutional MRA (or CTA) may still require catheter

Catheter-Based Renal Denervation for Resistant Hypertension: Will It Ever Be Ready for "Prime Time"?

Science.gov (United States)

Laffin, Luke J; Bakris, George L

2017-09-01

The year 2014 was a turning point for the field of renal denervation (RDN) and its potential use to treat resistant hypertension. Tremendous enthusiasm shifted to sober reflection on the efficacy of a technology once touted as the cure to resistant hypertension. The following review highlights 2 major questions: First, does catheter-based RDN lower blood pressure and, second, will RDN using catheter-directed therapy for the treatment of resistant hypertension ever become more than an investigational technology. © American Journal of Hypertension, Ltd 2016. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Accuracy of image-guided radiotherapy of prostate cancer based on the BeamCath urethral catheter technique

DEFF Research Database (Denmark)

Poulsen, Per Rugaard; Fokdal, Lars; Petersen, Jørgen B.B.

2007-01-01

BACKGROUND AND PURPOSE: To examine the accuracy of the BeamCath urethral catheter technique for prostate localization during radiotherapy. MATERIALS AND METHODS: Sixty-four patients were CT scanned twice with the BeamCath catheter, and once without the catheter. The catheter contains radiopaque...

Evaluation of a respiratory assist catheter that uses an impeller within a hollow fiber membrane bundle.

Science.gov (United States)

Mihelc, Kevin M; Frankowski, Brian J; Lieber, Samuel C; Moore, Nathan D; Hattler, Brack G; Federspiel, William J

2009-01-01

Respiratory assist using an intravenous catheter may be a potential treatment for patients suffering from acute or acute-on-chronic lung failure. The objective of this study was to evaluate a novel respiratory catheter that uses an impeller within the fiber bundle to enhance gas exchange efficiency, thus requiring a smaller fiber bundle and insertional size (25 Fr) and permitting simple percutaneous insertion. Bench testing of gas exchange in deionized water was used to evaluate eight impeller designs. The three best performing impeller designs were evaluated in acute studies in four calves (122 + or - 10 kg). Gas exchange increased significantly with increasing impeller rotation rate. The degree of enhancement varied with impeller geometry. The maximum gas exchange efficiency (exchange per unit surface area) for the catheter with the best performing impeller was 529 + or - 20 ml CO(2)/min/m(2) and 513 + or - 21 ml CO(2)/min/m(2) for bench and animal studies, respectively, at a rotation rate of 20,000 rpm. Absolute CO(2) exchange was 37 and 36 ml CO(2)/min, respectively. Active mixing by rotating impellers produced 70% higher gas exchange efficiency than pulsating balloon catheters. The sensitivity of gas exchange to impeller design suggests that further improvements can be made by computational fluid dynamics-based optimization of the impeller.

Concurrent use of pigtail and loop snare catheters for percutaneous retrieval of dislodged central venous port catheter

Directory of Open Access Journals (Sweden)

Ming-Tsung Chuang

2011-11-01

Full Text Available The purpose of this study was to report our experience of percutaneous retrieval of dislodged port catheters with concurrent use of pigtail and loop snare catheters. During a 5-year period at our institute (June 2005 to July 2010, a total of 23 dislodged port catheters were retrieved. The interval between port catheter implantation and dislodged catheter retrieval ranged from 43 days to 1,414 days (mean 586.7 days. The time of delayed retrieval ranged from 1 day to 45 days (mean 4.6 days. All dislodged catheters were retrieved with the concurrent use of pigtail and loop snare catheters via femoral venous route. The prevalence of port catheter dislodgement at our institute was 3.4%. All dislodged port catheters were removed successfully with pigtail and loop snare catheters together. No procedure-related complications were encountered, except for transient arrhythmia in two patients, which required no medication. In conclusion, the concurrent use of pigtail and loop snare catheters is a feasible and easy way for percutaneous retrieval of a dislodged central venous port catheter.

Design and performance evaluation of collision protection-based safety operation for a haptic robot-assisted catheter operating system.

Science.gov (United States)

Zhang, Linshuai; Guo, Shuxiang; Yu, Huadong; Song, Yu; Tamiya, Takashi; Hirata, Hideyuki; Ishihara, Hidenori

2018-02-23

The robot-assisted catheter system can increase operating distance thus preventing the exposure radiation of the surgeon to X-ray for endovascular catheterization. However, few designs have considered the collision protection between the catheter tip and the vessel wall. This paper presents a novel catheter operating system based on tissue protection to prevent vessel puncture caused by collision. The integrated haptic interface not only allows the operator to feel the real force feedback, but also combines with the newly proposed collision protection mechanism (CPM) to mitigate the collision trauma. The CPM can release the catheter quickly when the measured force exceeds a certain threshold, so as to avoid the vessel puncture. A significant advantage is that the proposed mechanism can adjust the protection threshold in real time by the current according to the actual characteristics of the blood vessel. To verify the effectiveness of the tissue protection by the system, the evaluation experiments in vitro were carried out. The results show that the further collision damage can be effectively prevented by the CPM, which implies the realization of relative safe catheterization. This research provides some insights into the functional improvements of safe and reliable robot-assisted catheter systems.

Thoracic Nerve Root Entrapment by Intrathecal Catheter Coiling: Case Report and Review of the Literature.

Science.gov (United States)

Han, Jing L; Loriaux, Daniel B; Tybout, Caroline; Kinon, Merritt D; Rahimpour, Shervin; Runyon, Scott L; Hopkins, Thomas J; Boortz-Marx, Richard L; Lad, Shivanand P

2016-03-01

Intrathecal catheter placement has long-term therapeutic benefits in the management of chronic, intractable pain. Despite the diverse clinical applicability and rising prevalence of implantable drug delivery systems in pain medicine, the spectrum of complications associated with intrathecal catheterization remains largely understudied and underreported in the literature. To report a case of thoracic nerve root entrapment resulting from intrathecal catheter migration. Case report. Inpatient hospital service. A 60-year-old man status post implanted intrathecal (IT) catheter for intractable low back pain secondary to failed back surgery syndrome returned to the operating room for removal of IT pump trial catheter after experiencing relapse of preoperative pain and pump occlusion. Initial attempt at ambulatory removal of the catheter was aborted after the patient reported acute onset of lower extremity radiculopathic pain during the extraction. Noncontrast computed tomography (CT) subsequently revealed that the catheter had ascended and coiled around the T10 nerve root. The patient was taken back to the operating room for removal of the catheter under fluoroscopic guidance, with possible laminectomy for direct visualization. Removal was ultimately achieved with slow continuous tension, with complete resolution of the patient's new radicular symptoms. This report describes a single case report. This case demonstrates that any existing loops in the intrathecal catheter during initial implantation should be immediately re-addressed, as they can precipitate nerve root entrapment and irritation. Reduction of the loop or extrication of the catheter should be attempted under continuous fluoroscopic guidance to prevent further neurosurgical morbidity.

Central venous catheter-related bacteremia caused by Kocuria kristinae: case report and review of the literature.

Science.gov (United States)

Dunn, Ryan; Bares, Sara; David, Michael Z

2011-08-24

Kocuria species are unusual human pathogens isolated most commonly from immunocompromised hosts, such as transplant recipients and cancer patients undergoing chemotherapy, or from patients with chronic medical conditions. A case of catheter-related bacteremia with pulmonary septic emboli in a pregnant adult female without chronic medical conditions is described. A review of other reported Kocuria infections is provided.

The efficacy of noble metal alloy urinary catheters in reducing catheter-associated urinary tract infection

Directory of Open Access Journals (Sweden)

Alanood Ahmed Aljohi

2016-01-01

Results: A 90% relative risk reduction in the rate of CAUTI was observed with the noble metal alloy catheter compared to the standard catheter (10 vs. 1 cases, P = 0.006. When considering both catheter-associated asymptomatic bacteriuria and CAUTI, the relative risk reduction was 83% (12 vs. 2 cases, P = 0.005. In addition to CAUTI, the risk of acquiring secondary bacteremia was lower (100% for the patients using noble metal alloy catheters (3 cases in the standard group vs. 0 case in the noble metal alloy catheter group, P = 0.24. No adverse events related to any of the used catheters were recorded. Conclusion: Results from this study revealed that noble metal alloy catheters are safe to use and significantly reduce CAUTI rate in ICU patients after 3 days of use.

Button self-retaining drainage catheter

International Nuclear Information System (INIS)

Caridi, James G.; Hawkins, Irvin F.; Akins, E. William; Young, Ronald S.

1997-01-01

To help improve patient acceptance of long-term internal/external catheter access to the biliary tract in those with benign biliary obstruction, a simple design allows the catheter end to remain flush with the skin. It consists of a clothes button affixed to the drainage catheter with a wood screw after the catheter has been cut off at the skin exit. This button/screw device has been used successfully in 22 patients over the last 10 years; catheter exchanges were easily accomplished

Old habits die hard; does early urinary catheter removal affect kidney size, bacteriuria and UTI after renal transplantation?

Science.gov (United States)

Akbari, Roghayeh; Rahmani Firouzi, Sedigheh; Akbarzadeh-Pasha, Abazar

2017-01-01

Introduction: Renal transplantation is the treatment of choice in chronic renal failure patients. Objectives: The purpose of this study was to evaluate the impact of urinary catheter removal time on transplanted kidney size and incidence of asymptomatic bacteriuria and urinary tract infections (UTIs). Patients and Methods: This retrospective cohort study evaluated the clinical outcomes of 109 consecutive live donor renal transplant recipients from December 2011 to July 2014. Routine ultrasound examinations were performed on donor's kidney prior to operation and one month later. Kidney volume was calculated. UTI and bacteriuria were evaluated one month later. Patients were divided into two groups based on time of Foley catheter removal (before and after fifth day posttransplantation). Results: In this study 74 males (67.9%) and 35 females (32.1%) were evaluated. Sixty-six patients (57.92%) were in group 1. None of the patients with positive urine culture had UTI but bacteriuria occurred in all of them (21.1%). Bacteriuria time after transplantation and catheter removal was significantly later in group 1 and it was not different in female group but they were later in male group. The mean renal volume increase was positively correlated to renal transplant recipient and donor's age and donor's body mass index (BMI) ( P UTI but increases the probability of bacteria in men whose catheter was removed within 5 days after transplantation. We also found that the renal volume change is not associated with catheter removal time and bacteriuria.

Role of echocardiography for catheter-based management of valvular heart disease.

Science.gov (United States)

Shiota, Takahiro

2017-01-01

Catheter-based treatment of valvular heart disease, such as transvalvular aortic valve replacement (TAVR) or mitral clip procedure, has been increasingly accepted as a treatment choice for the past several years. Such new treatment options have been changing the management of patients with valvular heart disease drastically while socio-economic factors regarding their application need to be taken into consideration. The use of echocardiography, including transesophageal echocardiography (TEE), for such catheter-based treatments is essential for the success of the procedures. Severe hypotension after TAVR is a life-threatening emergency. Rapid assessment and diagnosis in the catheterization or hybrid laboratory is essential for safety and a positive outcome. Possible diagnoses in this critical situation would include severe left ventricular dysfunction due to coronary obstruction, cardiac tamponade, aortic rupture, acute severe aortic and/or mitral valve regurgitation, and hypovolemia due to bleeding. Although new types of TAVR valves reduce para-valvular aortic regurgitation (AR) significantly, it is still important to judge the severity of para-valvular AR correctly in the laboratory. As for mitral clip procedure, TEE is vital for guiding and monitoring the entire process. Accurate identification of the location and the geometry of the regurgitant orifice is necessary for proper placement of the clip. Real-time 3D TEE provides helpful en face view of the mitral valve and clip together to this end. Residual mitral regurgitation (MR) after the first clip is not uncommon. Quick and precise imaging of the residual MR (location and severity) with TEE is extremely important for the interventionist to place the second clip and possibly third clip properly. After the completion of the clip procedure, mitral valve stenosis and also iatrogenic atrial septal defect need to be checked by TEE. Echocardiography, especially TEE, is also vital for the success of other newer trans-catheter

Risk factors for reinsertion of urinary catheter after early removal in thoracic surgical patients.

Science.gov (United States)

Young, John; Geraci, Travis; Milman, Steven; Maslow, Andrew; Jones, Richard N; Ng, Thomas

2018-03-08

To reduce the incidence of urinary tract infection, Surgical Care Improvement Project 9 mandates the removal of urinary catheters within 48 hours postoperatively. In patients with thoracic epidural anesthesia, we sought to determine the rate of catheter reinsertion, the complications of reinsertion, and the factors associated with reinsertion. We conducted a prospective observational study of consecutive patients undergoing major pulmonary or esophageal resection with thoracic epidural analgesia over a 2-year period. As per Surgical Care Improvement Project 9, all urinary catheters were removed within 48 hours postoperatively. Excluded were patients with chronic indwelling catheter, patients with urostomy, and patients requiring continued strict urine output monitoring. Multivariable logistic regression analysis was used to identify independent risk factors for urinary catheter reinsertion. Thirteen patients met exclusion criteria. Of the 275 patients evaluated, 60 (21.8%) required reinsertion of urinary catheter. There was no difference in the urinary tract infection rate between patients requiring reinsertion (1/60 [1.7%]) versus patients not requiring reinsertion (1/215 [0.5%], P = .389). Urethral trauma during reinsertion was seen in 1 of 60 patients (1.7%). After reinsertion, discharge with urinary catheter was required in 4 of 60 patients (6.7%). Multivariable logistic regression analysis found esophagectomy, lower body mass index, and benign prostatic hypertrophy to be independent risk factors associated with catheter reinsertion after early removal in the presence of thoracic epidural analgesia. When applying Surgical Care Improvement Project 9 to patients undergoing thoracic procedures with thoracic epidural analgesia, consideration to delayed removal of urinary catheter may be warranted in patients with multiple risk factors for reinsertion. Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Central venous catheter-related bacteremia caused by Kocuria kristinae: Case report and review of the literature

Directory of Open Access Journals (Sweden)

David Michael Z

2011-08-01

Full Text Available Abstract Kocuria species are unusual human pathogens isolated most commonly from immunocompromised hosts, such as transplant recipients and cancer patients undergoing chemotherapy, or from patients with chronic medical conditions. A case of catheter-related bacteremia with pulmonary septic emboli in a pregnant adult female without chronic medical conditions is described. A review of other reported Kocuria infections is provided.

Radiation recall secondary to adjuvant docetaxel after balloon-catheter based accelerated partial breast irradiation

International Nuclear Information System (INIS)

Wong, Nathan W.; Wong, William W.; Karlin, Nina J.; Gray, Richard J.

2010-01-01

For early stage breast cancer, wide local excision and post-operative whole breast irradiation is a standard treatment. If adjuvant chemotherapy is recommended, radiation is usually given after completion of chemotherapy. In recent years, accelerated partial breast irradiation (APBI) with balloon-cathetered based brachytherapy has become an option for selected patients. For these patients, adjuvant chemotherapy would have to be administered after radiation. The sequence of treatment with radiation followed by chemotherapy results in increased risk of radiation recall reaction (RRD) in these patients. Docetaxel is becoming a more commonly used drug as adjuvant treatment for breast cancer. Here we report a case of docetaxel induced RRD after APBI with balloon-cathetered based brachytherapy. Such reaction would have an adverse impact on the cosmetic outcome and quality of life of the patient. For patients who develop an intense skin reaction after the administration of docetaxel following APBI, RRD should be considered in the differential diagnosis.

Exploring relationships of catheter-associated urinary tract infection and blockage in people with long-term indwelling urinary catheters.

Science.gov (United States)

Wilde, Mary H; McMahon, James M; Crean, Hugh F; Brasch, Judith

2017-09-01

To describe and explore relationships among catheter problems in long-term indwelling urinary catheter users, including excess healthcare use for treating catheter problems. Long-term urinary catheter users experience repeated problems with catheter-related urinary tract infection and blockage of the device, yet little has been reported of the patterns and relationships among relevant catheter variables. Secondary data analysis was conducted from a sample in a randomised clinical trial, using data from the entire sample of 202 persons over 12 months' participation. Descriptive statistics were used to characterise the sample over time. Zero-inflated negative binomial models were employed for logistic regressions to evaluate predictor variables of the presence/absence and frequencies of catheter-related urinary tract infection and blockage. Catheter-related urinary tract infection was marginally associated with catheter blockage. Problems reported at least once per person in the 12 months were as follows: catheter-related urinary tract infection 57%, blockage 34%, accidental dislodgment 28%, sediment 87%, leakage (bypassing) 67%, bladder spasms 59%, kinks/twists 42% and catheter pain 49%. Regression analysis demonstrated that bladder spasms were significantly related to catheter-related urinary tract infection and sediment amount, and catheter leakages were marginally significantly and positively related to catheter-related urinary tract infection. Frequencies of higher levels of sediment and catheter leakage were significantly associated with higher levels of blockage, and being female was associated with fewer blockages. Persons who need help with eating (more disabled) were also more likely to have blockages. Catheter-related urinary tract infection and blockage appear to be related and both are associated with additional healthcare expenditures. More research is needed to better understand how to prevent adverse catheter outcomes and patterns of problems in

Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review.

Science.gov (United States)

Meddings, Jennifer; Rogers, Mary A M; Krein, Sarah L; Fakih, Mohamad G; Olmsted, Russell N; Saint, Sanjay

2014-04-01

Catheter-associated urinary tract infections (CAUTI) are costly, common and often preventable by reducing unnecessary urinary catheter (UC) use. To summarise interventions to reduce UC use and CAUTIs, we updated a prior systematic review (through October 2012), and a meta-analysis regarding interventions prompting UC removal by reminders or stop orders. A narrative review summarises other CAUTI prevention strategies including aseptic insertion, catheter maintenance, antimicrobial UCs, and bladder bundle implementation. 30 studies were identified and summarised with interventions to prompt removal of UCs, with potential for inclusion in the meta-analyses. By meta-analysis (11 studies), the rate of CAUTI (episodes per 1000 catheter-days) was reduced by 53% (rate ratio 0.47; 95% CI 0.30 to 0.64, pSMD) in catheterisation duration (days) was -1.06 overall (p=0.065) including a statistically significant decrease in stop-order studies (SMD -0.37; pSMD, -1.54; p=0.071). No significant harm from catheter removal strategies is supported. Limited research is available regarding the impact of UC insertion and maintenance technique. A recent randomised controlled trial indicates antimicrobial catheters provide no significant benefit in preventing symptomatic CAUTIs. UC reminders and stop orders appear to reduce CAUTI rates and should be used to improve patient safety. Several evidence-based guidelines have evaluated CAUTI preventive strategies as well as emerging evidence regarding intervention bundles. Implementation strategies are important because reducing UC use involves changing well-established habits.

Chronic Thromboembolic Pulmonary Hypertension: Pearls and Pitfalls of Diagnosis.

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Memon, Humna Abid; Lin, C Huie; Guha, Ashrith

2016-01-01

Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by chronic obstruction of major pulmonary arteries by organized thromboembolic material. Untreated CTEPH can result in pulmonary hypertension and eventually right heart failure, yet it is the only form of pulmonary hypertension that is potentially curable with surgical or catheter-based intervention. While early diagnosis is key to increasing the likelihood of successful treatment, CTEPH remains largely underdiagnosed. This article reviews the role of echocardiogram, ventilation/perfusion scan, and other available modalities in the diagnosis of CTEPH.

Peritoneal catheter fixation combined with straight upward tunnel and low implant position to prevent catheter malfunction.

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Zhang, Qingyan; Jiang, Chunming; Zhu, Wei; Sun, Cheng; Xia, Yangyang; Tang, Tianfeng; Wan, Cheng; Shao, Qiuyuan; Liu, Jing; Jin, Bo; Zhang, Miao

2018-03-01

Catheter malfunction is the main reason for early peritoneal dialysis (PD) technique failure. This study aimed to evaluate the effect of a new surgery technique with catheter fixation to the lower abdominal wall combined with straight upward tunnel and low implant position in reducing catheter malfunction. Patients with end stage renal disease who received PD in our centre from January 2013 to December 2015 were involved in this study. They were randomly divided into three groups according to surgical technique: traditional open surgery group, modified open surgery group and modified open surgery with catheter fixation group. All patients were followed up for six months after surgery. Catheter- related complications were analyzed. A total of 152 patients were involved. Among them, 49 received traditional open surgery (TOS group), 49 received modified open surgery (MOS group), and 54 received modified open surgery with catheter fixation (MOS-F group). During follow-up, no patients (0%) in MOS-F group developed catheter malfunction which was significantly lower than that of the TOS group (0 vs 16.33%, P = 0.002). Although not statistically significant, the incidence of catheter malfunction was lower in MOS-F group than that in MOS group (0 vs 4.08%, P = 0.134). No significant difference was observed in the episodes of infection, bleeding, leakage, inflow or outflow pain, hernia and delayed wound healing among the three groups (all P > 0.05). Catheter fixation combined with straight upward tunnel and low implant position can effectively prevent catheter malfunction in PD catheter placement. © 2016 Asian Pacific Society of Nephrology.

Development of a force-reflecting robotic platform for cardiac catheter navigation.

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Park, Jun Woo; Choi, Jaesoon; Pak, Hui-Nam; Song, Seung Joon; Lee, Jung Chan; Park, Yongdoo; Shin, Seung Min; Sun, Kyung

2010-11-01

Electrophysiological catheters are used for both diagnostics and clinical intervention. To facilitate more accurate and precise catheter navigation, robotic cardiac catheter navigation systems have been developed and commercialized. The authors have developed a novel force-reflecting robotic catheter navigation system. The system is a network-based master-slave configuration having a 3-degree of freedom robotic manipulator for operation with a conventional cardiac ablation catheter. The master manipulator implements a haptic user interface device with force feedback using a force or torque signal either measured with a sensor or estimated from the motor current signal in the slave manipulator. The slave manipulator is a robotic motion control platform on which the cardiac ablation catheter is mounted. The catheter motions-forward and backward movements, rolling, and catheter tip bending-are controlled by electromechanical actuators located in the slave manipulator. The control software runs on a real-time operating system-based workstation and implements the master/slave motion synchronization control of the robot system. The master/slave motion synchronization response was assessed with step, sinusoidal, and arbitrarily varying motion commands, and showed satisfactory performance with insignificant steady-state motion error. The current system successfully implemented the motion control function and will undergo safety and performance evaluation by means of animal experiments. Further studies on the force feedback control algorithm and on an active motion catheter with an embedded actuation mechanism are underway. © 2010, Copyright the Authors. Artificial Organs © 2010, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Catheter based mid-infrared reflectance and reflectance generated absorption spectroscopy

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Holman, Hoi-Ying N

2013-10-29

A method of characterizing conditions in a tissue, by (a) providing a catheter that has a light source that emits light in selected wavenumbers within the range of mid-IR spectrum; (b) directing the light from the catheter to an area of tissue at a location inside a blood vessel of a subject; (c) collecting light reflected from the location and generating a reflectance spectra; and (d) comparing the reflectance spectra to a reference spectra of normal tissue, whereby a location having an increased number of absorbance peaks at said selected wavenumbers indicates a tissue inside the blood vessel containing a physiological marker for atherosclerosis.

Epidural Catheter Breakage In-Situ

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Geetanjali S Verma

2014-09-01

Full Text Available A 45yr old woman diagnosed with dysfunctional uterine bleeding and incisional hernia was planned for total abdominal hysterectomy with bilateral salpingo-oophorectomy and mesh repair under combined spinal and epidural anaesthesia. Using VYGON® epidural catheter with its recommended introducer, the catheter was inserted but it snapped off at 11cm mark while positioning the catheter. After radiological confirmation, the neurosurgeon removed the catheter under general anaesthesia, which was followed by the scheduled surgery.

Performance evaluation of a robot-assisted catheter operating system with haptic feedback.

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Song, Yu; Guo, Shuxiang; Yin, Xuanchun; Zhang, Linshuai; Hirata, Hideyuki; Ishihara, Hidenori; Tamiya, Takashi

2018-06-20

In this paper, a novel robot-assisted catheter operating system (RCOS) has been proposed as a method to reduce physical stress and X-ray exposure time to physicians during endovascular procedures. The unique design of this system allows the physician to apply conventional bedside catheterization skills (advance, retreat and rotate) to an input catheter, which is placed at the master side to control another patient catheter placed at the slave side. For this purpose, a magnetorheological (MR) fluids-based master haptic interface has been developed to measure the axial and radial motions of an input catheter, as well as to provide the haptic feedback to the physician during the operation. In order to achieve a quick response of the haptic force in the master haptic interface, a hall sensor-based closed-loop control strategy is employed. In slave side, a catheter manipulator is presented to deliver the patient catheter, according to position commands received from the master haptic interface. The contact forces between the patient catheter and blood vessel system can be measured by designed force sensor unit of catheter manipulator. Four levels of haptic force are provided to make the operator aware of the resistance encountered by the patient catheter during the insertion procedure. The catheter manipulator was evaluated for precision positioning. The time lag from the sensed motion to replicated motion is tested. To verify the efficacy of the proposed haptic feedback method, the evaluation experiments in vitro are carried out. The results demonstrate that the proposed system has the ability to enable decreasing the contact forces between the catheter and vasculature.

A rare case of pelvic foreign body: foley catheter migration from the uterus to peritoneal cavity, perforating rectosigmoid colon and abscess formation

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F Sajjadian

2017-04-01

Full Text Available Background: Intraperitoneal foreign body is an unusual complication of abdomino pelvic surgery. In rare condition introduction of foreign body into the uterus, may be perforated and migrated to the adjacent organs. CasePresentation: A 41-year old woman with chronic abdominal pain was referred to the Imaging Center  for doing  Computed Tomography (CT scan  . A computed tomography of abdominopelvic demonstrated foley catheter in the pelvis with abscess.The patients have not had any abdominopelvic surgery. She had undergone criminal abortion by home midwife with the use of foley catheter 6 years ago. Laparatomy was done, foley catheter removed and abscess was evacuated. Conclusion:  The abdominopelvic foreign body is a rare condition in non operativepatients, it should be included in the differential diagnosis of abscess formation that was  detected in patients with a history of chronic abdominal pain.

[Percutaneous catheter-based implantation of artificial pulmonary valves in patients with congenital heart defects].

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Wyller, Vegard Bruun; Aaberge, Lars; Thaulow, Erik; Døhlen, Gaute

2011-07-01

Percutaneous catheter-based implantation of artificial heart valves is a new technique that may supplement surgery and which may be used more in the future. We here report our first experience with implantation of artificial pulmonary valves in children with congenital heart defects. Eligible patients were those with symptoms of heart failure combined with stenosis and/or insufficiency in an established artificial right ventricular outflow tract. The valve was inserted through a catheter from a vein in the groin or neck. Symptoms, echocardiography, invasive measurements and angiography were assessed for evaluation of treatment effect. Our treatment results are reported for the period April 2007-September 2009. Ten patients (seven men and three women, median age 17 years) were assessed. The procedure reduced pressure in the right ventricle (p = 0.008) and resolved the pulmonary insufficiency in all patients. The median time in hospital was two days. No patients had complications that were directly associated with the implantation procedure. One patient developed a pseudoaneurysm in the femoral artery, another had a short-lasting fever two days after the procedure and one patient experienced a stent fracture that required surgery 9 months after the implantation. After 6 months all patients had a reduced pressure gradient in the right ventricular outflow tract (p = 0.008), the pulmonary insufficiency had improved (p = 0.006) and they all reported improval of symptoms. These results persisted for at least 24 months for the four patients who were monitored until then. Percutaneous catheter-based implantation of artificial pulmonary valves improves hemodynamics in the right ventricle of selected patients with congenital heart defects. A randomized controlled study should be undertaken to provide a stronger evidence-base for usefulness of this procedure.

Vascular access in neonatology: peripherally inserted central catheter and peripheral venous catheter

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Marcia Lienemann

2014-04-01

The objective of this paper is to present aspects of peripherally inserted central catheter and peripheral venous catheter, highlighting important points in choosing the type of access. For the passage of peripherally inserted central catheter is previously performing specific course necessary, while the primary indication occurs when it is necessary to access the patient's stay for a long period of time. Whereas peripheral venipuncture is the most appropriate in cases of needing an IV line quickly and safely, for the administration of fluids, blood collection, blood transfusion and other.

Chronic urinary tract infections in patients with spinal cord lesions – biofilm infection with need for long-term antibiotic treatment

DEFF Research Database (Denmark)

Tofte, Nete; Nielsen, Alex C.Y.; Trøstrup, Hannah

2017-01-01

Patients suffering from spinal cord injuries resulting in complete or incomplete paraplegia or tetraplegia are highly disposed to frequent, recurrent or even chronic urinary tract infections (UTIs). The reason for the increased risk of acquiring UTIs is multifactorial, including reduced sensation...... of classical UTI symptoms, incomplete bladder emptying, frequent catheterizations or chronic urinary tract catheters. Biofilms in relation to UTIs have been shown both on catheters, on concrements or as intracellular bacterial communities (IBCs). Due to the increased risk of acquiring recurrent or chronic UTIs...... the UTI can also be challenging, especially distinguishing harmless colonization from pathogenic infection. Based on a previous study showing activation of humoral immune response toward UTI pathogens in patients with spinal cord lesions (SCL), the present mini review is an evaluation of using antibody...

Bi-layer sandwich film for antibacterial catheters.

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Franz, Gerhard; Schamberger, Florian; Zare, Hamideh Heidari; Bröskamp, Sara Felicitas; Jocham, Dieter

2017-01-01

Background: Approximately one quarter of all nosocomial infections can be attributed to the urinary tract. The infections are supposed to be mainly caused by implantations of urethral catheters and stents. A new catheter design is introduced with the aim to lower the high number of nosocomial urethral infections. In order to avoid limitations to use, the design is first applied to conventional commercially available balloon catheters. Results: The main feature of the design is a sandwich layer on both sides of the catheter wall, which is composed of a fragmented base layer of silver capped by a thin film of poly( p -xylylene). This top layer is mainly designed to release a controlled amount of Ag + ions, which is bactericidal, but not toxic to humans. Simultaneously, the lifetime is prolonged to at least one year. The base layer is electrolessly deposited applying Tollens' reagens, the cap layer is deposited by using chemical vapor deposition. Conclusion: The three main problems of this process, electroless deposition of a fragmented silver film on the surface of an electrically insulating organic polymer, irreproducible evaporation during heating of the precursor, and exponential decrease of the layer thickness along the capillary, have been solved trough the application of a simple electrochemical reaction and two standard principles of physics: Papin's pot and the principle of Le Chatelier.

Bi-layer sandwich film for antibacterial catheters

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Gerhard Franz

2017-09-01

Full Text Available Background: Approximately one quarter of all nosocomial infections can be attributed to the urinary tract. The infections are supposed to be mainly caused by implantations of urethral catheters and stents. A new catheter design is introduced with the aim to lower the high number of nosocomial urethral infections. In order to avoid limitations to use, the design is first applied to conventional commercially available balloon catheters.Results: The main feature of the design is a sandwich layer on both sides of the catheter wall, which is composed of a fragmented base layer of silver capped by a thin film of poly(p-xylylene. This top layer is mainly designed to release a controlled amount of Ag+ ions, which is bactericidal, but not toxic to humans. Simultaneously, the lifetime is prolonged to at least one year. The base layer is electrolessly deposited applying Tollens’ reagens, the cap layer is deposited by using chemical vapor deposition.Conclusion: The three main problems of this process, electroless deposition of a fragmented silver film on the surface of an electrically insulating organic polymer, irreproducible evaporation during heating of the precursor, and exponential decrease of the layer thickness along the capillary, have been solved trough the application of a simple electrochemical reaction and two standard principles of physics: Papin’s pot and the principle of Le Chatelier.

Emergency coronary angioplasty with stenting using Cordis® diagnostic coronary catheters when there is difficulty in engaging guide catheters and bench evaluation of diagnostic and guide catheters.

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Arokiaraj, Mark Christopher

2018-02-01

Difficulty in engaging with guide catheters is not uncommon in acute emergencies. We aimed to evaluate the use of Cordis ® INFINITI diagnostic catheters to perform angioplasty in patients in whom the coronaries cannot be engaged using standard guide catheters. In 34 cases of acute coronary syndrome, when difficulty in engagement with two standard guide catheters was encountered with reasonable manipulations, angioplasty was performed using diagnostic catheters. In total, 40 stents were placed by this technique. Pushability and trackability, distal tip flexion and three-point bending tests were performed to evaluate the performance of the guide and diagnostic catheters. Angioplasty was performed easily in a setting where it would have been very difficult to perform. Coronary dissection occurred in one patient, treated by a stent. The stent and dilatation balloons were easily passed through the diagnostic catheters. Pressure tracings were clearly preserved with certain stent delivery systems, and at angioplasty, although there was slightly reduced opacification of the respective artery, the coronary anatomy was sufficiently visualized to perform angioplasty. No periprocedural target lesion complications were seen in any cases. Pushability and trackability tests showed good force transmission along a tortuous path with diagnostic catheters, and balanced force-displacement curves from three-point bending tests and distal tip softness tests. Angioplasty with stenting can be performed safely through 6F Cordis ® infiniti diagnostic catheters when difficulty in engaging guide catheters is encountered. Copyright © 2018 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

Transhepatic venous catheters for hemodialysis

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Mohamed El Gharib

2014-06-01

Conclusion: Based on our findings, transhepatic hemodialysis catheters have proven to achieve good long-term functionality. A high level of maintenance is required to preserve patency, although this approach provides remarkably durable access for patients who have otherwise exhausted access options.

Intracorporeal knotting of a femoral nerve catheter

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Ghanem, Mohamed

2015-01-01

Full Text Available Peripheral nerve catheters are effective and well-established tools to provide postoperative analgesia to patients undergoing orthopedic surgery. The performance of these techniques is usually considered safe. However, placement of nerve catheters may be associated with a considerable number of side effects and major complications have repeatedly been published. In this work, we report on a patient who underwent total knee replacement with spinal anesthesia and preoperative insertion of femoral and sciatic nerve catheters for postoperative analgesia. During insertion of the femoral catheter, significant resistance was encountered upon retracting the catheter. This occurred due to knotting of the catheter. The catheter had to be removed by operative intervention which has to be considered a major complication. The postoperative course was uneventful. The principles for removal of entrapped peripheral catheters are not well established, may differ from those for neuroaxial catheters, and range from cautious manipulation up to surgical intervention.

Phlebitis associated with peripheral intravenous catheters in adults admitted to hospital in the Western Brazilian Amazon

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Sandra Maria Sampaio Enes

2016-04-01

Full Text Available Abstract OBJECTIVE To identify the presence of phlebitis and the factors that influence the development of this complication in adult patients admitted to hospital in the western Brazilian Amazon. METHOD Exploratory study with a sample of 122 peripheral intravenous catheters inserted in 122 patients in a medical unit. Variables related to the patient and intravenous therapy were analyzed. For the analysis, we used chi-square tests of Pearson and Fisher exact test, with 5% significance level. RESULTS Complication was the main reason for catheter removal (67.2%, phlebitis was the most frequent complication (31.1%. The mean duration of intravenous therapy use was 8.81 days in continuous and intermittent infusion (61.5%, in 20G catheter (39.3%, inserted in the dorsal hand vein arc (36.9 %, with mean time of usage of 68.4 hours. The type of infusion (p=0.044 and the presence of chronic disease (p=0.005 and infection (p=0.007 affected the development of phlebitis. CONCLUSION There was a high frequency of phlebitis in the sample, being influenced by concomitant use of continuous and intermittent infusion of drugs and solutions, and more frequent in patients with chronic diseases and infection.

Using optical coherence tomography to detect bacterial biofilms on foley catheters (Conference Presentation)

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Heidari, Andrew E.; Oh, Kyungjin; Chen, Zhongping

2017-02-01

Urinary tract infections(UTI) pose a serious problem for hospital patients accounting for 33% of all hospital acquired(nosocomial) infections with indwelling foley catheters. The presence of an indwelling foley catheter provides a scaffolding for circulating planktonic bacteria to adhere to and to form microbial biofilm communities that would typically be hindered by the body's innate immune system response. It is these biofilm communities that form on the inner lumen of foley catheters that provide a reservoir of pathogenic bacteria that could dislodge or disperse from the biofilm and infect urethra or bladder mucosal tissue in the urinary tract. Current diagnostic techniques of urine microbiological cultures are lacking in differentiating asymptomatic bacteriuria and symptomatic catheter-associated urinary tract infection(CAUTI) since almost all patients with chronic indwelling catheters are almost universally bacteriuruic. There is an unmet need of a diagnostic tool to assess the difference between the pathogenesis of asymptomatic bacteriuria and CAUTI, specifically at the site of the native biofilm formation. Optical Coherence Tomography(OCT) is an emerging high resolution, minimally invasive tomographic imaging technique that has shown promise in imaging biofilm structures previously in an endoscopic setting of the airway in-vivo and in microfluidic chambers. OCT can be adapted to image various sized biological surfaces and orifices such as airway branches and blood vessels by using a variety of minature endoscopic probes. In this work OCT will be used to image biofilm structure in-vitro on the inner lumen of extravasated critical care patient's foley catheters. Scanning electron microscopy will be conducted post OCT to confirm the presence of bacterial biofilm in OCT images.

Implantation of peritoneal catheters by laparotomy: nephrologists obtained similar results to general surgeons

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Restrepo CA

2014-10-01

Full Text Available Cesar A Restrepo, Carlos Alberto Buitrago, Cielo Holguin Division of Nephrology, Department of Health Sciences, Caldas University, Caldas, ColombiaPurpose: To analyze the complications and costs of minilaparotomies performed by a nephrologist (group A compared with conventional laparotomies performed by a surgeon (group B for peritoneal catheter implantation.Setting: Two university hospitals (Santa Sofia and Caldas in Manizales, Caldas, Colombia.Methods: The study included stage 5 chronic kidney disease patients, with indication of renal replacement therapy, who were candidates for peritoneal dialysis and gave informed consent for a peritoneal catheter implant. Minilaparotomies were performed by a nephrologist in a minor surgery room under local anesthesia. Conventional laparotomies were performed by a surgeon in an operating room under general anesthesia.Results: Two nephrologists inserted 157 peritoneal catheters, and seven general surgeons inserted 185 peritoneal catheters. The groups had similar characteristics: the mean age was 55 years, 49.5% were men, and the primary diagnoses were diabetic nephropathy, hypertensive nephropathy, and unknown etiology. The implant was successful for 98.09% of group A and 99.46% of group B. There was no procedure-related mortality. The most frequent complications in the first 30 days postsurgery in group A versus group B, respectively, were: peritonitis (6.37% versus 3.78%, exit-site infection (3.82% versus 2.16%, tunnel infection (0% versus 0.54%, catheter entrapment by omentum (1.27% versus 3.24%, peritoneal effluent spillover (1.91% versus 2.16%, draining failure (4.46% versus 6.49%, hematoma (0% versus 1.08%, catheter migration with kinking (3.18% versus 2.70%, hemoperitoneum (1.27% versus 0%, and hollow viscera accidental puncture (1.91% versus 0.54%. There were no statistically significant differences in the number of complications between groups. In 2013, the cost of a surgeon-implanted peritoneal

Radiologic placement of Hickman catheters

International Nuclear Information System (INIS)

Robertson, L.J.; Mauro, M.A.; Jaques, P.F.

1988-01-01

Hickman catheter inserter has previously been predominantly accomplished surgically by means of venous cutdown or percutaneous placement in the operating room. The authors describe their method and results for 55 consecutive percutaneous placements of Hickman catheters in the interventional radiology suite. Complication rates were comparable to those for surgical techniques. Radiologic placement resulted in increased convenience, decreased time and cost of insertion, and super fluoroscopic control of catheter placement and any special manipulations. Modern angiographic materials provide safer access to the subclavian vein than traditional methods. The authors conclude that radiologic placement of Hickman catheters offers significant advantages over traditional surgical placement

A catheter-based radiation detector for endovascular detection of atheromatous plaques

International Nuclear Information System (INIS)

Mukai, Takahiro; Konishi, Junji; Nohara, Ryuji; Ogawa, Mikako; Ishino, Seigo; Saji, Hideo; Kambara, Naoshige; Kataoka, Kazuaki; Kanoi, Toru; Saito, Kazuhiro; Motomura, Hiroshi

2004-01-01

Although various radiopharmaceuticals have been developed for the detection of atheromas, external imaging techniques have limitations when it comes to the detection of small plaques. In this study, we developed a charged particle-sensitive detector for the endovascular detection of small plaques. The device consists of a probe, an automatic pullback unit and a controller. The probe, which consists of a plastic scintillator and flexible optical fibres, is 1.0 mm in diameter. The probe was inserted into a catheter placed on 18 F point sources, and then the radioactivity was measured as the probe was pulled out stepwise. The sensitivity for 18 F was 9.3 cps/kBq, and there was a close linear correlation between the peak counts and source dose until at least 0.8 MBq. Furthermore, this device showed low background counts ( 18 F point sources were set on the ball's surface. Even though 298 MBq of 18 F-fluorodeoxyglucose was injected into the ball, the point sources located every 10 mm on the ball's surface were detectable separately. The data gathered suggest that a catheter-based radiation detector in combination with charged particle-emitting radiopharmaceuticals is useful for the endovascular detection of small lesions such as coronary plaques. (orig.)

Comparative study of peripherally inserted central venous catheter and traditional central catheter assisted with X-ray

International Nuclear Information System (INIS)

Yu Jianchun; Wang Xiurong; Jiang Zhuming

1999-01-01

Objective: To study the feasibility, complications, mid- and long-term advantages of peripherally inserted central catheters (PICC) compared with central venous access assisted with X-ray. Methods: From Jan 1997 to Dec 1998, the authors conducted a study in 60 patients with placed PICC lines and 60 patients with central lines. Study variables included tip placement and complication rates. Results: Tere were on significant differences between PICC and CVC in the successful placement 95.0% and 88.3%, t = 1.745, P 0.19; the mean duration 13(6-98) days and 14 (7-104) days, F = 0.049, P = 0.83; the total occlusion rate 6.7% (4/60) and 5.0%(3/60), t = 0.152, P = 0.70. In PICC patients, the occlusion rate was slightly higher in 3 Fr (20-gauge) catheter (3/20, 15.0%) than in 4 Fr(18-gauge) catheters (1/20, 5.0%), t = 1.111, P=0.29. Phlebitis occurred in 5.0% of patients (3/60) and one catheter fracture was happened on the catheter hub junction (1.7%). In 3 catheter tips dislocation cases, the catheter tips were moved to the optional position assisted with X-ray image. In CVC group, pneumothorax happened in 1 case (1.7%). In 4 catheter dislocation cases, the catheters were with drawn. No catheter-related sepsis and hemo-pneumothorax happened in both group patients. Conclusions: Both PICC and CVC can be acceptable in clinical use. PICC assisted with X-ray possesses the advantages of less trauma, accurate localization preventing some possible severe complications of central venous access such as pneumothorax. The new method provides a reliable, effective venous access for mid-and long-term usage in patients receiving a variety of solutions, primarily parenteral alimentation, chemotherapy or antibiotic infusion

Clinical study of the Erlanger silver catheter--data management and biometry.

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Martus, P; Geis, C; Lugauer, S; Böswald, M; Guggenbichler, J P

1999-01-01

The clinical evaluation of venous catheters for catheter-induced infections must conform to a strict biometric methodology. The statistical planning of the study (target population, design, degree of blinding), data management (database design, definition of variables, coding), quality assurance (data inspection at several levels) and the biometric evaluation of the Erlanger silver catheter project are described. The three-step data flow included: 1) primary data from the hospital, 2) relational database, 3) files accessible for statistical evaluation. Two different statistical models were compared: analyzing the first catheter only of a patient in the analysis (independent data) and analyzing several catheters from the same patient (dependent data) by means of the generalized estimating equations (GEE) method. The main result of the study was based on the comparison of both statistical models.

A pilot study to assess adductor canal catheter tip migration in a cadaver model.

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Leng, Jody C; Harrison, T Kyle; Miller, Brett; Howard, Steven K; Conroy, Myles; Udani, Ankeet; Shum, Cynthia; Mariano, Edward R

2015-04-01

An adductor canal catheter may facilitate early ambulation after total knee arthroplasty, but there is concern over preoperative placement since intraoperative migration of catheters may occur from surgical manipulation and result in ineffective analgesia. We hypothesized that catheter type and subcutaneous tunneling may influence tip migration for preoperatively inserted adductor canal catheters. In a male unembalmed human cadaver, 20 catheter insertion trials were divided randomly into one of four groups: flexible epidural catheter either tunneled or not tunneled; or rigid stimulating catheter either tunneled or not tunneled. Intraoperative patient manipulation was simulated by five range-of-motion exercises of the knee. Distance and length measurements were performed by a blinded regional anesthesiologist. Changes in catheter tip to nerve distance (p = 0.225) and length of catheter within the adductor canal (p = 0.467) were not different between the four groups. Two of five non-tunneled stimulating catheters (40 %) were dislodged compared to 0/5 in all other groups (p = 0.187). A cadaver model may be useful for assessing migration of regional anesthesia catheters; catheter type and subcutaneous tunneling may not affect migration of adductor canal catheters based on this preliminary study. However, future studies involving a larger sample size, actual patients, and other catheter types are warranted.

Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review

Science.gov (United States)

Meddings, Jennifer; Rogers, Mary A M; Krein, Sarah L; Fakih, Mohamad G; Olmsted, Russell N; Saint, Sanjay

2014-01-01

Background Catheter-associated urinary tract infections (CAUTI) are costly, common and often preventable by reducing unnecessary urinary catheter (UC) use. Methods To summarise interventions to reduce UC use and CAUTIs, we updated a prior systematic review (through October 2012), and a meta-analysis regarding interventions prompting UC removal by reminders or stop orders. A narrative review summarises other CAUTI prevention strategies including aseptic insertion, catheter maintenance, antimicrobial UCs, and bladder bundle implementation. Results 30 studies were identified and summarised with interventions to prompt removal of UCs, with potential for inclusion in the meta-analyses. By meta-analysis (11 studies), the rate of CAUTI (episodes per 1000 catheter-days) was reduced by 53% (rate ratio 0.47; 95% CI 0.30 to 0.64, p<0.001) using a reminder or stop order, with five studies also including interventions to decrease initial UC placement. The pooled (nine studies) standardised mean difference (SMD) in catheterisation duration (days) was −1.06 overall (p=0.065) including a statistically significant decrease in stop-order studies (SMD −0.37; p<0.001) but not in reminder studies (SMD, −1.54; p=0.071). No significant harm from catheter removal strategies is supported. Limited research is available regarding the impact of UC insertion and maintenance technique. A recent randomised controlled trial indicates antimicrobial catheters provide no significant benefit in preventing symptomatic CAUTIs. Conclusions UC reminders and stop orders appear to reduce CAUTI rates and should be used to improve patient safety. Several evidence-based guidelines have evaluated CAUTI preventive strategies as well as emerging evidence regarding intervention bundles. Implementation strategies are important because reducing UC use involves changing well-established habits. PMID:24077850

Dynamic Assessment of the Endothelialization of Tissue-Engineered Blood Vessels Using an Optical Coherence Tomography Catheter-Based Fluorescence Imaging System.

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Gurjarpadhye, Abhijit Achyut; DeWitt, Matthew R; Xu, Yong; Wang, Ge; Rylander, Marissa Nichole; Rylander, Christopher G

2015-07-01

Lumen endothelialization of bioengineered vascular scaffolds is essential to maintain small-diameter graft patency and prevent thrombosis postimplantation. Unfortunately, nondestructive imaging methods to visualize this dynamic process are lacking, thus slowing development and clinical translation of these potential tissue-engineering approaches. To meet this need, a fluorescence imaging system utilizing a commercial optical coherence tomography (OCT) catheter was designed to visualize graft endothelialization. C7 DragonFly™ intravascular OCT catheter was used as a channel for delivery and collection of excitation and emission spectra. Poly-dl-lactide (PDLLA) electrospun scaffolds were seeded with endothelial cells (ECs). Seeded cells were exposed to Calcein AM before imaging, causing the living cells to emit green fluorescence in response to blue laser. By positioning the catheter tip precisely over a specimen using high-fidelity electromechanical components, small regions of the specimen were excited selectively. The resulting fluorescence intensities were mapped on a two-dimensional digital grid to generate spatial distribution of fluorophores at single-cell-level resolution. Fluorescence imaging of endothelialization on glass and PDLLA scaffolds was performed using the OCT catheter-based imaging system as well as with a commercial fluorescence microscope. Cell coverage area was calculated for both image sets for quantitative comparison of imaging techniques. Tubular PDLLA scaffolds were maintained in a bioreactor on seeding with ECs, and endothelialization was monitored over 5 days using the OCT catheter-based imaging system. No significant difference was observed in images obtained using our imaging system to those acquired with the fluorescence microscope. Cell area coverage calculated using the images yielded similar values. Nondestructive imaging of endothelialization on tubular scaffolds showed cell proliferation with cell coverage area increasing from

SU-G-JeP2-14: MRI-Based HDR Prostate Brachytherapy: A Phantom Study for Interstitial Catheter Reconstruction with 0.35T MRI Images

International Nuclear Information System (INIS)

Park, S; Kamrava, M; Yang, Y

2016-01-01

Purpose: To evaluate the accuracy of interstitial catheter reconstruction with 0.35T MRI images for MRI-based HDR prostate brachytherapy. Methods: Recently, a real-time MRI-guided radiotherapy system combining a 0.35T MRI system and three cobalt 60 heads (MRIdian System, ViewRay, Cleveland, OH, USA) was installed in our department. A TrueFISP sequence for MRI acquisition at lower field on Viewray was chosen due to its fast speed and high signal-to-noise efficiency. Interstitial FlexiGuide needles were implanted into a tissue equivalent ultrasound prostate phantom (CIRS, Norfolk, Virginia, USA). After an initial 15s pilot MRI to confirm the location of the phantom, planning MRI was acquired with a 172s TrueFISP sequence. The pulse sequence parameters included: flip angle = 60 degree, echo time (TE) =1.45 ms, repetition time (TR) = 3.37 ms, slice thickness = 1.5 mm, field of view (FOV) =500 × 450mm. For a reference image, a CT scan was followed. The CT and MR scans were then fused with the MIM Maestro (MIM software Inc., Cleveland, OH, USA) and sent to the Oncentra Brachy planning system (Elekta, Veenendaal, Netherlands). Automatic catheter reconstruction using CT and MR image intensities followed by manual reconstruction was used to digitize catheters. The accuracy of catheter reconstruction was evaluated from the catheter tip location. Results: The average difference between the catheter tip locations reconstructed from the CT and MR in the transverse, anteroposterior, and craniocaudal directions was −0.1 ± 0.1 mm (left), 0.2 ± 0.2 mm (anterior), and −2.3 ± 0.5 mm (cranio). The average distance in 3D was 2.3 mm ± 0.5 mm. Conclusion: This feasibility study proved that interstitial catheters can be reconstructed with 0.35T MRI images. For more accurate catheter reconstruction which can affect final dose distribution, a systematic shift should be applied to the MR based catheter reconstruction in HDR prostate brachytherapy.

[Incidence of phlebitis due to peripherally inserted venous catheters: impact of a catheter management protocol].

Science.gov (United States)

Ferrete-Morales, C; Vázquez-Pérez, M A; Sánchez-Berna, M; Gilabert-Cerro, I; Corzo-Delgado, J E; Pineda-Vergara, J A; Vergara-López, S; Gómez-Mateos, J

2010-01-01

To assess the impact on the incidence of PPIVC by implementing a catheter management protocol and to determine risk factors for PPIVC development in hospitalized patients. A total of 3978 episodes of venous catheterization were prospectively included from September 2002 to December 2007. A catheter management protocol was implemented during this period of time. The incidence and variables associated to the occurrence of PPIVC were determined. The incidence of PPIVC from 2002 to 2007 was 4.8%, 4.3%, 3.6%, 2.5%, 1.3% and 1.8% (phistory of phlebitis was the only factor independently associated to phlebitis due to peripherally inserted central venous catheters (AOR 3.24; CI at 95% CI= 1.05-9.98, p=0.04). A catheter management protocol decreases the incidence of PPIVC in hospitalized patients. The risk of PPIVC increases for peripherally inserted central venous catheters when the patients have a history of phlebitis and for peripheral venous catheters when amiodarone or cefotaxime are infused. Catheterization of peripheral veins performed during morning shifts is associated with a lower incidence of PPIVC when compared with night shift catheterizations.

SU-F-T-20: Novel Catheter Lumen Recognition Algorithm for Rapid Digitization

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Dise, J; McDonald, D; Ashenafi, M; Peng, J; Mart, C; Koch, N; Vanek, K [Medical University of South Carolina, Charleston, SC (United States)

2016-06-15

Purpose: Manual catheter recognition remains a time-consuming aspect of high-dose-rate brachytherapy (HDR) treatment planning. In this work, a novel catheter lumen recognition algorithm was created for accurate and rapid digitization. Methods: MatLab v8.5 was used to create the catheter recognition algorithm. Initially, the algorithm searches the patient CT dataset using an intensity based k-means filter designed to locate catheters. Once the catheters have been located, seed points are manually selected to initialize digitization of each catheter. From each seed point, the algorithm searches locally in order to automatically digitize the remaining catheter. This digitization is accomplished by finding pixels with similar image curvature and divergence parameters compared to the seed pixel. Newly digitized pixels are treated as new seed positions, and hessian image analysis is used to direct the algorithm toward neighboring catheter pixels, and to make the algorithm insensitive to adjacent catheters that are unresolvable on CT, air pockets, and high Z artifacts. The algorithm was tested using 11 HDR treatment plans, including the Syed template, tandem and ovoid applicator, and multi-catheter lung brachytherapy. Digitization error was calculated by comparing manually determined catheter positions to those determined by the algorithm. Results: he digitization error was 0.23 mm ± 0.14 mm axially and 0.62 mm ± 0.13 mm longitudinally at the tip. The time of digitization, following initial seed placement was less than 1 second per catheter. The maximum total time required to digitize all tested applicators was 4 minutes (Syed template with 15 needles). Conclusion: This algorithm successfully digitizes HDR catheters for a variety of applicators with or without CT markers. The minimal axial error demonstrates the accuracy of the algorithm, and its insensitivity to image artifacts and challenging catheter positioning. Future work to automatically place initial seed

SU-F-T-20: Novel Catheter Lumen Recognition Algorithm for Rapid Digitization

International Nuclear Information System (INIS)

Dise, J; McDonald, D; Ashenafi, M; Peng, J; Mart, C; Koch, N; Vanek, K

2016-01-01

Purpose: Manual catheter recognition remains a time-consuming aspect of high-dose-rate brachytherapy (HDR) treatment planning. In this work, a novel catheter lumen recognition algorithm was created for accurate and rapid digitization. Methods: MatLab v8.5 was used to create the catheter recognition algorithm. Initially, the algorithm searches the patient CT dataset using an intensity based k-means filter designed to locate catheters. Once the catheters have been located, seed points are manually selected to initialize digitization of each catheter. From each seed point, the algorithm searches locally in order to automatically digitize the remaining catheter. This digitization is accomplished by finding pixels with similar image curvature and divergence parameters compared to the seed pixel. Newly digitized pixels are treated as new seed positions, and hessian image analysis is used to direct the algorithm toward neighboring catheter pixels, and to make the algorithm insensitive to adjacent catheters that are unresolvable on CT, air pockets, and high Z artifacts. The algorithm was tested using 11 HDR treatment plans, including the Syed template, tandem and ovoid applicator, and multi-catheter lung brachytherapy. Digitization error was calculated by comparing manually determined catheter positions to those determined by the algorithm. Results: he digitization error was 0.23 mm ± 0.14 mm axially and 0.62 mm ± 0.13 mm longitudinally at the tip. The time of digitization, following initial seed placement was less than 1 second per catheter. The maximum total time required to digitize all tested applicators was 4 minutes (Syed template with 15 needles). Conclusion: This algorithm successfully digitizes HDR catheters for a variety of applicators with or without CT markers. The minimal axial error demonstrates the accuracy of the algorithm, and its insensitivity to image artifacts and challenging catheter positioning. Future work to automatically place initial seed

Prospective study of catheter-related central vein thrombosis in home parenteral nutrition patients with benign disease using serial venous Doppler ultrasound.

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Cuerda, Cristina; Joly, Francisca; Corcos, Olivier; Concejo, Javier; Puiggrós, Carolina; Gil, Carmen; Pironi, Loris

2016-02-01

Catheter-related central vein thrombosis (CRVT) is a severe complication of home parenteral nutrition (HPN) that may be clinically manifest or subclinical. The aims of the study were to prospectively investigate the incidence of CRVT in patients on HPN with benign disease and determine the influence of different variables on this complication. A prospective, multicentre, observational study in the Home Artificial Nutrition-Chronic Intestinal Failure ESPEN group was performed. Patients with benign disease starting HPN or already on HPN after the insertion of a new catheter, were recruited and followed up with Color Doppler Duplex Sonography (CDDS) evaluations at baseline, 1 week, 3, 6 and 12 months after catheter insertion. Fisher's exact test was used to calculate the association of different variables (related to the patient, type of catheter, vascular access, insertion method, catheter care and anticoagulant treatment) with CRVT events. Sixty-two patients (31 males, 31 females) aged 50 ± 19 (19-83) years were included and followed for a median 363 days, with an Inter Quartile Range of 180-365 days, and a total of 16,186 catheter-days. Six patients had previous CRVT and 16 had history of thromboembolic disease (pulmonary and mesenteric). Forty one patients were receiving anticoagulant treatment. Fifty two patients had tunneled catheters and 10 implanted ports. Two patients had symptomatic thrombosis at 3 and 12 months of follow-up (2 and 3 weeks after normal routine CDDS evaluation). The incidence of CRVT was 0.045/catheter/year. CRVT was not significantly associated with any of the variables analyzed. The incidence of CRVT in patients on HPN for benign disease followed by CDDS is low in the first year of catheterization. We did not observe any case of asymptomatic CRVT. Based on our data, CDDS seems to have low effectiveness as a screening tool for CRVT in asymptomatic patients on HPN with benign disease. Copyright © 2015 Elsevier Ltd and European Society for

Radiofrequency catheter oblation in atrial flutter

International Nuclear Information System (INIS)

Yan Ji; Wang Heping; Xu Jian; Liu Fuyuan; Fan Xizhen; An Chunsheng; Han Xiaoping; Ding Xiaomei; Wang Jiasheng; Gu Tongyuan

2002-01-01

Objective: To evaluate the radiofrequency catheter ablation for type I atrial flutter through application of Holo catheter labelling with anatomic imaging localization to ablate the isthmus of IVCTA during complete double-way block. Methods: Eleven cases with type I atrial flutter undergone Holo catheter labelling technique and consecution with conduction time change of coronary venous sinus orifice with-right atrial lower lateral wall pace excitation, were performed with radiofrequency catheter ablation for the isthmus outcoming with complete double-way conduction block. Results: All together 11 cases with 4 of atrial flutter and 7 of sinus rhythm were undergone radiofrequency catheter ablation resulting with double-way conduction block of the isthmus accompanied by prolongation of right atrial conduction time 56.0 ± 2.3 ms and 53.0 ± 4.6 ms respectively. The right atrial excitation appeared to be in clockwise and counter-clockwise of single direction. No recurrence occurred during 3-34 months follow up with only one showing atrial fibrillation. Conclusions: The application of Holo catheter labelling technique with anatomic imaging localization to achieve the double-way conduction block by radiofrequency catheter ablation of TVC-TA isthmus, is a reliable method for treating atrial flutter

The effect of peripherally inserted central catheter (PICC) valve technology on catheter occlusion rates--the 'ELeCTRiC' study.

Science.gov (United States)

Johnston, Andrew J; Streater, Carmel T; Noorani, Remy; Crofts, Joanne L; Del Mundo, Aldwin B; Parker, Richard A

2012-01-01

Peripherally Inserted Central Catheters (PICCs) are increasingly being used to provide short to medium-term central venous access. The current study was designed to test the hypothesis that PICC valve technology does not influence PICC occlusion rates. Intensive care unit (ICU) patients who required a PICC were randomized to one of three types of dual lumen PICC (open ended non-valved, Groshong valve, PASV valve). PICC occlusions were recorded and managed with a protocol that used urokinase. A total of 102 patients were recruited to the study. The overall risk of occlusion per catheter was 35% (95% CI 26% to 44%). The overall rate of occlusion was 76 occlusions per 1000 catheter days (95% CI 61 to 95). Presence or type of valve did not significantly influence this rate (open-ended non-valved PICC 38% of catheters, 79 occlusions per 1000 catheter days; Groshong 38% of catheters, 60 occlusions per 1000 catheter days; PASV 27% of catheters, 99 occlusions per 1000 catheter days). The dose of urokinase required to treat PICC occlusions did not significantly differ between PICC types. Valved PICCs do not appear to influence PICC occlusion rates.

Prostate HDR brachytherapy catheter displacement between planning and treatment delivery

International Nuclear Information System (INIS)

Whitaker, May; Hruby, George; Lovett, Aimee; Patanjali, Nitya

2011-01-01

Background and purpose: HDR brachytherapy is used as a conformal boost for treating prostate cancer. Given the large doses delivered, it is critical that the volume treated matches that planned. Our outpatient protocol comprises two 9 Gy fractions, two weeks apart. We prospectively assessed catheter displacement between CT planning and treatment delivery. Materials and methods: Three fiducial markers and the catheters were implanted under transrectal ultrasound guidance. Metal marker wires were inserted into 4 reference catheters before CT; marker positions relative to each other and to the marker wires were measured from the CT scout. Measurements were repeated immediately prior to treatment delivery using pelvic X-ray with marker wires in the same reference catheters. Measurements from CT scout and film were compared. For displacements of 5 mm or more, indexer positions were adjusted prior to treatment delivery. Results: Results are based on 48 implants, in 25 patients. Median time from planning CT to treatment delivery was 254 min (range 81–367 min). Median catheter displacement was 7.5 mm (range −2.9–23.9 mm), 67% of implants had displacement of 5 mm or greater. Displacements were predominantly caudal. Conclusions: Catheter displacement can occur in the 1–3 h between the planning CT scan and treatment. It is recommended that departments performing HDR prostate brachytherapy verify catheter positions immediately prior to treatment delivery.

The reentry catheter: a second chance for endoluminal reentry at difficult lower extremity subintimal arterial recanalizations.

Science.gov (United States)

Etezadi, Vahid; Benenati, James F; Patel, Parag J; Patel, Rahul S; Powell, Alex; Katzen, Barry T

2010-05-01

From January 2005 to July 2008, a retrospective study was conducted at a single institution to investigate technical success of the use of a reentry device (Outback LTD reentry catheter) in aortoiliac and femoropopliteal artery recanalization in 34 patients (18 men; mean age +/- SD, 72 years +/- 11) in whom the conventional guide wires and catheters failed to reenter the true lumen. True lumen reentry was achieved in 87% (n = 23) and 91% (n = 11) of patients with femoropopliteal and aortoiliac occlusions, respectively. The overall technical success rate with the device was 88% (n = 34). The device success rate in Transatlantic Inter-Society Consensus II class D lesions was significantly lower than in lower lesion classes (71.4% vs 100%; P < .05). No procedure-related complications were encountered. In conclusion, the use of the reentry catheter enhances the likelihood of successful subintimal recanalization of chronic occlusions in femoropopliteal and aortoiliac arteries.

A computational fluid dynamics simulation framework for ventricular catheter design optimization.

Science.gov (United States)

Weisenberg, Sofy H; TerMaath, Stephanie C; Barbier, Charlotte N; Hill, Judith C; Killeffer, James A

2017-11-10

the standard catheter hole configuration as a baseline. While the standard ventricular catheter design featuring uniform inlet hole diameters and hole spacing has a standard deviation of 14.27% for the inlet flow rates, the optimized design has a standard deviation of 0.30%. CONCLUSIONS This customizable framework, paired with high-performance computing, provides a rapid method of design testing to solve complex flow problems. While a relatively simplified ventricular catheter model was used to demonstrate the framework, the computational approach is applicable to any baseline catheter model, and it is easily adapted to optimize catheters for the unique needs of different patients as well as for other fluid-based medical devices.

Activity-based cost analysis in catheter-based angiography and interventional radiology

International Nuclear Information System (INIS)

Rautio, R.; Keski-Nisula, L.; Paakkala, T.

2003-01-01

The aim of this study was to analyse the costs of the interventional radiology unit and to identify the cost factors in the different activities of catheter-based angiographies and interventional radiology. In 1999 the number of procedures in the interventional radiological unit at Tampere University Hospital was 2968; 1601 of these were diagnostic angiographies, 526 endovascular and 841 nonvascular interventions. The costs were analysed by using Activity Based Cost (ABC) analysis. The budget of the interventional unit was approximately 1.8 million Euro. Material costs accounted for 67%, personnel costs for 17%, equipment costs for 14% and premises costs for 2% of this. The most expensive products were endografting of aortic aneurysms, with a mean price of 5291 Euro and embolizations of cerebral aneurysms (4472 Euro). Endografts formed 87.3% of the total costs in endografting and Guglielmi detachable coils accounted for 63.3% of the total costs in embolizations. The material costs formed the majority of the costs, especially in the newest and most complicated endovascular treatments. Despite the high cost of angiography equipment, its share of the costs is minor. In our experience ABC system is suitable for analysing costs in interventional radiology. (orig.)

In vitro catheter and sorbent-based method for clearance of radiocontrast material during cerebral interventions

International Nuclear Information System (INIS)

Angheloiu, George O.; Hänscheid, Heribert; Reiners, Christoph; Anderson, William D.; Kellum, John A.

2013-01-01

Background: Contrast-induced acute kidney injury is a severe condition resulting from the use of radiology contrast in patients with predisposing factors. Hypothesis: We hypothesized that a novel system including a device containing polymer resin sorbent beads and a custom-made suctioning catheter could efficiently remove contrast from an in vitro novel model of circulatory system (MOCS) mimicking the cerebral circulation. Methods: A custom-made catheter was built and optimized for cerebral venous approach. The efficiency of a system made of a polymer resin sorbent beads column (CST 401, Cytosorbents) and this particular catheter was tested in the MOCS running a solution composed of 0.9% saline and radio-contrast. During two series of 18 cycles of first-pass experiments we assessed the catheter's suctioning efficiency and the system's ability to clear radio-contrast injected into the MOCS's cerebral arterial segment. We also assessed the functioning and reliability of the MOCS. Results: Mean suctioning efficiency of the catheter was 84% ± 24%. The polymer sorbent column contrast removal rate was initially 96% and gradually decreased with subsequent cycles in a linear fashion during an experiment lasting approximately 90 minutes. The MOCS had a reliability of 0.9946×min −1 where 1 × min −1 was the optimum value. Conclusion: A system including a polymer resin sorbent beads column and a custom-made suctioning catheter had an excellent initial efficiency in quickly removing contrast from an artificial MOCS mimicking the cerebral circulation. MOCS is an inexpensive and relatively reliable custom-made system that can be used for training or testing purposes

In vitro analysis of balloon cuffing phenomenon: inherent biophysical properties of catheter material or mechanics of catheter balloon deflation?

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Chung, Eric; So, Karina

2012-06-01

To investigates the different methods of balloon deflation, types of urinary catheters and exposure to urine media in catheter balloon cuffing. Bardex®, Bard-Lubri-Sil®, Argyle®, Releen® and Biocath® were tested in sterile and E.Coli inoculated urine at 0, 14 and 28 days. Catheter deflation was performed with active deflation; passive deflation; passive auto-deflation; and excision of the balloon inflow channel. Balloon cuffing was assessed objectively by running the deflated balloon over a plate of agar and subjectively by 3 independent observers. Bardex®, Argyle® and Biocath® showed greater degree of catheter balloon cuffing (p deflation was the worst method (p 0.05). Linear regression model analysis confirmed time as the most significant factor. The duration of catheters exposure, different deflation methods and types of catheters tested contributed significantly to catheter balloon cuffing (p < 0.01).

Chitosan-based coatings in the prevention of intravascular catheter-associated infections.

Science.gov (United States)

Mendoza, Gracia; Regiel-Futyra, Anna; Tamayo, Alejandra; Monzon, Marta; Irusta, Silvia; de Gregorio, Miguel Angel; Kyzioł, Agnieszka; Arruebo, Manuel

2018-01-01

Central venous access devices play an important role in patients with prolonged intravenous administration requirements. In the last years, the coating of these devices with bactericidal compounds has emerged as a potential tool to prevent bacterial colonization. Our study describes the modification of 3D-printed reservoirs and silicone-based catheters, mimicking central venous access devices, through different approaches including their coating with the well known biocompatible and bactericidal polymer chitosan, with the anionic polysaccharide alginate; also, plasma treated surfaces were included in the study to promote polymer adhesion. The evaluation of the antimicrobial action of those surface modifications compared to that exerted by a model antibiotic (ciprofloxacin) adsorbed on the surface of the devices was carried out. Surface characterization was developed by different methodologies and the bactericidal effects of the different coatings were assayed in an in vitro model of Staphylococcus aureus infection. Our results showed a significant reduction in the reservoir roughness (≤73%) after coating though no changes were observed for coated catheters which was also confirmed by scanning electron microscopy, pointing to the importance of the surface device topography for the successful attachment of the coating and for the subsequent development of bactericidal effects. Furthermore, the single presence of chitosan on the reservoirs was enough to fully inhibit bacterial growth exerting the same efficiency as that showed by the model antibiotic. Importantly, chitosan coating showed low cytotoxicity against human keratinocytes, human lung adenocarcinoma epithelial cells, and murine colon carcinoma cells displaying viability percentages in the range of the control samples (>95%). Chitosan-based coatings are proposed as an effective and promising solution in the prevention of microbial infections associated to medical devices.

Prevention of catheter-related blood stream infection.

Science.gov (United States)

Byrnes, Matthew C; Coopersmith, Craig M

2007-08-01

Catheter-related blood stream infections are a morbid complication of central venous catheters. This review will highlight a comprehensive approach demonstrated to prevent catheter-related blood stream infections. Elements of prevention important to inserting a central venous catheter include proper hand hygiene, use of full barrier precautions, appropriate skin preparation with 2% chlorhexidine, and using the subclavian vein as the preferred anatomic site. Rigorous attention needs to be given to dressing care, and there should be daily assessment of the need for central venous catheters, with prompt removal as soon as is practicable. Healthcare workers should be educated routinely on methods to prevent catheter-related blood stream infections. If rates remain higher than benchmark levels despite proper bedside practice, antiseptic or antibiotic-impregnated catheters can also prevent infections effectively. A recent program utilizing these practices in 103 ICUs in Michigan resulted in a 66% decrease in infection rates. There is increasing recognition that a comprehensive strategy to prevent catheter-related blood stream infections can prevent most infections, if not all. This suggests that thousands of infections can potentially be averted if the simple practices outlined herein are followed.

Stroke risk associated with balloon based catheter ablation for atrial fibrillation: Rationale and design of the MACPAF Study

Directory of Open Access Journals (Sweden)

Schultheiss Heinz-Peter

2010-07-01

Full Text Available Abstract Background Catheter ablation of the pulmonary veins has become accepted as a standard therapeutic approach for symptomatic paroxysmal atrial fibrillation (AF. However, there is some evidence for an ablation associated (silent stroke risk, lowering the hope to limit the stroke risk by restoration of rhythm over rate control in AF. The purpose of the prospective randomized single-center study "Mesh Ablator versus Cryoballoon Pulmonary Vein Ablation of Symptomatic Paroxysmal Atrial Fibrillation" (MACPAF is to compare the efficacy and safety of two balloon based pulmonary vein ablation systems in patients with symptomatic paroxysmal AF. Methods/Design Patients are randomized 1:1 for the Arctic Front® or the HD Mesh Ablator® catheter for left atrial catheter ablation (LACA. The predefined endpoints will be assessed by brain magnetic resonance imaging (MRI, neuro(psychological tests and a subcutaneously implanted reveal recorder for AF detection. According to statistics 108 patients will be enrolled. Discussion Findings from the MACPAF trial will help to balance the benefits and risks of LACA for symptomatic paroxysmal AF. Using serial brain MRIs might help to identify patients at risk for LACA-associated cerebral thromboembolism. Potential limitations of the study are the single-center design, the existence of a variety of LACA-catheters, the missing placebo-group and the impossibility to assess the primary endpoint in a blinded fashion. Trial registration clinicaltrials.gov NCT01061931

The development of a risk score for unplanned removal of peripherally inserted central catheter in newborns

Directory of Open Access Journals (Sweden)

Priscila Costa

2015-06-01

Full Text Available OBJECTIVE: to develop a risk score for unplanned removal of peripherally inserted central catheter in newborns.METHOD: prospective cohort study conducted in a neonatal intensive care unit with newborn babies who underwent 524 catheter insertions. The clinical characteristics of the newborn, catheter insertion and intravenous therapy were tested as risk factors for the unplanned removal of catheters using bivariate analysis. The risk score was developed using logistic regression. Accuracy was internally validated based on the area under the Receiver Operating Characteristic curve.RESULTS: the risk score was made up of the following risk factors: transient metabolic disorders; previous insertion of catheter; use of a polyurethane double-lumen catheter; infusion of multiple intravenous solutions through a single-lumen catheter; and tip in a noncentral position. Newborns were classified into three categories of risk of unplanned removal: low (0 to 3 points, moderate (4 to 8 points, and high (≥ 9 points. Accuracy was 0.76.CONCLUSION: the adoption of evidence-based preventative strategies based on the classification and risk factors faced by the newborn is recommended to minimize the occurrence of unplanned removals.

Pancreas tumor interstitial pressure catheter measurement

Science.gov (United States)

Nieskoski, Michael D.; Gunn, Jason; Marra, Kayla; Trembly, B. Stuart; Pogue, Brian W.

2016-03-01

This paper highlights the methodology in measuring interstitial pressure in pancreatic adenocarcinoma tumors. A Millar Mikrotip pressure catheter (SPR-671) was used in this study and a system was built to amplify and filter the output signal for data collection. The Millar pressure catheter was calibrated prior to each experiment in a water column at 37°C, range of 0 to 60 inH2O (112 mmHg), resulting in a calibration factor of 33 mV / 1 inH2O. The interstitial pressures measured in two orthotopically grown pancreatic adenocarcinoma tumor were 57 mmHg and 48 mmHg, respectively. Verteporfin uptake into the pancreatic adenocarcinoma tumor was measured using a probe-based experimental dosimeter.

Usefulness of a Biliary Manipulation Catheter in Percutaneous Transhepatic Biliary Drainage

Energy Technology Data Exchange (ETDEWEB)

Paek, Auh Whan [Dept. of Radiology, Virginia University Heath Center, Charlottesville (United States); Won, Je Hwan; Lee, Jei Hee; Sun, Joo Sung; Kwak, Kyu Sung; Bae, Jae Ik [Dept. of Radiology, Ajou University School of Medicine, Suwon (Korea, Republic of)

2011-04-15

To evaluate usefulness of a manipulation catheter in percutaneous transhepatic biliary drainage (PTBD). A biliary manipulation catheter was used for the aspiration of retained bile and lesion crossing during an initial PTBD in 91 consecutive patients over a 6 month period. This catheter allowed for a 0.035 inch guide wire made of 5F short steel braided polyurethane. The terminal 1 cm segment was tapered and 45 degree angulated. Two side holes were made in the terminal segment to facilitate the aspiration of bile. The safety of this procedure was evaluated based on whether the catheters caused complications during insertion and manipulation, and whether cholangitis was aggravated after the procedure. Effectiveness of the procedure was evaluated based on the ability to aspirate retained bile and to cross the lesion. Both the insertion of a 0.035 inch hydrophilic guide wire and aspiration of sufficient retained bile were successful with the catheter. Crossing the common bile duct (CBD) lesion had a 98.1% success rate during the initial PTBD. Crossing the hilar obstruction lesion was had a 94.7% success rate to the CBD and 92.1% to the contralateral lobe. Cholangitis improved in 97% of cases, and aggravated transiently in only 3% of cases after PTBD.

Usefulness of a Biliary Manipulation Catheter in Percutaneous Transhepatic Biliary Drainage

International Nuclear Information System (INIS)

Paek, Auh Whan; Won, Je Hwan; Lee, Jei Hee; Sun, Joo Sung; Kwak, Kyu Sung; Bae, Jae Ik

2011-01-01

To evaluate usefulness of a manipulation catheter in percutaneous transhepatic biliary drainage (PTBD). A biliary manipulation catheter was used for the aspiration of retained bile and lesion crossing during an initial PTBD in 91 consecutive patients over a 6 month period. This catheter allowed for a 0.035 inch guide wire made of 5F short steel braided polyurethane. The terminal 1 cm segment was tapered and 45 degree angulated. Two side holes were made in the terminal segment to facilitate the aspiration of bile. The safety of this procedure was evaluated based on whether the catheters caused complications during insertion and manipulation, and whether cholangitis was aggravated after the procedure. Effectiveness of the procedure was evaluated based on the ability to aspirate retained bile and to cross the lesion. Both the insertion of a 0.035 inch hydrophilic guide wire and aspiration of sufficient retained bile were successful with the catheter. Crossing the common bile duct (CBD) lesion had a 98.1% success rate during the initial PTBD. Crossing the hilar obstruction lesion was had a 94.7% success rate to the CBD and 92.1% to the contralateral lobe. Cholangitis improved in 97% of cases, and aggravated transiently in only 3% of cases after PTBD.

Usefulness of gram staining of blood collected from total parenteral nutrition catheter for rapid diagnosis of catheter-related sepsis.

Science.gov (United States)

Moonens, F; el Alami, S; Van Gossum, A; Struelens, M J; Serruys, E

1994-01-01

The accuracy of Gram staining of blood drawn from catheters used to administer total parenteral nutrition was compared with paired quantitative blood cultures for the diagnosis of catheter-related sepsis. Gram staining was positive in 11 of 18 episodes of catheter-related sepsis documented by quantitative culture (sensitivity, 61%) but in none of the 5 episodes of fever unrelated to catheter infection. Thus, this procedure enabled the rapid presumptive diagnosis and guidance of antimicrobial therapy for total parenteral nutrition catheter sepsis, with a positive predictive value of 100% and a negative predictive value of 42%. PMID:7521359

The safety and feasibility of guidezilla catheter in complex coronary interventions and an observational study.

Science.gov (United States)

Ma, Jianying; Hou, Lei; Qian, Juying; Ge, Lei; Zhang, Feng; Chang, Shufu; Xu, Rende; Qin, Qing; Ge, Junbo

2017-10-01

The monorail Guidezilla guide extension catheter was designed to provide additional backup and facilitate device delivery in percutaneous coronary intervention (PCI) for complex coronary anatomy such as chronic total occlusion (CTO), extreme vessel tortuosity, diseased bypass grafts, and anomalous coronary arteries, among others.The present retrospective, single-center study included 188 consecutive patients who underwent PCI using the Guidezilla catheter from March 2015 to August 2016. Study outcomes were rates of target lesion crossing success, procedural success, and complications.The Guidezilla catheter was used most commonly in PCI of CTOs (45%) and heavy proximal calcification (37%), followed by tortuosity (10%), previously deployed proximal stents (4%), and coronary artery anomaly (4%). The right coronary artery (48%) was most commonly intervened followed by the left ascending (35%) and left circumflex (17%) arteries. Rates of target lesion crossing success and procedural success were both 99%, with one device-related periprocedural complication, namely proximal vessel dissection secondary to deep insertion which was successfully treated with stent implantation. Ninety percent of PCI were performed and completed successfully by radial access.In a single center with experienced operators, the use of the Guidezilla guide extension catheter in PCI of complex coronary anatomy performed mostly via radial artery access appeared safe and efficacious, and greatly facilitated device delivery.

In vitro catheter and sorbent-based method for clearance of radiocontrast material during cerebral interventions

Energy Technology Data Exchange (ETDEWEB)

Angheloiu, George O., E-mail: goangheloiu@drmc.org [Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (United States); Department of Cardiology, Dubois Regional Medical Center, Dubois, PA (United States); Hänscheid, Heribert; Reiners, Christoph [Department of Nuclear Medicine, University of Würzburg, Würzburg (Germany); Anderson, William D. [Cardiology Department, Exempla Healthcare, Denver, CO (United States); Kellum, John A. [CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA (United States)

2013-07-15

Background: Contrast-induced acute kidney injury is a severe condition resulting from the use of radiology contrast in patients with predisposing factors. Hypothesis: We hypothesized that a novel system including a device containing polymer resin sorbent beads and a custom-made suctioning catheter could efficiently remove contrast from an in vitro novel model of circulatory system (MOCS) mimicking the cerebral circulation. Methods: A custom-made catheter was built and optimized for cerebral venous approach. The efficiency of a system made of a polymer resin sorbent beads column (CST 401, Cytosorbents) and this particular catheter was tested in the MOCS running a solution composed of 0.9% saline and radio-contrast. During two series of 18 cycles of first-pass experiments we assessed the catheter's suctioning efficiency and the system's ability to clear radio-contrast injected into the MOCS's cerebral arterial segment. We also assessed the functioning and reliability of the MOCS. Results: Mean suctioning efficiency of the catheter was 84% ± 24%. The polymer sorbent column contrast removal rate was initially 96% and gradually decreased with subsequent cycles in a linear fashion during an experiment lasting approximately 90 minutes. The MOCS had a reliability of 0.9946×min{sup −1} where 1 × min{sup −1} was the optimum value. Conclusion: A system including a polymer resin sorbent beads column and a custom-made suctioning catheter had an excellent initial efficiency in quickly removing contrast from an artificial MOCS mimicking the cerebral circulation. MOCS is an inexpensive and relatively reliable custom-made system that can be used for training or testing purposes.

Value of Micronester coils in port-catheter implantation for continuous hepatic arterial infusion chemotherapy with fixed catheter tip method

International Nuclear Information System (INIS)

Yamagami, Takuji; Kato, Takeharu; Hirota, Tatsuya; Yoshimatsu, Rika; Matsumoto, Tomohiro; Nishimura, Tsunehiko; White, Robert I.

2008-01-01

To retrospectively evaluate the use of Micronester coils in port-catheter implantation with the fixed catheter tip method in comparison with other previously used coils. The cohort of this study was 143 consecutive patients with unresectable advanced liver cancer for whom a port-catheter system was percutaneously implanted. In the most recent 32 patients, Micronester coils were used for catheter tip fixation. Details of embolic agents for fixation, persistent blood flow beyond the distal end of the indwelling catheter, and complications were compared between cases without and with Micronester coils. In all, percutaneous port-catheter placement was successful. Mean number of coils used for fixation was 4.2 without Micronester coils vs. 2.5 with Micronester coils. N-butyl cyanoacrylate (NBCA)-Lipiodol was additionally used for catheter tip fixation in 85.6% of 111 procedures without Micronester coils and in 50% of 32 using Micronester coils. The gastroduodenal artery beyond the distal end was not detected at the final examination after any procedure. Catheter dislocation occurred in five and hepatic arterial obstruction or severe stenosis in eight. The number of coils used and necessity of NBCA-Lipiodol could be decreased with usage of Micronester coils without decreasing fixation ability compared to other coils. (orig.)

Large-deflection statics analysis of active cardiac catheters through co-rotational modelling.

Science.gov (United States)

Peng Qi; Chen Qiu; Mehndiratta, Aadarsh; I-Ming Chen; Haoyong Yu

2016-08-01

This paper presents a co-rotational concept for large-deflection formulation of cardiac catheters. Using this approach, the catheter is first discretized with a number of equal length beam elements and nodes, and the rigid body motions of an individual beam element are separated from its deformations. Therefore, it is adequate for modelling arbitrarily large deflections of a catheter with linear elastic analysis at the local element level. A novel design of active cardiac catheter of 9 Fr in diameter at the beginning of the paper is proposed, which is based on the contra-rotating double helix patterns and is improved from the previous prototypes. The modelling section is followed by MATLAB simulations of various deflections when the catheter is exerted different types of loads. This proves the feasibility of the presented modelling approach. To the best knowledge of the authors, it is the first to utilize this methodology for large-deflection static analysis of the catheter, which will enable more accurate control of robot-assisted cardiac catheterization procedures. Future work would include further experimental validations.

Control of intravascular catheters using an array of active steering coils.

Science.gov (United States)

Gudino, N; Heilman, J A; Derakhshan, J J; Sunshine, J L; Duerk, J L; Griswold, M A

2011-07-01

To extend the concept of deflecting the tip of a catheter with the magnetic force created in an MRI system through the use of an array of independently controllable steering coils located in the catheter tip, and to present methods for visualization of the catheter and/or surrounding areas while the catheter is deflected. An array of steering coils made of 42-gauge wire was built over a 2.5 Fr (0.83 mm) fiber braided microcatheter. Two of the coils were 70 turn axial coils separated by 1 cm, and the third was a 15-turn square side coil that was 2 x 4 mm2. Each coil was driven independently by a pulse width modulation (PWM) current source controlled by a microprocessor that received commands from a MATLAB routine that dynamically set current amplitude and direction for each coil. The catheter was immersed in a water phantom containing 1% Gd-DTPA that was placed at the isocenter of a 1.5 T MRI scanner. Deflections of the catheter tip were measured from image-based data obtained with a real-time radio frequency (RF) spoiled gradient echo sequence (GRE). The small local magnetic fields generated by the steering coils were exploited to generate a hyperintense signal at the catheter tip by using a modified GRE sequence that did not include slice-select rewinding gradients. Imaging and excitation modes were implemented by synchronizing the excitation of the steering coil array with the scanner by ensuring that no current was driven through the coils during the data acquisition window; this allowed visualization of the surrounding tissue while not affecting the desired catheter position. Deflections as large as 2.5 cm were measured when exciting the steering coils sequentially with a 100 mA maximum current per coil. When exciting a single axial coil, the deflection was half this value with 30% higher current. A hyperintense catheter tip useful for catheter tracking was obtained by imaging with the modified GRE sequence. Clear visualization of the areas surrounding the

21 CFR 868.5120 - Anesthesia conduction catheter.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia conduction catheter. 868.5120 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5120 Anesthesia conduction catheter. (a) Identification. An anesthesia conduction catheter is a flexible tubular device used to inject...

Agile and Bright Intracardiac Catheters

NARCIS (Netherlands)

M. Pekař (Martin)

2017-01-01

markdownabstractIntracardiac imaging catheters represent unique instruments to diagnose and treat a diseased heart. While there are imminent advances in medical innovation, many of the commercially available imaging catheters are outdated. Some of them have been designed more than 20 years and

A National Implementation Project to Prevent Catheter-Associated Urinary Tract Infection in Nursing Home Residents.

Science.gov (United States)

Mody, Lona; Greene, M Todd; Meddings, Jennifer; Krein, Sarah L; McNamara, Sara E; Trautner, Barbara W; Ratz, David; Stone, Nimalie D; Min, Lillian; Schweon, Steven J; Rolle, Andrew J; Olmsted, Russell N; Burwen, Dale R; Battles, James; Edson, Barbara; Saint, Sanjay

2017-08-01

Catheter-associated urinary tract infection (UTI) in nursing home residents is a common cause of sepsis, hospital admission, and antimicrobial use leading to colonization with multidrug-resistant organisms. To develop, implement, and evaluate an intervention to reduce catheter-associated UTI. A large-scale prospective implementation project was conducted in community-based nursing homes participating in the Agency for Healthcare Research and Quality Safety Program for Long-Term Care. Nursing homes across 48 states, Washington DC, and Puerto Rico participated. Implementation of the project was conducted between March 1, 2014, and August 31, 2016. The project was implemented over 12-month cohorts and included a technical bundle: catheter removal, aseptic insertion, using regular assessments, training for catheter care, and incontinence care planning, as well as a socioadaptive bundle emphasizing leadership, resident and family engagement, and effective communication. Urinary catheter use and catheter-associated UTI rates using National Healthcare Safety Network definitions were collected. Facility-level urine culture order rates were also obtained. Random-effects negative binomial regression models were used to examine changes in catheter-associated UTI, catheter utilization, and urine cultures and adjusted for covariates including ownership, bed size, provision of subacute care, 5-star rating, presence of an infection control committee, and an infection preventionist. In 4 cohorts over 30 months, 568 community-based nursing homes were recruited; 404 met inclusion criteria for analysis. The unadjusted catheter-associated UTI rates decreased from 6.78 to 2.63 infections per 1000 catheter-days. With use of the regression model and adjustment for facility characteristics, the rates decreased from 6.42 to 3.33 (incidence rate ratio [IRR], 0.46; 95% CI, 0.36-0.58; P project. Catheter utilization remained unchanged (4.50 at baseline, 4.45 at conclusion of project; IRR, 0

21 CFR 876.5030 - Continent ileostomy catheter.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Continent ileostomy catheter. 876.5030 Section 876...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5030 Continent ileostomy catheter. (a) Identification. A continent ileostomy catheter is a flexible tubular device used as a form...

FAQs about Catheter-Associated Urinary Tract Infection

Science.gov (United States)

... do so. o Avoid disconnecting the catheter and drain tube. This helps to pre - vent germs from getting into the catheter tube. o The catheter is secured to the leg to prevent pulling on the ... regularly. The drainage spout should not touch any - thing while emptying ...

The dangers of long-term catheter drainage.

Science.gov (United States)

Lowthian, P

There are many dangers associated with long-term urinary bladder drainage by catheter. For various reasons, the choice of catheter is important, and its initial insertion can be particularly hazardous. All catheterizations should, however, be safer when there is some urine (or other fluid) in the bladder. The appropriate choice of drainage system attached to the catheter can delay bacterial invasion of the bladder. Great care is needed to prevent blockage of the system, particularly when bacteriuria is present. Recent evidence indicates that some bacteria encourage the development of encrustations, so that, in some circumstances, catheters may become blocked within 24 hours. This, together with other considerations, strongly suggests that indwelling catheters should be changed at intervals of not more than 5 days. The practical implications of this are considered, as are the benefits that may accrue. Accidental catheter traction is another danger, and some possible methods of avoiding this are discussed. Finally, the need for a new kind of drainage-bag support is highlighted.

An efficient cardiac mapping strategy for radiofrequency catheter ablation with active learning.

Science.gov (United States)

Feng, Yingjing; Guo, Ziyan; Dong, Ziyang; Zhou, Xiao-Yun; Kwok, Ka-Wai; Ernst, Sabine; Lee, Su-Lin

2017-07-01

A major challenge in radiofrequency catheter ablation procedures is the voltage and activation mapping of the endocardium, given a limited mapping time. By learning from expert interventional electrophysiologists (operators), while also making use of an active-learning framework, guidance on performing cardiac voltage mapping can be provided to novice operators or even directly to catheter robots. A learning from demonstration (LfD) framework, based upon previous cardiac mapping procedures performed by an expert operator, in conjunction with Gaussian process (GP) model-based active learning, was developed to efficiently perform voltage mapping over right ventricles (RV). The GP model was used to output the next best mapping point, while getting updated towards the underlying voltage data pattern as more mapping points are taken. A regularized particle filter was used to keep track of the kernel hyperparameter used by GP. The travel cost of the catheter tip was incorporated to produce time-efficient mapping sequences. The proposed strategy was validated on a simulated 2D grid mapping task, with leave-one-out experiments on 25 retrospective datasets, in an RV phantom using the Stereotaxis Niobe ® remote magnetic navigation system, and on a tele-operated catheter robot. In comparison with an existing geometry-based method, regression error was reduced and was minimized at a faster rate over retrospective procedure data. A new method of catheter mapping guidance has been proposed based on LfD and active learning. The proposed method provides real-time guidance for the procedure, as well as a live evaluation of mapping sufficiency.

Low-angled peripheral intravenous catheter tip placement decreases phlebitis.

Science.gov (United States)

Tanabe, Hidenori; Murayama, Ryoko; Yabunaka, Koichi; Oe, Makoto; Takahashi, Toshiaki; Komiyama, Chieko; Sanada, Hiromi

2016-11-02

Peripheral intravenous catheters (PIVCs) are frequently removed due to phlebitis. We hypothesized that catheters made of polyurethane, which is more flexible than Teflon, would decrease phlebitis, and that flexibility could be estimated by measuring the catheter-tip angle. Ultrasonography in two groups of patients with different catheter types was then used to compare catheter-tip angles and phlebitis. Observational studies were carried out at a medical ward in a university hospital. Infusion therapy was administered to one group of patients in 2014 using Teflon catheters (control group, n = 200), and to another group of patients in 2015 using polyurethane catheters (investigational group, n = 207). The symptoms were assessed according to a scale developed by the Infusion Nurses Society. Long-axis ultrasonography images taken immediately before catheter removal were used to measure the angle between the central line of the catheter within 2 mm from the distal point and a tangent to the vessel wall. There were no significant differences between the two groups with respect to sex, age, and medical diagnosis. In the control and investigational groups, the rates of phlebitis were 37% (73/200) and 17% (36/207), respectively (pPhlebitis occurred more frequently when the catheter-tip was placed at angle >5.8°. The frequency of phlebitis was lower in the polyurethane, in which the catheter was placed at lower angle, almost parallel to the vessel. Our results will aid in developing new catheters and in improving PIVC-securement techniques.

Paravertebral block catheter breakage by electrocautery during thoracic surgery.

Science.gov (United States)

Saeki, Noboru; Sugimoto, Yuki; Mori, Yoko; Kato, Takahiro; Miyoshi, Hirotsugu; Nakamura, Ryuji; Koga, Tomomichi

2017-06-01

Advantages of thoracic paravertebral analgesia (TPA) include placement of the catheter closer to the surgical field; however, the catheter can become damaged during the operation. We experienced a case of intraoperative TPA catheter breakage that prompted us to perform an experiment to investigate possible causes. A 50-year-old male underwent a thoracoscopic lower lobectomy under general anesthesia with TPA via an intercostal approach. Following surgery, it was discovered that the catheter had become occluded, as well as cut and fused, so we reopened the incision and removed the residual catheter. From that experience, we performed an experiment to examine electrocautery-induced damage in normal (Portex™, Smith's Medical), radiopaque (Perifix SoftTip™, BBraun), and reinforced (Perifix FX™, BBraun) epidural catheters (n = 8 each). Chicken meat was penetrated by each catheter and then cut by electrocautery. In the normal group, breakage occurred in 8 and occlusion in 6 of the catheters, and in the radiopaque group breakage occurred in 8 and occlusion in 7. In contrast, breakage occurred in only 3 and occlusion in none in the reinforced group, with the 5 without breakage remaining connected only by the spring coil. Furthermore, in 7 of the reinforced catheters, electric arc-induced thermal damage was observed at the tip of the catheter. A TPA catheter for thoracic surgery should be inserted via the median approach, or it should be inserted after surgery to avoid catheter damage during surgery.

Spinal canal extension of hyperalimentation catheter without neurologic sequela

International Nuclear Information System (INIS)

Glasier, M.; Arkansas Children's Hospital, Little Rock; Hassell, D.R.

1989-01-01

An attempt at placement of a left femoral vein hyperalimentation catheter resulted in entrance of the catheter into the spinal canal. Catheter location was documented by injections of nonionic contrast material into the catheter without neurologic sequellae. (orig.)

Urinary catheter-associated microbiota change in accordance with treatment and infection status.

Science.gov (United States)

Bossa, Laetitia; Kline, Kimberly; McDougald, Diane; Lee, Bonsan Bonne; Rice, Scott A

2017-01-01

The use of long-term catheterisation to manage insensate bladders, often associated with spinal cord injury (SCI), increases the risk of microbial colonisation and infection of the urinary tract. Urinary tract infection (UTI) is typically diagnosed and treated based on the culturing of organisms from the urine, although this approach overlooks low titer, slow growing and non-traditional pathogens. Here, we present an investigation of the urinary tract microbiome in catheterised SCI individuals, using T-RFLP and metagenomic sequencing of the microbial community. We monitored three neurogenic patients over a period of 12 months, who were part of a larger study investigating the efficacy of probiotics in controlling UTIs, to determine how their urinary tract microbial community composition changed over time and in relation to probiotic treatment regimens. Bacterial biofilms adherent to urinary catheters were examined as a proxy for bladder microbes. The microbial community composition of the urinary tract differed significantly between individuals. Probiotic therapy resulted in a significant change in the microbial community associated with the catheters. The community also changed as a consequence of UTI and this shift in community composition preceded the clinical diagnosis of infection. Changes in the microbiota due to probiotic treatment or infection were transient, resolving to microbial communities similar to their pre-treatment communities, suggesting that the native community was highly resilient. Based on these results, we propose that monitoring a patient's microbial community can be used to track the health of chronically catheterized patients and thus, can be used as part of a health-status monitoring program.

Incidence of phlebitis associated with the use of peripheral IV catheter and following catheter removal

Directory of Open Access Journals (Sweden)

Janete de Souza Urbanetto

Full Text Available ABSTRACT Objective: to investigate the incidence of phlebitis and its association with risk factors when using peripheral IV catheters (PIC and following their removal - (post-infusion phlebitis in hospitalized adults. Method: a cohort study of 171 patients using PIC, totaling 361 punctures. Sociodemographic variables and variables associated with the catheter were collected. Descriptive and analytical statistical analyses were performed. Results: average patient age was 56.96 and 51.5% of the sample population was male. The incidence of phlebitis was 1.25% while using PIC, and 1.38% post-infusion. The incidence of phlebitis while using PIC was associated with the length of time the catheter remained in place, whereas post-infusion phlebitis was associated with puncture in the forearm. Ceftriaxone, Clarithromycin and Oxacillin are associated with post-infusion phlebitis. Conclusions: this study made it possible to investigate the association between risk factors and phlebitis during catheter use and following its removal. The frequency of post-infusion phlebitis was larger than the incidence of phlebitis with the catheter in place, with Phlebitis Grade III and II being the most frequently found in each of these situations, respectively. Aspects related to post-infusion phlebitis can be explained, given the limited number of studies addressing this theme from this perspective.

Repositioning of malpositioned or flipped central venous catheters

Energy Technology Data Exchange (ETDEWEB)

Thalhammer, A.; Jacobi, V.; Balzer, J.; Vogl, T.J. [Institute for Diagnostic and Interventional Radiology, Central Radiology Clinic, J.W. Goethe University, Frankfurt am Main (Germany)

2002-03-01

Primary misplaced or secondary flipped implanted catheters are located mostly in the right jugular vein. We demonstrate an effective method to replace fix implanted catheters such as Ports, Grochomg or Hickman catheters. Using a femoral venous approach, replacement into the superior vena cava can easily be done with a Sidewinder 1 catheter which is hooked over the misplaced central venous approach. In all our patients the method was successful. The repositioning technique described is simple, fast and has low costs. We can keep sterile conditions and do not need to solve the catheters' fixation. (orig.)

Management of Distal Gastric Leak After Laparoscopic Sleeve Gastrectomy by Double Pigtail Catheter

Directory of Open Access Journals (Sweden)

Mani Habibi

2016-07-01

Full Text Available Gastric leakage postsurgery is the most feared complication of laparoscopic sleeve gastrectomy due to the difficulty of its management. While gastric leakagemanagement postsurgery is often performed using internal drainage catheters accompanied by self-expandable metal stents, endoscopic internal drainage by double pigtail catheter has recently become a recommended approach. Here we describe our treatment of a patient who experienced distal gastric leakage after undergoing laparoscopic sleeve gastrectomy using double pigtail catheter and our treatment recommendations based on the patient outcome.

Account for Clinical Heterogeneity in Assessment of Catheter-based Renal Denervation among Resistant Hypertension Patients: Subgroup Meta-analysis

Directory of Open Access Journals (Sweden)

Xiao-Han Chen

2017-01-01

Conclusions: In all patients with RH, the catheter-based RDN is not more effective in lowering ambulatory or office BP than an optimized antihypertensive drug treatment at 6 and 12 months. However, among RH patients with higher baseline SBP, RDN might be more effective in reducing SBP.

CATHETER DURATION AND THE RISK OF SEPSIS IN PREMATURE BABIES WITH UMBILICAL VEIN CATHETERS

Directory of Open Access Journals (Sweden)

Hartojo Hartojo

2012-01-01

Full Text Available Umbilical catheters are frequently required in the management of severely ill premature babies. The risk of complications may increase with duration of UVC use. Objective: To determine whether the risk of central line-associated bloodstream infections (CLA-BSIs and sepsis remained constant over the duration of umbilical vein catheters (UVCs in high-risk premature neonates. Methods:retrospective analysis. The data were collected from the medical record of high risk premature neonates who had a UVC placed in neonatal care unit of Husada Utama Hospital between April 1st 2008 to April 30th 2011 with purposive sampling. Catheter duration was observed before and after 14 days on placement. Blood and UVC culture was performed to establish the risk of CLA-BSIs and sepsis. Chi-square and logistic regression analysis were performed in the laboratorium data. Result: A total 44 high risk premature babies with UVCs were enrolled (sepsis group: n = 23 and non sepsis group: n = 21. Baseline demographics were similar between the groups. 15 babies in sepsis group have UVCs duration > 14 days, and 8 babies have UVCs 14 days show blood culture performance in 11 babies with positive evidence, UVCs culture performance is negative in 18 babies (p = 0.456. Burkholderia cepacia and Klebsiella pneumonia mostly appeared in blood culture performance. 25% of UVC culture performance shows Pseudomonas aeroginosa. Conclusions: The catheter duration have no significant difference in risk of sepsis in premature babies with Umbilical Vein Catheters.

Catheter-based high-intensity ultrasound for epicardial ablation of the left ventricle: device design and in vivo feasiblity

Science.gov (United States)

Salgaonkar, Vasant A.; Nazer, Babak; Jones, Peter D.; Tanaka, Yasuaki; Martin, Alastair; Ng, Bennett; Duggirala, Srikant; Diederich, Chris J.; Gerstenfeld, Edward P.

2015-03-01

The development and in vivo testing of a high-intensity ultrasound thermal ablation catheter for epicardial ablation of the left ventricle (LV) is presented. Scar tissue can occur in the mid-myocardial and epicardial space in patients with nonischemic cardiomyopathy and lead to ventricular tachycardia. Current ablation technology uses radiofrequency energy, which is limited epicardially by the presence of coronary vessels, phrenic nerves, and fat. Ultrasound energy can be precisely directed to deliver targeted deep epicardial ablation while sparing intervening epicardial nerve and vessels. The proof-of-concept ultrasound applicators were designed for sub-xyphoid access to the pericardial space through a steerable 14-Fr sheath. The catheter consists of two rectangular planar transducers, for therapy (6.4 MHz) and imaging (5 MHz), mounted at the tip of a 3.5-mm flexible nylon catheter coupled and encapsulated within a custom-shaped balloon for cooling. Thermal lesions were created in the LV in a swine (n = 10) model in vivo. The ultrasound applicator was positioned fluoroscopically. Its orientation and contact with the LV were verified using A-mode imaging and a radio-opaque marker. Ablations employed 60-s exposures at 15 - 30 W (electrical power). Histology indicated thermal coagulation and ablative lesions penetrating 8 - 12 mm into the left ventricle on lateral and anterior walls and along the left anterior descending artery. The transducer design enabled successful sparing from the epicardial surface to 2 - 4 mm of intervening ventricle tissue and epicardial fat. The feasibility of targeted epicardial ablation with catheter-based ultrasound was demonstrated.

Development of a Web-Based Self-management Intervention for Intermittent Urinary Catheter Users With Spinal Cord Injury.

Science.gov (United States)

Wilde, Mary H; Fairbanks, Eileen; Parshall, Robert; Zhang, Feng; Miner, Sarah; Thayer, Deborah; Harrington, Brian; Brasch, Judith; McMAHON, James M

2015-11-01

While Web-based interventions have proliferated recently, information in the literature is often lacking about how the intervention was developed. In response to that gap, this is a report of the development of a Web-based self-management intervention for intermittent urinary catheter users and pretesting with four adults with spinal cord injury living in the community. Two Web sites were created, one for recruitment and the other for the intervention itself. The intervention involved developing new Web-based technology, including an interactive urinary diary (with fluid intake/urine output and a journal), extensive catheter products information, three intervention nurse phone call consultations, and user-community discussion forums. Study participants completed an online survey and were interviewed twice about the enrollment process and their perceptions of their involvement in the intervention. Suggestions from the pretesting participants were used to revise the Web site applications prior to the next stage of research (a feasibility study). Numerous recommendations and comments were received related to content, interactivity of components, and usability. This article provides a description of how the Web sites were developed (including the technology and software programs used), issues encountered and what was done to address them, and how the Web-based intervention was modified for improvements.

Catheter Occlusion in Home Infusion: The Influence of Needleless Connector Design on Central Catheter Occlusion.

Science.gov (United States)

Williams, Ann

Thrombotic catheter occlusion is a common complication associated with central venous catheters (CVCs). A wide variety of needleless connectors that differ greatly in design and function are available for use with CVCs; however, there are a limited number of studies comparing the catheter occlusion rate associated with differently designed needleless connectors. This retrospective observational study compared occlusion rates associated with a split-septum neutral-displacement needleless connector versus those of a solid-surface neutral-reflux needleless connector in patients undergoing home infusion therapy. The neutral-reflux needleless connector was associated with a significant reduction in occlusion rate and thrombolytic use versus the neutral-displacement needleless connector.

Attitudes Towards Catheter Ablation for Atrial Fibrillation

DEFF Research Database (Denmark)

Vadmann, Henrik; Pedersen, Susanne S; Nielsen, Jens Cosedis

2015-01-01

BACKGROUND: Catheter ablation for atrial fibrillation (AF) is an important but expensive procedure that is the subject of some debate. Physicians´ attitudes towards catheter ablation may influence promotion and patient acceptance. This is the first study to examine the attitudes of Danish...... cardiologists towards catheter ablation for AF, using a nationwide survey. METHODS AND RESULTS: We developed a purpose-designed questionnaire to evaluate attitudes towards catheter ablation for AF that was sent to all Danish cardiologists (n = 401; response n = 272 (67.8%)). There was no association between...... attitudes towards ablation and the experience or age of the cardiologist with respect to patients with recurrent AF episodes with a duration of 7 days and/or need for cardioversion. The majority (69%) expected a recurrence of AF after catheter ablation in more than 30% of the cases...

Catheter Angiography

Medline Plus

Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us News Physician Resources Professions Site Index A-Z Catheter Angiography ...

Technique of Peritoneal Catheter Placement under Fluoroscopic Guidance

International Nuclear Information System (INIS)

Abdel-Aal, A.K.; Gaddikeri, S.; Saddekni, S.

2011-01-01

Peritoneal catheters are mainly used for peritoneal dialysis in patients with end-stage renal disease. Other uses of this catheter include intraperitoneal chemotherapy and gene therapy for ovarian cancer and draining of uncontrolled refractory ascites in patients with liver cirrhosis. Traditionally, surgeons place most of these peritoneal catheters either by laparoscopy or open laparotomy. We detail our percutaneous approach to placing peritoneal catheters using fluoroscopic guidance. We emphasize the use of additional ultrasound guidance, including gray scale and color Doppler ultrasound, to determine the safest puncture site and to guide the initial needle puncture in order to avoid bowel perforation and injury to epigastric artery. We present our experience in placing peritoneal catheters using this technique in 95 patients with various indications. Fluoroscopic guided percutaneous placement of peritoneal catheters is a safe, minimally invasive, and effective alternative to open surgical or laparoscopic placement.

Detection of electrophysiology catheters in noisy fluoroscopy images.

Science.gov (United States)

Franken, Erik; Rongen, Peter; van Almsick, Markus; ter Haar Romeny, Bart

2006-01-01

Cardiac catheter ablation is a minimally invasive medical procedure to treat patients with heart rhythm disorders. It is useful to know the positions of the catheters and electrodes during the intervention, e.g. for the automatization of cardiac mapping. Our goal is therefore to develop a robust image analysis method that can detect the catheters in X-ray fluoroscopy images. Our method uses steerable tensor voting in combination with a catheter-specific multi-step extraction algorithm. The evaluation on clinical fluoroscopy images shows that especially the extraction of the catheter tip is successful and that the use of tensor voting accounts for a large increase in performance.

Incidence of thrombosis in children with tunneled central venous access devices versus peripherally inserted central catheters (PICCs).

Science.gov (United States)

Kanin, Maralee; Young, Guy

2013-11-01

The recent proliferation of deep vein thrombosis in children has been attributed to the increased use of central venous catheters, specifically tunneled lines and peripherally inserted central catheters. A formal comparison of the incidence rate for deep vein thrombosis between tunneled lines and peripherally inserted central catheters has not been undertaken. Children inclusion. Data were extracted from the hospital discharge database which includes data on all procedures and up to 20 diagnoses per admission. Diagnoses and procedures were identified by International Classification of Disease, Ninth Revision coding. Patients were excluded if they received more than one central line. Data collected included type of central line, deep vein thrombosis event, and underlying medical illnesses classified according to chronic complex conditions. Over the seven year study period there was an overall rate of 73 deep vein thromboses per 10,000 hospital discharges. Of the 6915 eligible subjects, 181 had a deep vein thrombosis for an overall incidence rate of 2.6%. There were 152 thrombi (2.6%) in subjects with peripherally inserted central catheters and 29 thrombi (3.1%) in subjects with tunneled lines [OR=.83 (0.55, 1.29), p=0.38]. Despite the relative ease and simplicity of use of peripherally inserted central catheters leading to a substantial rise in their use, this study demonstrates that such lines pose a substantial risk for venous thrombosis and no difference in incidence was detected between such lines and tunneled lines. © 2013.

Successful treatment of central venous catheter induced superior vena cava syndrome with ultrasound accelerated catheter-directed thrombolysis.

Science.gov (United States)

Dumantepe, Mert; Tarhan, Arif; Ozler, Azmi

2013-06-01

Superior vena cava (SVC) syndrome results from obstruction of flow through the vessel either by external compression or thrombosis. External compression by intrathoracic neoplasms is the most common etiology, especially lung cancer and lymphoma. Thrombosis is becoming increasingly common due to the use of indwelling catheters and implantable central venous access devices. Most patients are unresponsive to anticoagulation alone which appears to be effective only in the mildest cases. However, recent advances in catheter-based interventions have led to the development of a variety of minimally invasive endovascular strategies to remove venous thrombus and accepted as an important first-line treatment given its high overall success rate and low morbidity as compared with medical and surgical treatments. Ultrasound accelerated catheter-directed thrombolysis (UACDT) has been developed to rapidly and completely resolve the existing thrombus. This technique integrates high frequency, low intensity ultrasound (US) with standard CDT in order to accelerate clot dissolution, reducing treatment time and the incidence of thrombolysis-related complications. An US wave enhances drug permeation through thrombus by disaggregating the fibrin matrix, exposing additional plasminogen receptor sites to the thrombolytic agent. The US energy affects thrombus in the entire venous segment, increasing the probability of complete thrombus clearing. We report the case of a 56-year-old man who presented with a 5 days history of SVC syndrome symptoms who had been receiving chemotherapy for colon cancer through a right subclavian vein port catheter. The patient successfully treated with UACDT with EkoSonic(®) Mach4e Endovascular device with an overnight infusion. © 2013 Wiley Periodicals, Inc. Copyright © 2013 Wiley Periodicals, Inc.

UK Renal Registry 15th annual report: Chapter 8 UK multisite peritoneal dialysis access catheter audit for first PD catheters 2011.

Science.gov (United States)

Briggs, Victoria; Pitcher, David; Braddon, Fiona; Fogarty, Damian; Wilkie, Martin

2013-01-01

The central paradigm of effective peritoneal dialysis (PD) is an appropriate standard of PD catheter function. The aim of the project was to develop an effective national PD access audit which would identify an 'appropriate standard' of PD catheter function. The UK Renal Registry collected centre specific information on various PD access outcome measures including catheter functionality and post-insertion complications. The first PD access audit covering England, Northern Ireland and Wales was conducted during April to June 2012 looking at incident dialysis patients in 2011. Forty three data collection spreadsheets were returned from a total of 65 centres describing 917 PD catheter placements. The median age of PD patients was 61 years and 61.5% were male. The proportion of patients initiated on PD in comparison to HD was lower in socially deprived areas. There was a relationship between the timing of nephrology referral and the likelihood of surgical assessment regarding PD catheter placement. Patients with diabetes did not have higher rates of PD catheter failure or of early peritonitis. A comparative PD catheter audit has the potential to provide valuable information on an important patient related outcome measure and lead to an improvement in patient experience. There was wide variation between centres of PD catheter use for late presenting patients. Overall patients were more likely to get a PD catheter if they had been known to the service for more than 1 year. The percutaneous insertion technique was associated with a higher early (less than 2 week) peritonitis rate and more catheter flow problems. Copyright © 2013 S. Karger AG, Basel.

Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients.

Science.gov (United States)

Meddings, Jennifer; Rogers, Mary A M; Macy, Michelle; Saint, Sanjay

2010-09-01

Prolonged catheterization is the primary risk factor for catheter-associated urinary tract infection (CAUTI). Reminder systems are interventions used to prompt the removal of unnecessary urinary catheters. To summarize the effect of urinary catheter reminder systems on the rate of CAUTI, urinary catheter use, and the need for recatheterization, we performed a systematic review and meta-analysis. Studies were identified in MEDLINE, the Cochrane Library, Biosis, the Web of Science, EMBASE, and CINAHL through August 2008. Only interventional studies that used reminders to physicians or nurses that a urinary catheter was in use or stop orders to prompt catheter removal in hospitalized adults were included. A total of 6679 citations were identified; 118 articles were reviewed, and 14 articles met the selection criteria. The rate of CAUTI (episodes per 1000 catheter-days) was reduced by 52% (P SMD) in the duration of catheterization was -1.11 overall (P = 070), including a statistically significant decrease in studies that used a stop order (SMD, -0.30; P = .001) but not in those that used a reminder (SMD, -1.54; P = .071). Recatheterization rates were similar in control and intervention groups. Urinary catheter reminders and stop orders appear to reduce the rate of CAUTI and should be strongly considered to enhance the safety of hospitalized patients.

Steam-deformed Judkins-left guiding catheter with use of the GuideLiner catheter to deliver stents for anomalous right coronary artery

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Toshiki Kuno

2015-10-01

Full Text Available Objective: Percutaneous coronary intervention for anomalous right coronary artery (RCA originating from the left coronary cusp is challenging because of our current inability to coaxially engage the guiding catheter. Methods: We report a case of an 88-year-old woman with non-ST segment elevation myocardial infarction, with an anomalous RCA origin. Using either the Judkins-Left catheter or Amplatz-Left catheter was difficult because of RCA ostium tortuosity. Thus, we used steam to deform the Judkins-Left catheter, but back-up support was insufficient to deliver the stent. Results: We used GuideLiner®, a novel pediatric catheter with rapid exchange/monorail systems, to enhance back-up support. Conclusions: We were able to successfully stent with both the deformed Judkins-Left guiding catheter and GuideLiner® for an anomalous RCA origin.

Dosimetric equivalence of nonstandard HDR brachytherapy catheter patterns

International Nuclear Information System (INIS)

Cunha, J. A. M.; Hsu, I-C.; Pouliot, J.

2009-01-01

Purpose: To determine whether alternative high dose rate prostate brachytherapy catheter patterns can result in similar or improved dose distributions while providing better access and reducing trauma. Materials and Methods: Standard prostate cancer high dose rate brachytherapy uses a regular grid of parallel needle positions to guide the catheter insertion. This geometry does not easily allow the physician to avoid piercing the critical structures near the penile bulb nor does it provide position flexibility in the case of pubic arch interference. This study used CT datasets with 3 mm slice spacing from ten previously treated patients and digitized new catheters following three hypothetical catheter patterns: conical, bi-conical, and fireworks. The conical patterns were used to accommodate a robotic delivery using a single entry point. The bi-conical and fireworks patterns were specifically designed to avoid the critical structures near the penile bulb. For each catheter distribution, a plan was optimized with the inverse planning algorithm, IPSA, and compared with the plan used for treatment. Irrelevant of catheter geometry, a plan must fulfill the RTOG-0321 dose criteria for target dose coverage (V 100 Prostate >90%) and organ-at-risk dose sparing (V 75 Bladder 75 Rectum 125 Urethra <<1 cc). Results: The three nonstandard catheter patterns used 16 nonparallel, straight divergent catheters, with entry points in the perineum. Thirty plans from ten patients with prostate sizes ranging from 26 to 89 cc were optimized. All nonstandard patterns fulfilled the RTOG criteria when the clinical plan did. In some cases, the dose distribution was improved by better sparing the organs-at-risk. Conclusion: Alternative catheter patterns can provide the physician with additional ways to treat patients previously considered unsuited for brachytherapy treatment (pubic arch interference) and facilitate robotic guidance of catheter insertion. In addition, alternative catheter

Catheter ablation of epicardial ventricular tachycardia

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Takumi Yamada, MD, PhD

2014-08-01

Full Text Available Ventricular tachycardias (VTs can usually be treated by endocardial catheter ablation. However, some VTs can arise from the epicardial surface, and their substrate can be altered only by epicardial catheter ablation. There are two approaches to epicardial catheter ablation: transvenous and transthoracic. The transvenous approach through the coronary venous system (CVS has been commonly used because it is easily accessible. However, this approach may be limited by the distribution of the CVS and insufficient radiofrequency energy delivery. Transthoracic epicardial catheter ablation has been developed to overcome these limitations of the transvenous approach. It is a useful supplemental or even preferred strategy to eliminate epicardial VTs in the electrophysiology laboratory. This technique has been applied for scar-related VTs secondary to often non-ischemic cardiomyopathy and sometimes ischemic cardiomyopathy, and idiopathic VTs as the epicardial substrates of these VTs have become increasingly recognized. When endocardial ablation and epicardial ablation through the CVS are unsuccessful, transthoracic epicardial ablation should be the next option. Intrapericardial access is usually obtained through a subxiphoidal pericardial puncture. This approach might not be possible in patients with pericardial adhesions caused by prior cardiac surgery or pericarditis. In such cases, a hybrid procedure involving surgical access with a subxiphoid pericardial window and a limited anterior or lateral thoracotomy might be a feasible and safe method of performing an epicardial catheter ablation in the electrophysiology laboratory. Potential complications associated with this technique include bleeding and collateral damage to the coronary arteries and phrenic nerve. Although the risk of these complications is low, electrophysiologists who attempt epicardial catheter ablation should know the complications associated with this technique, how to minimize their

Catheter Angiography

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Catheter Angiography

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Full Text Available ... a catheter, x-ray imaging guidance and an injection of contrast material to examine blood vessels in ... technologies and, in most cases, a contrast material injection is needed to produce pictures of blood vessels ...

Catheter Angiography

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Full Text Available ... spaghetti. top of page How does the procedure work? Catheter angiography works much the same as a ... angiogram may be performed in less than an hour; however, it may last several hours. top of ...

Catheter Angiography

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Full Text Available ... the American College of Radiology (ACR) and the European Society of Urogenital Radiology note that the available ... will regain their normal function within five to seven days. Rarely, the catheter punctures the artery, causing ...

Catheter Angiography

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Full Text Available ... diagnosis and treatment in a single procedure. An example is finding an area of severe arterial narrowing, ... contrast material, your radiologist may advise that you take special medication for 24 hours before catheter angiography ...

Catheter Angiography

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Full Text Available ... possible to combine diagnosis and treatment in a single procedure. Catheter angiography produces very detailed, clear and ... possible to combine diagnosis and treatment in a single procedure. An example is finding an area of ...

Catheter Angiography

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Full Text Available ... far outweighs the risk. If you have a history of allergy to x-ray contrast material, your ... Angiography (CTA) X-ray, Interventional Radiology and Nuclear Medicine Radiation Safety Images related to Catheter Angiography Sponsored ...

Catheter Angiography

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Full Text Available ... examine blood vessels in key areas of the body for abnormalities such as aneurysms and disease such ... to produce pictures of blood vessels in the body. Angiography is performed using: x-rays with catheters ...

Catheter Angiography

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Full Text Available ... rare, and radiology departments are well-equipped to deal with them. There is a small risk that ... standard x-ray contrast. Catheter angiography should be done very cautiously—if at all—in patients who ...

Catheter Angiography

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Full Text Available ... atherosclerosis (plaque). The use of a catheter makes it possible to combine diagnosis and treatment in a ... the aorta in the chest or abdomen or its major branches. show the extent and severity of ...

Catheter Angiography

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Full Text Available ... 20 minutes (or by using a special closure device). When the examination is complete, you may be ... contrast material, your radiologist may advise that you take special medication for 24 hours before catheter angiography ...

Catheter Angiography

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Full Text Available ... rays ). top of page What are some common uses of the procedure? Catheter angiography is used to ... community, you can search the ACR-accredited facilities database . This website does not provide cost information. The ...

Catheter Angiography

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Full Text Available ... spaghetti. top of page How does the procedure work? Catheter angiography works much the same as a ... and x-rays. Manufacturers of intravenous contrast indicate mothers should not breastfeed their babies for 24-48 ...

Catheter Angiography

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Full Text Available ... spaghetti. top of page How does the procedure work? Catheter angiography works much the same as a ... possible to combine diagnosis and treatment in a single procedure. An example is finding an area of ...

Catheter Angiography

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Full Text Available ... Once the catheter is guided to the area being examined, a contrast material is injected through the ... You should inform your physician of any medications being taken and if there are any allergies, especially ...

Percutaneous transfemoral repositioning of malpositioned central venous catheters.

Science.gov (United States)

Hartnell, G G; Roizental, M

1995-04-01

Central venous catheters inserted by blind surgical placement may not advance into a satisfactory position and may require repositioning. Malpositioning via surgical insertion is common in patients in whom central venous catheters have previously been placed, as these patients are more likely to have central venous thrombosis and distortion of central venous anatomy. This is less of a problem when catheter placement is guided by imaging; however, even when insertion is satisfactory, central venous catheters may become displaced spontaneously after insertion (Fig. 1). Repositioning can be effected by direct manipulation using guidewires or tip-deflecting wires [1, 2], by manipulation via a transfemoral venous approach [3-5], and by injection of contrast material or saline [6]. Limitations of the direct approach include (1) the number and type of maneuvers that can be performed to effect repositioning when anatomy is distorted, (2) difficulty in accessing the catheter, and (3) the risk of introducing infection. Moreover, these patients are often immunosuppressed, and there is a risk of introducing infection by exposing and directly manipulating the venous catheter. Vigorous injection of contrast material or saline may be unsuccessful for the same reasons: It seldom exerts sufficient force to reposition large-caliber central venous catheters and may cause vessel damage or rupture if injection is made into a small or thrombosed vessel. We illustrate several alternative methods for catheter repositioning via a transfemoral venous approach.

Removal of non-deflatable retained foley catheter in the bladder by percutaneous puncture of catheter balloon

International Nuclear Information System (INIS)

Yoo, Jae Duk; Kim, Jae Kyu; Park, Jin Gyun; Chung, Hyon De

1988-01-01

Nondeflatable Foley catheter in the bladder is an uncommon event. We recently experienced a patient in whom the urologist were unable to remove a Foley catheter with cystoscope due to public bone fractures. The procedure, which was successfully carried out, consists of puncturing the ballon under fluoroscope.

Iatrogenic Bowel Injury at Exchange of Supra-Pubic Catheter

LENUS (Irish Health Repository)

Foran, AT

2018-04-01

Suprapubic catheter insertion and exchange is a common urological procedure, but it is not without risks and complications. While bowel perforation is a recognised complication at suprapubic catheter insertion, it is not commonly reported at suprapubic catheter exchange. We report our experience of recognition, diagnosis and subsequent successful management of the most important complication related to suprapubic catheters.

Analog experiment of transarterial catheter hyperthermic infusion in vitro

International Nuclear Information System (INIS)

Fan Shufeng Li Zheng; Gu Weizhong; Ru Fuming

2006-01-01

Objective: To investigate the factors related to the heating effect by transarterial catheter hyperthermic infusion with the evaluation of the feasibility in controlling the tumor temperature. Methods: Infusing 55-68 degree C liquid at the speed of 10-40 ml/min through 6F, 5F or 3F catheter with different length respectively under the similar clinical condition. The liquid temperature at the terminal exit of the catheter was measured with a digital thermometer. The factors related to the liquid temperature at the exit of the catheter were analyzed by multiple regression analysis. Results: The infusion temperature , rate and the catheter length were the main related factors to the liquid temperature at the exit of the catheter as the condition similar in clinical use. When 60-65 degree C liquid was infused at the rate of 20-40 ml/min through 5F catheter with length of 80 cm, the mean and 95% confident interval of the liquid temperature at the catheter exit were (47.55±0.44) degree C and 44.61-48.49 degree C respectively. Conclusions: The liquid temperature at the exit of infusion catheter can be regulated and controlled through adjusting the liquid perfusion temperature and speed. (authors)

A Dynamical Training and Design Simulator for Active Catheters

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Georges Dumont

2008-11-01

Full Text Available This work addresses the design of an active multi-link micro-catheter actuated by Shape Memory Alloy (SMA micro actuators. This may be a response to one medical major demand on such devices, which will be useful for surgical explorations and interventions. In this paper, we focus on a training and design simulator dedicated to such catheters. This simulator is based on an original simulation platform (OpenMASK. The catheter is a robotic system, which is evaluated by a dynamical simulation addressing a navigation task in its environment. The design of the prototype and its mechanical model are presented. We develop an interaction model for contact. This model uses a real medical database for which distance cartography is proposed. Then we focus on an autonomous control model based on a multi-agent approach and including the behaviour description of the SMA actuators. Results of mechanical simulations including interaction with the ducts are presented. Furthermore, the interest of such a simulator is presented by applying virtual prototyping techniques for the design optimization. This optimization process is achieved by using genetic algorithms at different stages with respect to the specified task.

A Dynamical Training and Design Simulator for Active Catheters

Directory of Open Access Journals (Sweden)

Georges Dumont

2004-12-01

Full Text Available This work addresses the design of an active multi-link micro-catheter actuated by Shape Memory Alloy (SMA micro actuators. This may be a response to one medical major demand on such devices, which will be useful for surgical explorations and interventions. In this paper, we focus on a training and design simulator dedicated to such catheters. This simulator is based on an original simulation platform (OpenMASK. The catheter is a robotic system, which is evaluated by a dynamical simulation addressing a navigation task in its environment. The design of the prototype and its mechanical model are presented. We develop an interaction model for contact. This model uses a real medical database for which distance cartography is proposed. Then we focus on an autonomous control model based on a multi-agent approach and including the behaviour description of the SMA actuators. Results of mechanical simulations including interaction with the ducts are presented. Furthermore, the interest of such a simulator is presented by applying virtual prototyping techniques for the design optimization. This optimization process is achieved by using genetic algorithms at different stages with respect to the specified task.

The bowed catheter sign: a risk for pericardial tamponade

Energy Technology Data Exchange (ETDEWEB)

Towbin, Richard [Phoenix Children' s Hospital, Department of Radiology, Phoenix, AZ (United States)

2008-03-15

The use of a central venous catheter (CVC) has become commonplace in the care of children with a wide variety of medical and surgical problems. Complications resulting from the insertion of these catheters are well recognized and can be life-threatening. When a temporary CVC or other catheter is inserted into the central venous system it is secured to the skin with a combination of sutures and sterile dressing. This fixes the catheter in place and does not allow it to retract, thereby putting pressure on the right atrial wall via the catheter tip if it is too long. The probability of wall penetration is increased if a catheter or device is tapered at the point of contact. The purpose of this case report is to present the bowed catheter sign and to review the anatomy of the cavotricuspid isthmus, a possible predisposing factor to cardiac perforation and tamponade. (orig.)

The bowed catheter sign: a risk for pericardial tamponade

International Nuclear Information System (INIS)

Towbin, Richard

2008-01-01

The use of a central venous catheter (CVC) has become commonplace in the care of children with a wide variety of medical and surgical problems. Complications resulting from the insertion of these catheters are well recognized and can be life-threatening. When a temporary CVC or other catheter is inserted into the central venous system it is secured to the skin with a combination of sutures and sterile dressing. This fixes the catheter in place and does not allow it to retract, thereby putting pressure on the right atrial wall via the catheter tip if it is too long. The probability of wall penetration is increased if a catheter or device is tapered at the point of contact. The purpose of this case report is to present the bowed catheter sign and to review the anatomy of the cavotricuspid isthmus, a possible predisposing factor to cardiac perforation and tamponade. (orig.)

Steam-deformed Judkins-left guiding catheter with use of the GuideLiner(®) catheter to deliver stents for anomalous right coronary artery.

Science.gov (United States)

Kuno, Toshiki; Fujisawa, Taishi; Yamazaki, Hiroyuki; Motoda, Hiroyuki; Kodaira, Masaki; Numasawa, Yohei

2015-01-01

Percutaneous coronary intervention for anomalous right coronary artery (RCA) originating from the left coronary cusp is challenging because of our current inability to coaxially engage the guiding catheter. We report a case of an 88-year-old woman with non-ST segment elevation myocardial infarction, with an anomalous RCA origin. Using either the Judkins-Left catheter or Amplatz-Left catheter was difficult because of RCA ostium tortuosity. Thus, we used steam to deform the Judkins-Left catheter, but back-up support was insufficient to deliver the stent. We used GuideLiner®, a novel pediatric catheter with rapid exchange/monorail systems, to enhance back-up support. We were able to successfully stent with both the deformed Judkins-Left guiding catheter and GuideLiner® for an anomalous RCA origin.

Catheter Associated Urinary Tract Infection Prevention bundle

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O. Zarkotou

2017-01-01

Full Text Available Catheter-associated urinary tract infections (CAUTI are among the most common healthcare-associated infections, and potentially lead to significant morbidity and mortality. Multifaceted infection control strategies implemented as bundles can prevent nosocomial infections associated with invasive devices such as CAUTIs. The components of the CAUTI bundle proposed herein, include appropriate indications for catheterization and recommendations for the procedures of catheter insertion and catheter maintenance and care. Avoiding unnecessary urinary catheter use is the most effective measure for their prevention. To minimize the risk of CAUTI, urinary catheters should be placed only when a clinical valid indication is documented and they should be removed as soon as possible; alternatives to catheterization should also be considered. Aseptic insertion technique, maintenance of closed drainage system and strict adherence to hand hygiene are essential for preventing CAUTI. The successful implementation of the bundle requires education and training for all healthcare professionals and evaluation of surveillance data.

Central venous catheter insertion problem solving using intravenous catheter: technical communication

Directory of Open Access Journals (Sweden)

Alemohammad M

2013-02-01

Full Text Available Insertion of central venous catheter is an accepted method for hemodynamic monitor-ring, drug and fluid administration, intravenous access, hemodialysis and applying cardiac pace-maker in hospitalized patients. This procedure can be associated with severe complications. The aim of this article is to provide a practical approach to prevent catheter malposition in states that the guide wire will not pass freely.During central venous insertion in internal jugular vein using modified seldinger technique, when after venous insertion, the passage of the guide wire shows difficulties and don’t pass freely, insertion of an intravenous cannula over the wire and re-insertion of the wire can help to prevent malposition of the wire and the catheter. Use of an intravenous cannula over the guide, in situations that the guide wire cannot pass freely among the needle inserted in internal jugular vein, and re-insertion of the guide can probably prevent or reduce the tissue or vascular trauma and the associated complica-tions. This simple maneuver can be helpful in difficult cases especially in cardiac surgery patients who receive high dose heparin and it is necessary to avoid traumatize-tion of carotid artery.

Catheter Angiography

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First-in-Man Experience with a Novel Catheter-Based Renal Denervation System of Ultrasonic Ablation in Patients with Resistant Hypertension.

Science.gov (United States)

Chernin, Gil; Szwarcfiter, Iris; Scheinert, Dierk; Blessing, Erwin; Diehm, Nicolas; Dens, Jo; Walton, Antony; Verheye, Stefan; Shetty, Sharad; Jonas, Michael

2018-06-16

To report results of renal denervation (RDN) with the first catheter-based, non-balloon occlusion ultrasonic system in patients with resistant hypertension. In a multicenter, single-arm trial, 39 patients with resistant hypertension (defined as uncontrolled hypertension while taking ≥ 3 antihypertensive medications) were treated. The cohort consisted of 4 groups: severe resistant hypertension (office systolic blood pressure [OSBP] ≥ 160 mm Hg) treated with a unidirectional catheter (group 1; n = 14); severe resistant hypertension treated with a multidirectional catheter (group 2; n = 18); moderate resistant hypertension (OSBP 140-159 mm Hg) treated with a multidirectional catheter (group 3; n = 5); and recurrent severe resistant hypertension, after an initial response to RF RDN (group 4; n = 2). Blood pressure monitoring was performed for 6 months. Severe adverse events were not noted immediately after the procedure or during follow-up. Treatment time was longer with unidirectional than with multidirectional catheters (36.7 min ± 9.6 vs 11.9 min ± 5.8; P < .001). Mean reductions in office blood pressure (systolic/diastolic) at 1, 3, and 6 months were -26.1/-9.6 mm Hg, -28.0/-9.9 mm Hg, and -30.6/-14.1 mm Hg (P < .01 for all). Per-group analysis showed significant OSBP reduction for groups 1 and 2. Patients with isolated systolic hypertension had a significantly smaller reduction in OSBP after 6 months compared with patients with combined systolic/diastolic hypertension (-16.2 mm Hg ± 18.5 vs -9.9 mm Hg ± 33.4; P < .005). Use of the RDN system was feasible and safe in this phase I study. Significant blood pressure reductions were observed over 6 months, although less in patients with isolated systolic hypertension. Copyright © 2018 SIR. All rights reserved.

An epidural catheter removal after recent percutaneous coronary intervention and coronary artery stenting: Epidural catheter and antiaggregation therapy

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Joksić Nikola

2016-01-01

Full Text Available Introduction: Anticoagulation and antiplatelet therapy in the presence of the epidural catheter is still controversial. It is well known that dual antiplatelet therapy is indicated for 12 months after the placement of drug-eluting stents (DES. Removal of an epidural catheter during that period is related to an increased risk of stent occlusion in case of discontinuation of platelet function inhibitors or, on the other hand, increased risk of epidural hematoma associated with neurological deficit if suppressed platelet function is still present. Case Report: Here we present a case of a 63-year-old man who was admitted to Institute for Cardiovascular Diseases Dedinje for elective aortic surgery. Before the induction, an epidural catheter was inserted at the Th10-Th11 epidural space. Uneventful surgery was performed under the combined epidural and general anesthesia. On the 2nd postoperative day, the patient sustained a ST depression myocardial infarction treated with percutaneous coronary intervention with DES placement, while epidural catheter was still in place. Dual antiplatelet therapy with 600mg of clopidogrel, 100 mg of acetilsalicylic acid (ASA and low molecular weight heparin (LMWH were started during the procedure. The next day, clopidogrel (75 mg and ASA (100 mg were continued as well as LMWH. The decision to remove the epidural catheter was made on the 9th postoperative day, after platelet aggregation assays were performed. Six hours after catheter removal the patient again received clopidogrel, ASA and LMWH. There were no signs of epidural hematoma. Conclusion: This case shows that point-of-care testing with platelet aggregation assays may be useful in increasing the margin of safety for epidural catheter removal during dual antiplatelet therapy.

Current status of endovascular catheter robotics.

Science.gov (United States)

Lumsden, Alan B; Bismuth, Jean

2018-06-01

In this review, we will detail the evolution of endovascular therapy as the basis for the development of catheter-based robotics. In parallel, we will outline the evolution of robotics in the surgical space and how the convergence of technology and the entrepreneurs who push this evolution have led to the development of endovascular robots. The current state-of-the-art and future directions and potential are summarized for the reader. Information in this review has been drawn primarily from our personal clinical and preclinical experience in use of catheter robotics, coupled with some ground-breaking work reported from a few other major centers who have embraced the technology's capabilities and opportunities. Several case studies demonstrating the unique capabilities of a precisely controlled catheter are presented. Most of the preclinical work was performed in the advanced imaging and navigation laboratory. In this unique facility, the interface of advanced imaging techniques and robotic guidance is being explored. Although this procedure employs a very high-tech approach to navigation inside the endovascular space, we have conveyed the kind of opportunities that this technology affords to integrate 3D imaging and 3D control. Further, we present the opportunity of semi-autonomous motion of these devices to a target. For the interventionist, enhanced precision can be achieved in a nearly radiation-free environment.

Urethral catheters: can we reduce use?

NARCIS (Netherlands)

Broek, P.J. van den; Wille, J.C.; Benthem, B.H.B. van; Perenboom, R.J.M.; Akker-van Marle, M.E. van den; Nielen, A.M.A.

2011-01-01

Indwelling urinary catheters are the main cause of healthcare-associated urinary tract infections. It can be expected that reduction of the use of urinary catheters will lead to decreased numbers of urinary tract infection. The efficacy of an intervention programme to improve adherence to

Bacterial Biofilms and Catheters: A Key to Understanding Bacterial Strategies in Catheter-Associated Urinary Tract Infection

Directory of Open Access Journals (Sweden)

J Curtis Nickel

1992-01-01

Full Text Available Despite major technological improvements in catheter drainage systems, the indwelling Foley catheter remains the most common cause of nosocomial infection in medical practice. By approaching this common complicated urinary tract infection from the perspective of the biofilm strategy bacteria appear to use to overcome obstacles to produce bacteriuria, one appreciates a new understanding of these infections. An adherent biofilm of bacteria in their secretory products ascends the luminal and external surface of the catheter and drainage system from a contaminated drainage spigot or urethral meatus into the bladder. If the intraluminal route of bacterial ascent is delayed by strict sterile closed drainage or addition of internal modifications to the system, the extraluminal or urethral route assumes greater importance in the development of bacteriuria, but takes significantly longer. Bacterial growth within these thick coherent biofilms confers a large measure of relative resistance to antibiotics even though the individual bacterium remains sensitive, thus accounting for the failure of antibiotic therapy. With disruption of the protective mucous layer of the bladder by mechanical irritation, the bacteria colonizing the catheter can adhere to the bladder’s mucosal surface and cause infection. An appreciation of the role of bacterial biofilms in these infections should suggest future directions for research that may ultimately reduce the risk of catheter-associated infection.

Spontaneous rotation of the monorail-type guide extension support catheter during advancement of a curved guiding catheter: the potential hazard of twisting with the coronary guidewire.

Science.gov (United States)

Hashimoto, Sho; Takahashi, Akihiko; Yamada, Takeshi; Mizuguchi, Yukio; Taniguchi, Norimasa; Hata, Tetsuya; Nakajima, Shunsuke

2017-11-20

The extension support guiding catheter has been used to perform complex percutaneous coronary intervention to increase back-up support for the guiding catheter or to ensure deep intubation for device delivery. However, because of its monorail design, advancement of the stent into the distal extension tubing segment is sometimes problematic. Although this problem is considered due to simple collision of the stent, operators have observed tangling between a monorail extension catheter and coronary guidewire in some patients. To examine movement of the collar of the extension guide catheter during advancement of the guiding catheter, we set up an in vitro model in which the guiding catheter had two curves. Rotation of the extension guide catheter was examined by both fluoroscopic imaging and movement of the hub of the proximal end of the catheter. During advancement in the first curve, the collar moved toward the outer side of the curve of the guiding catheter as the operator pushed the shaft of the extension guiding catheter, which overrode the guidewire. After crossing the first curve, the collar moved again to the outer side of the second curve (the inner side of the first curve) of the mother catheter, and then, another clockwise rotation was observed in the proximal hub. Consequently, the collar and tubing portion of the extension guide catheter rotated 360° around the coronary guidewire, and the monorail extension catheter and guidewire became tangled. There is a potential risk of unintentional twisting with the guidewire during advancement into the curved guiding catheter because of its monorail design.

Non-imaging assisted insertion of un-cuffed, non-tunneled internal jugular venous catheters for hemodialysis: Safety and utility in modern day world

Directory of Open Access Journals (Sweden)

Manish Rathi

2016-08-01

Full Text Available Background: Absolute necessity in acute kidney injury (AKI and ignorance in chronic kidney disease (CKD make the use of un-cuffed, non-tunneled catheters an indispensable vascular access for hemodialysis. Although these catheters should be inserted under radiological guidance, it may not be feasible in certain circumstances. The aim of the present study was to evaluate safety and outcome of non-imaging assisted insertion of these catheters in internal jugular vein (IJV for hemodialysis. Methods: We analyzed 233 attempts of non-imaging assisted un-cuffed, non-tunneled IJV catheterization at our center. The immediate insertion complications, duration of use, rate and type of infection and other complications were assessed. Results: Out of the 233 attempts, 223 (213-right, 10-left were successful. The most common indication was AKI (n = 127, 54.5%, followed by CKD (n = 99, 42.5%. Successful catheterization at first attempt was achieved in 78.9%. Insertion complications were noted in 12.8% and included arterial puncture (5.2%, hematoma (3.0% and malposition (2.1%. Amongst 219 catheters followed for 4825 days, the mean duration of use was 22 days. Catheter related infections occurred in 42 patients with an incidence of 8.7 per 1000 catheter days. Bacteraemia was present in 10/36 cases (27.7%, positive catheter tip cultures in 71.4% cases and staphylococcal species were the most common organism. Cumulative hazard analysis by Cox regression revealed a linear increase in the risk for infection with each week. Conclusion: Non-imaging assisted insertion of uncuffed, non-tunneled catheters is associated with slightly higher rate of insertion complication but comparable outcome in terms of infection rate or days of use. Keywords: Hemodialysis, Internal jugular vein catheterization, Catheter related infection

Catheter placement for lysis of spontaneous intracerebral hematomas: does a catheter position in the core of the hematoma allow more effective and faster hematoma lysis?

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Malinova, Vesna; Schlegel, Anna; Rohde, Veit; Mielke, Dorothee

2017-07-01

For the fibrinolytic therapy of intracerebral hematomas (ICH) using recombinant tissue plasminogen activator (rtPA), a catheter position in the core of the hematoma along the largest clot diameter was assumed to be optimal for an effective clot lysis. However, it never had been proven that core position indeed enhances clot lysis if compared with less optimal catheter positions. In this study, the impact of the catheter position on the effectiveness and on the time course of clot lysis was evaluated. We analyzed the catheter position using a relative error calculating the distance perpendicular to the catheter's center in relation to hematoma's diameter and evaluated the relative hematoma volume reduction (RVR). The correlation of the RVR with the catheter position was evaluated. Additionally, we tried to identify patterns of clot lysis with different catheter positions. The patient's outcome at discharge was evaluated using the Glasgow outcome score. A total of 105 patients were included in the study. The mean hematoma volume was 56 ml. The overall RVR was 62.7 %. In 69 patients, a catheter position in the core of the clot was achieved. We found no significant correlation between catheter position and hematoma RVR (linear regression, p = 0.14). Core catheter position leads to more symmetrical hematoma RVR. Faster clot lysis happens in the vicinity of the catheter openings. We found no significant difference in the patient's outcome dependent on the catheter position (linear regression, p = 0.90). The catheter position in the core of the hematoma along its largest diameter does not significantly influence the effectiveness of clot lysis after rtPA application.

Types of urethral catheter for reducing symptomatic urinary tract infections in hospitalised adults requiring short-term catheterisation: multicentre randomised controlled trial and economic evaluation of antimicrobial- and antiseptic-impregnated urethral catheters (the CATHETER trial).

Science.gov (United States)

Pickard, R; Lam, T; Maclennan, G; Starr, K; Kilonzo, M; McPherson, G; Gillies, K; McDonald, A; Walton, K; Buckley, B; Glazener, C; Boachie, C; Burr, J; Norrie, J; Vale, L; Grant, A; N'dow, J

2012-11-01

Catheter-associated urinary tract infection (CAUTI) is a major preventable cause of harm for patients in hospital and incurs significant costs for health-care providers such as the UK NHS. Many preventative strategies and measures have been introduced to minimise CAUTI risk, including the use of antimicrobial catheters. However, there is considerable uncertainty regarding their usefulness in terms of reducing symptomatic CAUTI, and whether or not they are cost-effective. Do antimicrobial catheters reduce the rate of symptomatic urinary tract infection (UTI) during short-term hospital use and is their use cost-effective for the UK NHS? A pragmatic multicentre UK randomised controlled trial comparing three catheters as they would be used in the UK NHS: antimicrobial-impregnated (nitrofurazone) and antiseptic-coated (silver alloy) catheters with the standard polytetrafluoroethylene (PTFE)-coated catheters. Economic evaluation used a decision model populated with data from the trial. Sensitivity analysis was used to explore uncertainty. Relevant clinical departments in 24 NHS hospitals throughout the UK. Adults requiring temporary urethral catheterisation for a period of between 1 and 14 days as part of their care, predominantly as a result of elective surgery. Eligible participants were randomised 1 : 1 : 1 to one of three types of urethral catheter in order to make the following pragmatic comparisons: nitrofurazone-impregnated silicone catheter compared with standard PTFE-coated latex catheter; and silver alloy-coated hydrogel latex catheter compared with standard PTFE-coated latex catheter. The primary outcome for clinical effectiveness was the incidence of UTI at any time up to 6 weeks post randomisation. This was defined as any symptom reported during catheterisation, up to 3 days or 1 or 2 weeks post catheter removal or 6 weeks post randomisation combined with a prescription of antibiotics, at any of these times, for presumed symptomatic UTI. The primary economic

Catheter Angiography

Medline Plus

Full Text Available ... key areas of the body for abnormalities such as aneurysms and disease such as atherosclerosis (plaque). The use of a catheter makes ... including the: brain neck heart chest abdomen (such as the kidneys and liver) pelvis legs and feet ...

Catheter Angiography

Medline Plus

Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us News Physician ... Catheter Angiography? Angiography is a minimally invasive medical test that helps physicians diagnose and treat medical conditions. ...

Safety related to the implantation of jugular catheters for haemodialysis and usefulness of PA chest X rays post procedure

International Nuclear Information System (INIS)

Restrepo, Cesar A; Chacon, Jose Arnob; Mauricio Villota, Duvan

2007-01-01

The objective is to determine how safe the implantation of transient double lumen jugular catheters is for hemodialysis in patients with renal disease, and who require dialysis therapy and Posterior Anterior (PA) chest X-Ray post procedure. Design: observational descriptive study. Site: renal units at RTS Ltda. Sucursal Caldas (Hospital Santa Sofia y Hospital Infantil Rafael Henao Toro de la Cruz Roja). Patients: all patients with renal disease in whom it was necessary to do hemodyalitic therapy with implantation of a jugular catheter, with medical records of the events and complications that occurred during the procedure, with subsequent control AP chest X Ray and that showed reports made by the radiologist or physician who carried out the procedure, about the findings in the chest X Ray. Patients with renal disease, in whom jugular catheters had been inserted: Methods: variables such as age, gender, race, body mass index (BMI) etiology of the renal failure,time of evolution of the disease, indications for insertion, priority of catheter insertion, type of catheter inserted, amount of punctures, physician who carried out the procedure and patient's co-morbidities were analyzed. The events considered as complicated were analyzed as well as if there was any relationship with co-morbidities and the analyzed variables. Findings in the PA chest X-Ray were recorded and their relationship with the difficulties encountered during the procedure. A bi-variance analysis was done. The dependent and independent variables were classified in the nominal measurement scale. Results: 774 clinical histories were reviewed. 562 were excluded due to lack of variables and impossibility to read the notes. Men older than de 55 (45,7%). 212 (97.1%) patients with diagnosis of chronic renal disease (CRD) and in whom 238 procedures were carried out. seven patients (2,85%) had acute renal failure (ARF). The fi rst indication for central catheter insertion was in patients with chronic uremia

Radiologic Placement of Tunneled Central Venous Catheters in Pediatric Patients

International Nuclear Information System (INIS)

Kim, Eun Ji; Song, Soon Young; Cho, On Koo; Koh, Byung Hee; Kim, Yong Soo; Jeong, Woo Kyoung; Lee, Yong Ho

2010-01-01

We evaluated the technical success and complication rates associated with the radiological placement of tunneled central venous catheters in pediatric patients. Between May 1, 2005 and March 31, 2008, a total of 46 tunneled central venous catheters were placed in 34 children (M:F = 22:12; mean age, 9.9 years [9 months to 16.8 years]). All procedures were performed under ultrasonographic and fluoroscopic guidance. Follow-up data were obtained through the retrospective review of the medical records. We used the Kaplan-Meier survival method for the evaluation of survival rate of the catheters. All procedures were technically successful. The observed periprocedural complications included hematoma formation in three patients. The mean catheter life was 189.3 days (total, 8710 days; range, 7-810). Catheters were removed due to death (n=9), the end of treatment (n=8), catheter sepsis (n=4), malfunction (n=8), and accidental removal (n=4). The rate of catheter sepsis and malfunction was 0.459 and 0.919 for every 1000 catheter days, respectively. The expected mean catheter life was 479.6 days as per the Kaplan- Meier analysis. The results suggest that the radiologic placement of a tunneled central venous catheter is an effective technique with a high technical success rate and low complication rate

Radiologic Placement of Tunneled Central Venous Catheters in Pediatric Patients

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Kim, Eun Ji; Song, Soon Young; Cho, On Koo; Koh, Byung Hee; Kim, Yong Soo; Jeong, Woo Kyoung; Lee, Yong Ho [Hanyang University College of Medicine, Seoul (Korea, Republic of)

2010-08-15

We evaluated the technical success and complication rates associated with the radiological placement of tunneled central venous catheters in pediatric patients. Between May 1, 2005 and March 31, 2008, a total of 46 tunneled central venous catheters were placed in 34 children (M:F = 22:12; mean age, 9.9 years [9 months to 16.8 years]). All procedures were performed under ultrasonographic and fluoroscopic guidance. Follow-up data were obtained through the retrospective review of the medical records. We used the Kaplan-Meier survival method for the evaluation of survival rate of the catheters. All procedures were technically successful. The observed periprocedural complications included hematoma formation in three patients. The mean catheter life was 189.3 days (total, 8710 days; range, 7-810). Catheters were removed due to death (n=9), the end of treatment (n=8), catheter sepsis (n=4), malfunction (n=8), and accidental removal (n=4). The rate of catheter sepsis and malfunction was 0.459 and 0.919 for every 1000 catheter days, respectively. The expected mean catheter life was 479.6 days as per the Kaplan- Meier analysis. The results suggest that the radiologic placement of a tunneled central venous catheter is an effective technique with a high technical success rate and low complication rate.

Management of Non- Deflating Foley Suprapubic Catheters - A ...

African Journals Online (AJOL)

The procedure described uses a 10 ml syringe and needle passed through the lumen of the catheter to puncture the inner surface of the catheter balloon and thus deflate it. Because the catheter balloon does not burst in this procedure there is no risk of balloon fragmentation or subsequent stone formation. The technique is ...

Urethral catheters: can we reduce use?

Directory of Open Access Journals (Sweden)

van den Akker-van Marle M Elske

2011-05-01

Full Text Available Abstract Background Indwelling urinary catheters are the main cause of healthcare-associated urinary tract infections. It can be expected that reduction of the use of urinary catheters will lead to decreased numbers of urinary tract infection. Methods The efficacy of an intervention programme to improve adherence to recommendations to reduce the use of urethral catheters was studied in a before-after comparison in ten Dutch hospitals. The programme detected barriers and facilitators and each individual facility was supported with developing their own intervention strategy. Outcome was evaluated by the prevalence of catheters, alternatives such as diapers, numbers of urinary tract infections, the percentage of correct indications and the duration of catheterization. The costs of the implementation as well as the catheterization were evaluated. Results Of a population of 16,495 hospitalized patients 3335 patients of whom 2943 were evaluable for the study, had a urethral catheter. The prevalence of urethral catheters decreased insignificantly in neurology (OR 0.93; 95% CI 0.77 - 1.13 and internal medicine wards (OR 0.97; 95% CI 0.83 - 1.13, decreased significantly in surgical wards (OR 0.84; 95% CI 0.75 - 0.96, but increased significantly in intensive care (IC and coronary care (CC units (OR 1.48; 95% CI 1.01 - 2.17. The use of alternatives was limited and remained so after the intervention. Duration of catheterization decreased insignificantly in IC/CC units (ratio after/before 0.95; 95% CI 0.78 - 1.16 and neurology (ratio 0.97; 95% CI 0.80 - 1.18 and significantly in internal medicine (ratio 0.81; 95% CI 0.69 - 0.96 and surgery wards (ratio 0.80; 95% CI 0.71 - 0.90. The percentage of correct indications on the day of inclusion increased from 50 to 67% (p Conclusion Targeted implementation of recommendations from an existing guideline can lead to better adherence and cost savings. Especially, hospitals which use a lot of urethral catheters or

21 CFR 880.5200 - Intravascular catheter.

Science.gov (United States)

2010-04-01

... Devices § 880.5200 Intravascular catheter. (a) Identification. An intravascular catheter is a device that consists of a slender tube and any necessary connecting fittings and that is inserted into the patient's vascular system for short term use (less than 30 days) to sample blood, monitor blood pressure, or...

Local Intravascular Drug Delivery: In Vitro Comparison of Three Catheter Systems

International Nuclear Information System (INIS)

Alfke, Heiko; Wagner, Hans-Joachim; Calmer, Christian; Klose, Klaus Jochen

1998-01-01

Purpose: The aim of this in vitro study was to compare different catheter systems for local drug delivery with respect to the penetration depth of a biotin marker solution delivered into the vessel wall. Methods: Post-mortem carotid arteries from pigs were locally infused with a biotin solution using three different catheter systems. With all catheters (microporous balloon catheter, hydrogel-coated balloon catheter, and spiral balloon catheter) we used the same pressure of 405 kPa (4 atm) and infusion times of 60, 90, and 300 sec. After infusion the arteries were histologically prepared and stained using a biotin-specific method. With a light microscope an observer, blinded to the catheter type, scored the amount of biotin within the vessel wall, measured as staining intensity, and the penetration depth of the biotin. Results: Delivery with the hydrogel-coated balloon catheter was limited to the intima and the innermost parts of the media. The spiral balloon and microporous balloon catheter showed both a deeper penetration and a larger amount of delivered biotin compared with the hydrogel catheter, with a slightly deeper penetration using the microporous catheter. The penetration depth showed a correlation with infusion time for the spiral balloon and microporous catheters, but not for the hydrogel-coated catheter. Conclusion: Different catheter designs lead to different patterns of local drug delivery. The differences in penetration depth and amount of the substance delivered to the vessel wall should be known and might be useful for targeting specific areas within the vessel wall

Epidemiology of peritonitis following maintenance peritoneal dialysis catheter placement during infancy: a report of the SCOPE collaborative.

Science.gov (United States)

Zaritsky, Joshua Jacob; Hanevold, Coral; Quigley, Raymond; Richardson, Troy; Wong, Cynthia; Ehrlich, Jennifer; Lawlor, John; Rodean, Jonathan; Neu, Alicia; Warady, Bradley A

2018-04-01

Maintenance peritoneal dialysis (PD) is the dialysis modality of choice for infants and young children. However, there are limited outcome data for those who undergo PD catheter insertion and initiate maintenance PD within the first year of life. Using data from the Children's Hospital Association's Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (ESRD) Collaborative (SCOPE), we examined peritonitis rates and patient survival in 156 infants from 29 North American pediatric dialysis centers who had a chronic PD catheter placed prior to their first birthday. In-hospital and overall annualized rates of peritonitis were 1.73 and 0.76 episodes per patient-year, respectively. Polycystic kidney disease was the most frequent renal diagnosis and pulmonary hypoplasia the most common co-morbidity in infants with peritonitis. Multivariable regression models demonstrated that nephrectomy at or prior to PD catheter placement and G-tube insertion after catheter placement were associated with a nearly sixfold and nearly threefold increased risk of peritonitis, respectively. Infants with peritonitis had longer initial hospital stays and lower overall survival (86.3 vs. 95.6%, respectively; P high and several risk factors associated with the development of peritonitis were identified. Given that peritonitis was associated with a longer duration of initial hospitalization and increased mortality, increased attention to the potentially modifiable risk factors for infection is needed.

Miniaturization of catheter systems for angiography

International Nuclear Information System (INIS)

Hawkins, I.F. Jr.; Akins, E.W.

1988-01-01

The authors discuss the use of small catheters and needles in angiography and interventional procedures to improve the quality of the procedures and increase the success rate and safety. This philosophy was initially poorly received, both by operators and by industry; however, more recently microtechniques have become more acceptable primarily because of the changing economic climate requiring procedures with shorter or no hospitalization time. Since 1970, the authors have performed well over 10,000 angiographic procedures using 5 French catheters, or smaller. During the last 12 years, they have used almost exclusively 4 French catheters, primarily with standard filming techniques which have resulted in no thrombosed arteries, or significant hematoma formation

Cryoballoon Catheter Ablation in Atrial Fibrillation

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Cevher Ozcan

2011-01-01

Full Text Available Pulmonary vein isolation with catheter ablation is an effective treatment in patients with symptomatic atrial fibrillation refractory or intolerant to antiarrhythmic medications. The cryoballoon catheter was recently approved for this procedure. In this paper, the basics of cryothermal energy ablation are reviewed including its ability of creating homogenous lesion formation, minimal destruction to surrounding vasculature, preserved tissue integrity, and lower risk of thrombus formation. Also summarized here are the publications describing the clinical experience with the cryoballoon catheter ablation in both paroxysmal and persistent atrial fibrillation, its safety and efficacy, and discussions on the technical aspect of the cryoballoon ablation procedure.

[Prevention of catheter-related infection: usefulness and cost-effectiveness of antiseptic catheters in children].

Science.gov (United States)

Lenz, Ana M; Vassallo, Juan C; Moreno, Guillermo E; Althabe, María; Gómez, Silvia; Magliola, Ricardo; Casimir, Lidia; Bologna, Rosa; Barretta, Jorge; Ruffa, Pablo

2010-06-01

To evaluate the cost-effectiveness of the antiseptic-impregnated catheter compared with conventional catheters in preventing catheter- related blood stream infections (CR-BSI). Cost-effectiveness analysis; clinical trial, experimental, randomized, controlled, prospective, open label. Patients and methods. A 172 patient cohort, under 1-year-old or less than 10 kg, postoperative cardiovascular children with central venous catheters (CVC) admitted to Cardiac Intensive Care Unit (UCI 35) at Hospital Nacional de Pediatría "Prof. Dr. Juan P. Garrahan", since September 2005 to December 2007. Demographic and CVC data were retrieved to compare: age, gender, weight, diagnosis, surgery, CVC days, costs and complications. Intervention. CVC Arrow, double-lumen, > 48 h of duration; intervention group: antiseptic-impregnated CVC vs. control group: CVC without antiseptics (conventional). The incidence of CR-IE (CR-Infected Events: colonization, local infection and/or CRBSI; combined end point) was 27% for antiseptic- impregnated CVC vs. 31% for conventional catheters (p= 0.6) with similar accumulated incidence of CR- BSI: 2.8 vs. 3.3 per 1000 dayscatheter. We found no differences between groups, except in weight: median 4.0 kg (r 2-17) vs. 4.7 kg (r 2-9) p= 0.0002 and age, median 2 months (r 1- 48) vs. 5 months (r 1- 24) p= 0.0019 in antiseptic-impregnated CVC group. These differences, though statistically significant were clinically non relevant. Median cost per patient during intensive care stay in the conventional CVC group was $3.417 (359-9.453) and in the antiseptic-impregnated-CVC group was $4.962 (239-24.532), p= 0.10. The use of antiseptic-impregnated CVC compared with conventional CVC did not decrease CR-BSI in this population. The cost per patients was higher in the antiseptic impregnated CVC group. These results do not support the routine use of this type of CVC in our population.

Improvement of Myocardial Function Following Catheter-Based Renal Denervation in Heart Failure

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Song-Yan Liao, MD

2017-06-01

Full Text Available Summary: Renal denervation (RD is a potential novel nonpharmacological therapy for heart failure (HF. We performed bilateral catheter-based RD in 10 adult pigs and compared them with 10 control subjects after induction of HF to investigate the long-term beneficial effects of RD on left ventricular (LV function and regional norepinephrine gradient after conventional HF pharmacological therapy. Compared with control subjects, animals treated with RD demonstrated an improvement in LV function and reduction of norepinephrine gradients over the myocardium and kidney at 10-week follow-up. Our results demonstrated that effective bilateral RD decrease regional norepinephrine gradients and improve LV contractile function compared with medical therapy alone. Key Words: heart failure, left ventricular function, norepinephrine, renal denervation

Patency of Femoral Tunneled Hemodialysis Catheters and Factors Predictive of Patency Failure

International Nuclear Information System (INIS)

Burton, Kirsteen R.; Guo, Lancia L. Q.; Tan, Kong T.; Simons, Martin E.; Sniderman, Kenneth W.; Kachura, John R.; Beecroft, John R.; Rajan, Dheeraj K.

2012-01-01

Purpose: To determine the patency rates of and factors associated with increased risk of patency failure in patients with femoral vein tunneled hemodialysis catheters. Methods: All femoral tunneled catheter insertions from 1996 to 2006 were reviewed, during which time 123 catheters were inserted. Of these, 66 were exchanges. Patients with femoral catheter failure versus those with femoral catheter patency were compared. Confounding factors, such as demographic and procedural factors, were incorporated and assessed using univariate and multivariable Cox proportional hazards regression analyses. Results: Mean catheter primary patency failure time was 96.3 days (SE 17.9 days). Primary patency at 30, 60, 90, and 180 days was 53.8%, 45.4%, 32.1%, and 27.1% respectively. Crude rates of risk of catheter failure did not suggest a benefit for patients receiving catheters introduced from one side versus the other, but more cephalad location of catheter tip was associated with improved patency. Multivariate analysis showed that patients whose catheters were on the left side (p = 0.009), were of increasing age at the time of insertion (p = 0.002) and that those who had diabetes (p = 0.001) were at significantly greater risk of catheter failure. The catheter infection rate was 1.4/1000 catheter days. Conclusion: Patients who were of a more advanced age and had diabetes were at greater risk of femoral catheter failure, whereas those who received femoral catheters from the right side were less at risk of catheter failure.

Use of monorail PTCA balloon catheter for local drug delivery.

Science.gov (United States)

Trehan, Vijay; Nair, Girish M; Gupta, Mohit D

2007-01-01

We report the use of monorail coronary balloon as an infusion catheter to give bailout abciximab selectively into the site of stent thrombosis as an adjunct to plain old balloon angioplasty (POBA) in a patient of subacute stent thrombosis of the left anterior descending coronary artery. The balloon component (polyamide material) of the monorail balloon catheter was shaved off the catheter so that abciximab injected through the balloon port of the catheter exited out the shaft of the balloon catheter at the site from where the balloon material was shaved off. We believe that selective infusion with abciximab along with POBA established antegrade flow and relieved the patient's ischemia. In the absence of essential hardware to give intracoronary drugs in an emergency situation, one may employ our technique of infusion through a monorail balloon catheter after shaving the balloon component from the catheter.

Radiologically placed tunneled peritoneal catheter in palliation of malignant ascites

International Nuclear Information System (INIS)

Akinci, Devrim; Erol, Bekir; Ciftci, Tuerkmen T.; Akhan, Okan

2011-01-01

The purpose of this study was to evaluate retrospectively the safety and effectiveness of radiologically placed tunneled peritoneal catheter in palliation of malignant ascites. Between July 2005 and June 2009, 41 tunneled peritoneal catheters were placed under ultrasonographic and fluoroscopic guidance in 40 patients (mean age, 55 years; 22 women) who had symptomatic malignant ascites. No procedure related mortality was observed. Major complication occurred in one patient (2.5%) in the form of serious bacterial peritonitis that necessitated catheter removal. Minor complications such as minor bacterial peritonitis, catheter dislodgement, tunnel infection, and catheter blockage occurred in 11 patients (27.5%). The mean duration of survival after catheter placement was 11.8 weeks. All patients expired of their primary malignancies in the follow-up. Radiologically placed tunneled peritoneal catheter is safe and effective in palliation of symptomatic malignant ascites.

Radiologically placed tunneled peritoneal catheter in palliation of malignant ascites

Energy Technology Data Exchange (ETDEWEB)

Akinci, Devrim; Erol, Bekir; Ciftci, Tuerkmen T. [Hacettepe University, Faculty of Medicine, Department of Radiology, 06100 Ankara (Turkey); Akhan, Okan, E-mail: akhano@tr.net [Hacettepe University, Faculty of Medicine, Department of Radiology, 06100 Ankara (Turkey)

2011-11-15

The purpose of this study was to evaluate retrospectively the safety and effectiveness of radiologically placed tunneled peritoneal catheter in palliation of malignant ascites. Between July 2005 and June 2009, 41 tunneled peritoneal catheters were placed under ultrasonographic and fluoroscopic guidance in 40 patients (mean age, 55 years; 22 women) who had symptomatic malignant ascites. No procedure related mortality was observed. Major complication occurred in one patient (2.5%) in the form of serious bacterial peritonitis that necessitated catheter removal. Minor complications such as minor bacterial peritonitis, catheter dislodgement, tunnel infection, and catheter blockage occurred in 11 patients (27.5%). The mean duration of survival after catheter placement was 11.8 weeks. All patients expired of their primary malignancies in the follow-up. Radiologically placed tunneled peritoneal catheter is safe and effective in palliation of symptomatic malignant ascites.

Where does the pulmonary artery catheter float: Transesophageal echocardiography evaluation

Directory of Open Access Journals (Sweden)

Deepak K Tempe

2015-01-01

Full Text Available Background: Pulmonary artery (PA catheter provides a variety of cardiac and hemodynamic parameters. In majority of the patients, the catheter tends to float in the right pulmonary artery (RPA than the left pulmonary artery (LPA. We evaluated the location of PA catheter with the help of transesophageal echocardiography (TEE to know the incidence of its localization. Three views were utilized for this purpose; midesophageal ascending aorta (AA short-axis view, modified mid esophageal aortic valve long-axis view, and modified bicaval view. Methods: We enrolled 135 patients undergoing elective cardiac surgery where both the PA catheter and TEE were to be used; for this prospective observational study. PA catheter was visualized by TEE in the above mentioned views and the degree of clarity of visualization by three views was also noted. Position of the PA catheter was further confirmed by a postoperative chest radiograph. Results: One patient was excluded from the data analysis. PA catheter was visualized in RPA in 129 patients (96% and in LPA in 4 patients (3%. In 1 patient, the catheter was visualized in main PA in the chest radiograph. The midesophageal AA short-axis, modified aortic valve long-axis, and modified bicaval view provided good visualization in 51.45%, 57.4%, and 62.3% patients respectively. Taken together, PA catheter visualization was good in 128 (95.5% patients. Conclusion: We conclude that the PA catheter has a high probability of entering the RPA as compared to LPA (96% vs. 3% and TEE provides good visualization of the catheter in RPA.

An ovine model of cerebral catheter venography for implantation of an endovascular neural interface.

Science.gov (United States)

Oxley, Thomas James; Opie, Nicholas Lachlan; Rind, Gil Simon; Liyanage, Kishan; John, Sam Emmanuel; Ronayne, Stephen; McDonald, Alan James; Dornom, Anthony; Lovell, Timothy John Haynes; Mitchell, Peter John; Bennett, Iwan; Bauquier, Sebastien; Warne, Leon Norris; Steward, Chris; Grayden, David Bruce; Desmond, Patricia; Davis, Stephen M; O'Brien, Terence John; May, Clive N

2018-04-01

OBJECTIVE Neural interface technology may enable the development of novel therapies to treat neurological conditions, including motor prostheses for spinal cord injury. Intracranial neural interfaces currently require a craniotomy to achieve implantation and may result in chronic tissue inflammation. Novel approaches are required that achieve less invasive implantation methods while maintaining high spatial resolution. An endovascular stent electrode array avoids direct brain trauma and is able to record electrocorticography in local cortical tissue from within the venous vasculature. The motor area in sheep runs in a parasagittal plane immediately adjacent to the superior sagittal sinus (SSS). The authors aimed to develop a sheep model of cerebral venography that would enable validation of an endovascular neural interface. METHODS Cerebral catheter venography was performed in 39 consecutive sheep. Contrast-enhanced MRI of the brain was performed on 13 animals. Multiple telescoping coaxial catheter systems were assessed to determine the largest wide-bore delivery catheter that could be delivered into the anterior SSS. Measurements of SSS diameter and distance from the motor area were taken. The location of the motor area was determined in relation to lateral and superior projections of digital subtraction venography images and confirmed on MRI. RESULTS The venous pathway from the common jugular vein (7.4 mm) to the anterior SSS (1.2 mm) was technically challenging to selectively catheterize. The SSS coursed immediately adjacent to the motor cortex (SSS. Attempted access with 5-Fr and 6-Fr delivery catheters was associated with longer procedure times and higher complication rates. A 4-Fr catheter (internal lumen diameter 1.1 mm) was successful in accessing the SSS in 100% of cases with no associated complications. Complications included procedure-related venous dissection in two major areas: the torcular herophili, and the anterior formation of the SSS. The

Central venous catheters: the role of radiology

International Nuclear Information System (INIS)

Tan, P.L.; Gibson, M.

2006-01-01

The insertion and management of long-term venous catheters have long been the province of anaesthetists, intensive care physicians and surgeons. Radiologists are taking an increasing role in the insertion of central venous catheters (CVCs) because of their familiarity with the imaging equipment and their ability to manipulate catheters and guide-wires. The radiological management of the complications of CVCs has also expanded as a result. This article reviews the role of radiology in central venous access, covering the detection and management of their complications

Magnetic catheter manipulation in the interventional MR imaging environment.

Science.gov (United States)

Wilson, Mark W; Martin, Alastair B; Lillaney, Prasheel; Losey, Aaron D; Yee, Erin J; Bernhardt, Anthony; Malba, Vincent; Evans, Lee; Sincic, Ryan; Saeed, Maythem; Arenson, Ronald L; Hetts, Steven W

2013-06-01

To evaluate deflection capability of a prototype endovascular catheter, which is remotely magnetically steerable, for use in the interventional magnetic resonance (MR) imaging environment. Copper coils were mounted on the tips of commercially available 2.3-3.0-F microcatheters. The coils were fabricated in a novel manner by plasma vapor deposition of a copper layer followed by laser lithography of the layer into coils. Orthogonal helical (ie, solenoid) and saddle-shaped (ie, Helmholtz) coils were mounted on a single catheter tip. Microcatheters were tested in water bath phantoms in a 1.5-T clinical MR scanner, with variable simultaneous currents applied to the coils. Catheter tip deflection was imaged in the axial plane by using a "real-time" steady-state free precession MR imaging sequence. Degree of deflection and catheter tip orientation were measured for each current application. The catheter tip was clearly visible in the longitudinal and axial planes. Magnetic field artifacts were visible when the orthogonal coils at the catheter tip were energized. Variable amounts of current applied to a single coil demonstrated consistent catheter deflection in all water bath experiments. Changing current polarity reversed the observed direction of deflection, whereas current applied to two different coils resulted in deflection represented by the composite vector of individual coil activations. Microcatheter navigation through the vascular phantom was successful through control of applied current to one or more coils. Controlled catheter deflection is possible with laser lithographed multiaxis coil-tipped catheters in the MR imaging environment. Copyright © 2013 SIR. Published by Elsevier Inc. All rights reserved.

Positioning of nasobiliary tube using magnet-loaded catheters.

Science.gov (United States)

Watanabe, Seitaro; Sato, Takamitsu; Kato, Shingo; Hosono, Kunihiro; Kobayashi, Noritoshi; Nakajima, Atsushi; Kubota, Kensuke

2013-10-01

In endoscopic nasobiliary drainage (ENBD), repositioning the catheter from the mouth to the nose is complicated. We devised a method using catheters with magnets and verified its utility and safety. We prospectively enrolled 20 patients undergoing ENBD at Yokohama City University Hospital. The procedures were successful in all 20 cases and no case required a change of operators to a senior doctor. The mean time for the procedure was 36.6 seconds. The emetic reflex was induced 0.5 times on average using the magnet method. The mean X-ray exposure time was 29.6 seconds. No complications occurred. The magnet-loaded catheter method for positioning the ENBD catheter before finally leading it through the nose took little time and was performed successfully and safely. Therefore, the magnet method could become the first choice among techniques for ENBD catheter placement. © Georg Thieme Verlag KG Stuttgart · New York.

SU-E-T-574: Fessiblity of Using the Calypso System for HDR Interstitial Catheter Reconstruction

International Nuclear Information System (INIS)

Li, J S; Ma, C

2014-01-01

Purpose: It is always a challenge to reconstruct the interstitial catheter for high dose rate (HDR) brachytherapy on patient CT or MR images. This work aims to investigate the feasibility of using the Calypso system (Varian Medical, CA) for HDR catheter reconstruction utilizing its accuracy on tracking the electromagnetic transponder location. Methods: Experiment was done with a phantom that has a HDR interstitial catheter embedded inside. CT scan with a slice thickness of 1.25 mm was taken for this phantom with two Calypso beacon transponders in the catheter. The two transponders were connected with a wire. The Calypso system was used to record the beacon transponders’ location in real time when they were gently pulled out with the wire. The initial locations of the beacon transponders were used for registration with the CT image and the detected transponder locations were used for the catheter path reconstruction. The reconstructed catheter path was validated on the CT image. Results: The HDR interstitial catheter was successfully reconstructed based on the transponders’ coordinates recorded by the Calypso system in real time when the transponders were pulled in the catheter. After registration with the CT image, the shape and location of the reconstructed catheter are evaluated against the CT image and the result shows an accuracy of 2 mm anywhere in the Calypso detectable region which is within a 10 cm X 10 cm X 10 cm cubic box for the current system. Conclusion: It is feasible to use the Calypso system for HDR interstitial catheter reconstruction. The obstacle for its clinical usage is the size of the beacon transponder whose diameter is bigger than most of the interstitial catheters used in clinic. Developing smaller transponders and supporting software and hardware for this application is necessary before it can be adopted for clinical use

Intravascular catheter related infections in children admitted on the ...

African Journals Online (AJOL)

peripheral venous intravascular catheters uncoated with no antibiotic or antiseptic, was done. Social demographic characteristics, anthropometry, clinical examination including the catheter site were determined at enrollment. The children had their blood, catheter tip and hub samples taken off for culture and sensitivity as ...

Inflammatory C-reactive protein and cytokine levels in asymptomatic people with chronic spinal cord injury.

Science.gov (United States)

Frost, Frederick; Roach, Mary Jo; Kushner, Irving; Schreiber, Peter

2005-02-01

To determine the relation between serologic markers of information and clinical characteristics of people with chronic spinal cord injury (SCI). Cross-sectional study. Academic medical center SCI outpatient clinic. Convenience sample of 37 men with chronic SCI and 10 healthy control subjects. Not applicable. Serum levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and C-reactive protein (CRP). The following results achieved statistical significance at P less than .05. Asymptomatic chronic SCI patients differed from referent controls with respect to serum CRP levels but not IL-6 or TNF-alpha. In SCI patients, higher levels of CRP correlated negatively with hemoglobin and albumin levels. A longer time since injury correlated with lower TNF-alpha values, whereas higher TNF-alpha levels correlated with higher serum albumin. Pressure ulcers and indwelling urinary catheters were associated with higher mean levels of CRP but not of the cytokines TNF-alpha and IL-6. Intermittent urinary catheterization was associated with lower levels of CRP when compared with other methods of bladder management. Asymptomatic people with long-term SCI, especially those with indwelling urinary catheters, showed serologic evidence of a systemic inflammatory state. There was no evidence of an elevation in proinflammatory cytokines. Detection of an ongoing systemic inflammatory response in apparently healthy people with indwelling urinary catheters and small skin ulcers further supports the aggressive pursuit of catheter-free voiding options and pressure ulcer healing.

The importance of effective catheter securement.

Science.gov (United States)

Fisher, Jayne

This article examines the importance of securing/fixing indwelling urinary catheters. The Oxford English dictionary interlinks the two words-'secure' and 'fix'-as having the same meaning. To secure the catheter should not be confused with 'support', whereby the weight of the urine drainage bag is supported with the use of velcro straps or a sleeve. The author introduces the need for the concept of this practice to be at the forefront of nurses' minds in all settings, and this is demonstrated through the use of case studies. Current guidance in this area is reviewed, as well as the problems that can arise when catheters are not secured properly and the available products for health professionals to use.

A system to use electromagnetic tracking for the quality assurance of brachytherapy catheter digitization

Energy Technology Data Exchange (ETDEWEB)

Damato, Antonio L., E-mail: adamato@lroc.harvard.edu; Viswanathan, Akila N.; Don, Sarah M.; Hansen, Jorgen L.; Cormack, Robert A. [Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Hospital, Boston, Massachusetts 02115 (United States)

2014-10-15

Purpose: To investigate the use of a system using electromagnetic tracking (EMT), post-processing and an error-detection algorithm for detecting errors and resolving uncertainties in high-dose-rate brachytherapy catheter digitization for treatment planning. Methods: EMT was used to localize 15 catheters inserted into a phantom using a stepwise acquisition technique. Five distinct acquisition experiments were performed. Noise associated with the acquisition was calculated. The dwell location configuration was extracted from the EMT data. A CT scan of the phantom was performed, and five distinct catheter digitization sessions were performed. No a priori registration of the CT scan coordinate system with the EMT coordinate system was performed. CT-based digitization was automatically extracted from the brachytherapy plan DICOM files (CT), and rigid registration was performed between EMT and CT dwell positions. EMT registration error was characterized in terms of the mean and maximum distance between corresponding EMT and CT dwell positions per catheter. An algorithm for error detection and identification was presented. Three types of errors were systematically simulated: swap of two catheter numbers, partial swap of catheter number identification for parts of the catheters (mix), and catheter-tip shift. Error-detection sensitivity (number of simulated scenarios correctly identified as containing an error/number of simulated scenarios containing an error) and specificity (number of scenarios correctly identified as not containing errors/number of correct scenarios) were calculated. Catheter identification sensitivity (number of catheters correctly identified as erroneous across all scenarios/number of erroneous catheters across all scenarios) and specificity (number of catheters correctly identified as correct across all scenarios/number of correct catheters across all scenarios) were calculated. The mean detected and identified shift was calculated. Results: The

A system to use electromagnetic tracking for the quality assurance of brachytherapy catheter digitization

International Nuclear Information System (INIS)

Damato, Antonio L.; Viswanathan, Akila N.; Don, Sarah M.; Hansen, Jorgen L.; Cormack, Robert A.

2014-01-01

Purpose: To investigate the use of a system using electromagnetic tracking (EMT), post-processing and an error-detection algorithm for detecting errors and resolving uncertainties in high-dose-rate brachytherapy catheter digitization for treatment planning. Methods: EMT was used to localize 15 catheters inserted into a phantom using a stepwise acquisition technique. Five distinct acquisition experiments were performed. Noise associated with the acquisition was calculated. The dwell location configuration was extracted from the EMT data. A CT scan of the phantom was performed, and five distinct catheter digitization sessions were performed. No a priori registration of the CT scan coordinate system with the EMT coordinate system was performed. CT-based digitization was automatically extracted from the brachytherapy plan DICOM files (CT), and rigid registration was performed between EMT and CT dwell positions. EMT registration error was characterized in terms of the mean and maximum distance between corresponding EMT and CT dwell positions per catheter. An algorithm for error detection and identification was presented. Three types of errors were systematically simulated: swap of two catheter numbers, partial swap of catheter number identification for parts of the catheters (mix), and catheter-tip shift. Error-detection sensitivity (number of simulated scenarios correctly identified as containing an error/number of simulated scenarios containing an error) and specificity (number of scenarios correctly identified as not containing errors/number of correct scenarios) were calculated. Catheter identification sensitivity (number of catheters correctly identified as erroneous across all scenarios/number of erroneous catheters across all scenarios) and specificity (number of catheters correctly identified as correct across all scenarios/number of correct catheters across all scenarios) were calculated. The mean detected and identified shift was calculated. Results: The

Efficacy of a one-catheter concept for transradial coronary angiography.

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Christoph Langer

Full Text Available Transradial coronary angiography (TRC can be performed with a one-catheter approach for the right and left coronary ostium (R/LCO. We investigated the performance of a special diagnostic catheter widely used for the one-catheter-approach, the Tiger (Tiger II, TerumoTM.In a dual center registry we analyzed 1412 TRC-procedures exclusively performed by experienced TRC-operators. We compared the performance of the Tiger with Judkins catheters by retrospectively judging ostial catheter stability during contrast injection, and by measuring contrast use, fluoroscopy time (FT and complication rate.Poor or failed ostial engagement was found in 40.5% in the Tiger group, compared to 46.6% with the use of Judkins catheters (p<0.183. Ostial instability of the Tiger was found more often during engagement of the LCO than the RCO (34.4% vs. 10.8%, p<0.001, whereas it was similar in the LCO and RCO for Judkins catheters (27.4% vs. 26.7%, p = 0.840. TRC-procedures performed with Tiger catheters were associated with less contrast volume (63.48 ± 29.83mL vs. 82.51 ± 56.58mL, p<0.004 and shorter FT than with Judkins catheters. (198.27 ± 194.8sec vs. 326.85 ± 329.70sec. Forearm hematomas occurred less often with the Tiger (1.2% vs. 6.6%, p< 0.02.The Tiger employed as a single catheter in TRC is an effective tool to achieve lower contrast volume and fluoroscopy time at a low complication rate. Unstable engagement affects predominantly the left coronary artery, but its overall frequency is similar for both, the Tiger and Judkins catheters.

Anorectal motility abnormalities in children with encopresis and chronic constipation.

Science.gov (United States)

Raghunath, Neeraj; Glassman, Mark S; Halata, Michael S; Berezin, Stuart H; Stewart, Julian M; Medow, Marvin S

2011-02-01

To evaluate the response to rectal distension in children with chronic constipation and children with chronic constipation and encopresis. We studied 27 children, aged 3 to 16 years, with chronic constipation; 12 had encopresis. Anorectal motility was measured with a solid state catheter. When the catheter was located in the internal sphincter, the balloon was inflated to 60 mL with air. There were no differences in age, sex distribution, and duration of constipation in the two groups. Comparing groups, anorectal manometry showed no differences in the resting sphincter pressure, recovery pressure, the lowest relaxation pressure, and percent relaxation. However, time to maximum relaxation, time to recovery to baseline pressure, and duration of relaxation were significantly higher in patients with constipation and encopresis, compared with patients who had constipation alone. There may be an imbalance in neuromuscular control of defecation in constipated patients with encopresis that results in incontinence as a consequence of the increased time to recovery and duration of relaxation of the internal anal sphincter. Copyright © 2011 Mosby, Inc. All rights reserved.

An intervention to improve the catheter associated urinary tract infection rate in a medical intensive care unit: Direct observation of catheter insertion procedure.

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Galiczewski, Janet M; Shurpin, Kathleen M

2017-06-01

Healthcare associated infections from indwelling urinary catheters lead to increased patient morbidity and mortality. The purpose of this study was to determine if direct observation of the urinary catheter insertion procedure, as compared to the standard process, decreased catheter utilization and urinary tract infection rates. This case control study was conducted in a medical intensive care unit. During phase I, a retrospective data review was conducted on utilsiation and urinary catheter infection rates when practitioners followed the institution's standard insertion algorithm. During phase II, an intervention of direct observation was added to the standard insertion procedure. The results demonstrated no change in utilization rates, however, CAUTI rates decreased from 2.24 to 0 per 1000 catheter days. The findings from this study may promote changes in clinical practice guidelines leading to a reduction in urinary catheter utilization and infection rates and improved patient outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

Femoral venous catheters: a safe alternative for delivering parenteral alimentation.

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Friedman, B; Kanter, G; Titus, D

1994-04-01

Femoral vein catheterization is an alternative method of obtaining central venous access. Placement of femoral venous catheters (FVCs) is possible in the majority of patients, suitable for most indications, and associated with a low complication rate during insertion. We wished to determine the incidence of infections or other complications resulting when parenteral nutrition was delivered through FVCs. Fifty-two patients were followed from a hospital-wide population including patients in the critical care units. Triple-lumen catheters were placed by using the sterile Seldinger technique, and sites were examined daily for inflammation. Bacteriologic surveillance was accomplished by submitting the catheter tip for semiquantitative cultures. If catheter line sepsis was suspected, blood samples for cultures were drawn through the catheter and peripherally. The rate of occurrence of colonized catheters was 9.6% (five of 52), and catheter sepsis was found in one case (1.9%). Other than inflammation at six (11.5%) of 52 catheter sites, noninfectious complications of FVCs were not found. On the basis of these findings, we consider FVC-delivered parenteral alimentation a safe and effective alternative to other forms of central venous access.

Therapeutic options in chronic heart failure. Findings on chest X-ray

International Nuclear Information System (INIS)

Granitz, M.R.; Meissnitzer, T.; Meissnitzer, M.W.; Hergan, K.; Altenberger, J.; Granitz, C.

2016-01-01

The contribution covers drugless therapeutic options for chronic heart failure: the implantable cardioverter/defibrillator (ICD), the cardiac resynchronization therapy (CRT), the interventional catheter treatment of functional mitral insufficiency, and mechanical heart supporting systems and heart transplantation.

Totally implantable venous catheters for chemotherapy: experience in 500 patients

Directory of Open Access Journals (Sweden)

Nelson Wolosker

Full Text Available CONTEXT: Totally implantable devices are increasingly being utilized for chemotherapy treatment of oncological patients, although few studies have been done in our environment to analyze the results obtained from the implantation and utilization of such catheters. OBJECTIVE: To study the results obtained from the implantation of totally implantable catheters in patients submitted to chemotherapy. TYPE OF STUDY: Prospective. SETTING: Hospital do Câncer A.C. Camargo, São Paulo, Brazil. METHODS: 519 totally implantable catheters were placed in 500 patients submitted to chemotherapy, with preference for the use of the right external jugular vein. Evaluations were made of the early and late-stage complications and patient evolution until removal of the device, death or the end of the treatment. RESULTS: The prospective analysis showed an average duration of 353 days for the catheters. There were 427 (82.2% catheters with no complications. Among the early complications observed, there were 15 pathway hematomas, 8 cases of thrombophlebitis of the distal stump of the external jugular vein and one case of pocket infection. Among the late-stage complications observed, there were 43 infectious complications (0.23/1000 days of catheter use, 11 obstructions (0.06/1000 days of catheter use and 14 cases of deep vein thrombosis (0.07/1000 days of catheter use. Removal of 101 catheters was performed: 35 due to complications and 66 upon terminating the treatment. A total of 240 patients died while the catheter was functioning and 178 patients are still making use of the catheter. CONCLUSION: The low rate of complications obtained in this study confirms the safety and convenience of the use of totally implantable accesses in patients undergoing prolonged chemotherapy regimes.

Quantitative evaluation of catheter radiopacity by fiber optic scanning densitometry

International Nuclear Information System (INIS)

Solomon, D.D.; Byron, M.P.; Lipton, M.J.

1989-01-01

A rapid accurate method has been developed utilizing fiber optic scanning densitometry to quantify the radiopacity of vascular catheters. The technique provides for computerized calculation of relative catheter radiopacity and an appropriate control standard. A densitometer with a 180 degree collection angle for diffuse transmission density measurements was selected based on the diffusing nature of X-ray film (Q-factor 1.80). A benchmark catheter and 2 mil thick brass shim stock were selected as control standards for evaluation of mono-and multilumen tubing using standard X-ray conditions and an aluminum block attenuator. The authors present results from reproducibility studies which show scan-to-scan repeatability is within ±1%, and day-to-day variability is less than 5%. Application studies demonstrate a linear relationship between percent barium sulfate loading and the radiopaqueness of 16 gauge monolumen tubing. Results were also obtained from a clinical chest X-ray film showing good in-vivo/in-vitro correlation

Monorail Piccolino catheter: a new rapid exchange/ultralow profile coronary angioplasty system.

Science.gov (United States)

Mooney, M R; Douglas, J S; Mooney, J F; Madison, J D; Brandenburg, R O; Fernald, R; Van Tassel, R A

1990-06-01

The Monorail Piccolino coronary angioplasty balloon catheter (MBC) was evaluated on 118 patients at two centers. Technical success was achieved in 110 patients (93%). Time for catheter exchange and total fluoroscopy time were significantly lower for the Monorail catheter than with standard equipment (exchange time 97 vs. 170 seconds P less than .05 and fluoroscopy time 17 vs. 88 seconds P less than .001). The advantages of rapid exchange and the ability of utilize 2 Monorail balloon catheters through one 9F guiding catheter for simultaneous inflations allowed for maximal flexibility in treating patients with bifurcation lesions. The double wire approach utilizing one Monorail balloon catheter with a 7F guiding catheter was also technically successful. The Monorail Piccolino balloon catheter has unique features that allow for greater ease of operator use, rapid catheter exchange, and optimal angiographic visualization. It is felt that this catheter design provides distinct advantages over standard angioplasty equipment.

Radiographic signs of non-venous placement of intended central venous catheters in children

Energy Technology Data Exchange (ETDEWEB)

Taylor, Erin C. [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States); Taylor, George A. [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States); Harvard Medical School, Department of Radiology, Boston, MA (United States)

2016-02-15

Central venous catheters (CVCs) are commonly used in children, and inadvertent arterial or extravascular cannulation is rare but has potentially serious complications. To identify the radiographic signs of arterial placement of CVCs. We retrospectively reviewed seven cases of arterially malpositioned CVCs on chest radiograph. These cases were identified through departmental quality-assurance mechanisms and external consultation. Comparison of arterial cases was made with 127 age-matched chest radiographs with CVCs in normal, expected venous location. On each anteroposterior (AP) radiograph we measured the distance of the catheter tip from the right lateral border of the thoracic spine, and the angle of the vertical portion of the catheter relative to the midline. On each lateral radiograph we measured the angle of the vertical portion of each catheter relative to the anterior border of the thoracic spine. When bilateral subclavian catheters were present, the catheter tips were described as crossed, overlapping or uncrossed. On AP radiographs, arterially placed CVCs were more curved to the left, with catheter tip positions located farther to the left of midline than normal venous CVCs. When bilateral, properly placed venous catheters were present, all catheters crossed at the level of the superior vena cava (SVC). When one of the bilateral catheters was in arterial position, neither of the catheters crossed or the inter-catheter crossover distance was exaggerated. On lateral radiographs, there was a marked anterior angulation of the vertical portion of the catheter (mean angle 37 ± 15 standard deviation [SD] in arterial catheters versus 5.9 ± 8.3 SD in normally placed venous catheters). Useful radiographic signs suggestive of unintentional arterial misplacement of vascular catheters include leftward curvature of the vertical portion of the catheter, left-side catheter tip position, lack of catheter crossover on the frontal radiograph, as well as exaggerated

Catheter-Related Sepsis Due to Rhodotorula glutinis

Science.gov (United States)

Hsueh, Po-Ren; Teng, Lee-Jene; Ho, Shen-Wu; Luh, Kwen-Tay

2003-01-01

We describe a central venous catheter-related (Port-A-Cath; Smiths Industries Medical Systems [SIMS] Deltec, Inc., St. Paul, Minn.) infection caused by Rhodotorula glutinis in a 51-year-old man with nasopharyngeal carcinoma. He was treated with fluconazole for 8 weeks and had the catheter removed. Two isolates of R. glutinis recovered from blood specimens (one obtained via peripheral veins and one via the catheter) before administration of fluconazole and one recovered from the removed catheter 17 days after initiation of fluconazole therapy exhibited high-level resistance to fluconazole (MICs, >256 μg/ml). These three isolates were found to belong to a single clone on the basis of identical antibiotypes determined by the E test (PDM Epsilometer; AB Biodisk, Solna, Sweden) and biotypes determined by API ID32 C (bioMerieux, Marcy I'Etoile, France) and their identical random amplified polymorphic DNA patterns. PMID:12574300

Use of asymmetric bidirectional catheters with different curvature radius for catheter ablation of cardiac arrhythmias.

Science.gov (United States)

Mantziari, Lilian; Suman-Horduna, Irina; Gujic, Marko; Jones, David G; Wong, Tom; Markides, Vias; Foran, John P; Ernst, Sabine

2013-06-01

The impact of recently introduced asymmetric bidirectional ablation catheters on procedural parameters and acute success rates of ablation procedures is unknown. We retrospectively analyzed data regarding ablations using a novel bidirectional catheter in a tertiary cardiac center and compared these in 1:5 ratio with a control group of procedures matched for age, gender, operator, and ablation type. A total of 50 cases and 250 controls of median age 60 (50-68) years were studied. Structural heart disease was equally prevalent in both groups (39%) while history of previous ablations was more common in the study arm (54% vs 30%, P = 0.001). Most of the ablation cases were for atrial fibrillation (46%), followed by atrial tachycardia (28%), supraventricular tachycardia (12%), and ventricular tachycardia (14%). Median procedure duration was 128 (52-147) minutes with the bidirectional, versus 143 (105-200) minutes with the conventional catheter (P = 0.232), and median fluoroscopy time was 17 (10-34) minutes versus 23 (12-39) minutes, respectively (P = 0.988). There was a trend toward a lower procedure duration for the atrial tachycardia ablations, 89 (52-147) minutes versus 130 (100-210) minutes, P = 0.064. The procedure was successfully completed in 96% of the bidirectional versus 84% of the control cases (P = 0.151). A negative correlation was observed between the relative fluoroscopy duration and the case number (r = -0.312, P = 0.028), reflecting the learning curve for the bidirectional catheter. The introduction of the bidirectional catheter resulted in no prolongation of procedure parameters and similar success rates, while there was a trend toward a lower procedure duration for atrial tachycardia ablations. ©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.

Number and location of drainage catheter side holes: in vitro evaluation.

Science.gov (United States)

Ballard, D H; Alexander, J S; Weisman, J A; Orchard, M A; Williams, J T; D'Agostino, H B

2015-09-01

To evaluate the influence of number and location of catheter shaft side holes regarding drainage efficiency in an in vitro model. Three different drainage catheter models were constructed: open-ended model with no side holes (one catheter), unilateral side hole model (six catheters with one to six unilateral side holes), and bilateral side hole model (six catheters with one to six bilateral side holes). Catheters were inserted into a drainage output-measuring device with a constant-pressure reservoir of water. The volume of water evacuated by each of the catheters at 10-second intervals was measured. A total of five trials were performed for each catheter. Data were analysed using one-way analysis of variance. The open-ended catheter had a mean drainage volume comparable to the unilateral model catheters with three, four, and five side holes. Unilateral model catheters had significant drainage volume increases up to three side holes; unilateral model catheters with more than three side holes had no significant improvement in drainage volume. All bilateral model catheters had significantly higher mean drainage volumes than their unilateral counterparts. There was no significant difference between the mean drainage volume with one, two, or three pairs of bilateral side holes. Further, there was no drainage improvement by adding additional bilateral side holes. The present in vitro study suggests that beyond a critical side hole number threshold, adding more distal side holes does not improve catheter drainage efficiency. These results may be used to enhance catheter design towards improving their drainage efficiency. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Training of nurses on Foley catheter insertion in intensive care unit patients: limits and possibilities

Directory of Open Access Journals (Sweden)

Magno Conceição Merces

2013-04-01

Full Text Available Backgound and Objectives: Nursing has an important role in urinary tract infection prevention and control. Urinary catheters insertion represents the local topography with the highest rate of hospital infection. Foley catheter placement is performed solely by the nurse and requires aseptic techniques during its performance, thus preventing risks to the patients. The study aimed to evaluate the training of nurses on Foley catheter insertion and point out limits and possibilities of this practice in patients at the Intensive Care Unit (ICU of Hospital Geral do Interior da Bahia (HGIB. Methods: This was a qualitative, exploratory and descriptive study. Data collection was carried out through semi-structured interviews. After data analysis, two categories were evaluated, namely: the training of nurses on Foley catheter insertion in ICU patients and the limits and possibilities of Foley catheter insertion practice by nurses in ICU patients. Bardin analysis was used for data analysis. Results: The study shows that the nurse’s practice on Foley catheter insertion in ICU patients is based on the use of aseptic techniques for urinary tract infection prevention, theoretical and practical knowledge on Foley catheter insertion in ICU patients, knowledge on urinary tract infections and associations with catheter insertion, whereas the limits and possibilities of Foley catheter insertion practice by nurses are understood through measures to minimize the risk of hospital infection caused by long-term catheter use in the ICU. Nurses point out that the risks of hospital infection are inherent to long-term catheter use. This is an important fact, as the knowledge or its absence may constitute a limit or possibility for Foley catheter insertion practice by the nurse in ICU patients. Conclusion: Nurses must seek the systematization of knowledge, which warrants support for the team, as well as information, safety and prompt care, allowing the reduction of urinary

Suprapubic catheter care

Science.gov (United States)

... going back into your bladder. Try not to disconnect the catheter more than you need to. Keeping ... Copyright Privacy Accessibility Quality Guidelines Viewers & Players MedlinePlus Connect for EHRs For Developers U.S. National Library of ...

Three-Catheter Technique for Ablation of Left-Sided Accessory Pathways in Wolff-Parkinson-White is Less Expensive and Equally Successful When Compared to a Five-Catheter Technique.

Science.gov (United States)

Capone, Christine A; Ceresnak, Scott R; Nappo, Lynn; Gates, Gregory J; Schechter, Clyde B; Pass, Robert H

2015-12-01

To compare the efficacy, safety, and cost-effectiveness of a three-catheter approach with a conventional five-catheter approach for the mapping and ablation of supraventricular tachycardia in pediatric patients with Wolff-Parkinson-White Syndrome (WPW) and concealed accessory pathways (APs). A retrospective review from 2008 to 2012 of patients less than 21 years with WPW who underwent a three-catheter radiofrequency (RF) ablation of a left-sided AP (ablation, right ventricular [RV] apical, and coronary sinus [CS] decapolar catheters) was performed. The three-catheter group was compared to a control group who underwent a standard five-catheter (ablation, RV apical, CS decapolar, His catheter, and right atrial catheter) ablation for the treatment of left-sided WPW or concealed AP. Demographics, ablation outcomes, and costs were compared between groups. Twenty-eight patients met inclusion criteria with 28 control patients. The groups did not differ in gender, age, weight, or body surface area. Locations of the AP on the mitral annulus were similar between the groups. All patients were ablated via transseptal approach. Note that 28 of 28 in the three-catheter group (100%) and 27 of 28 (96%) controls were acutely successfully ablated (P = 0.31). No complications were encountered. There was no difference in procedural time, time to loss of AP conduction, or number of RF applications. Use of the three-catheter technique resulted in a total savings of $2,465/case, which includes the $680 savings from using fewer catheters as well as the savings from a shortened procedure time. Ablation in patients with WPW and a left-sided AP can be performed using three catheters with similar efficacy and safety while offering significant cost savings compared to a conventional five-catheter approach. © 2015 Wiley Periodicals, Inc.

Translumbar aortography by catheter technique

International Nuclear Information System (INIS)

Hagen, B.; Honemeyer, U.; Meier-Duis, H.

1982-01-01

400 examinations performed during the last three years by TLA (only catheter technique) were subjected to critical analysis and studied particularly in respect to the rate of complications. We observed 13 complications (3.25%) of moderate severity, including 3 large hematomas (documented by CT), 3 paravasations and 7 dissections, but no fatal complication. Two (0.5%) of these complications had clinical evidence. The advantages of the catheter technique of TLA are described. Injections through rigid metal cannula should be avoided because of the high incidence of complications (mainly the increased risk of dissection). Downstream injection resulted in excellent visualization of peripheral occluding vascular disease. Upstream injection should be preferred to demonstrate the major abdominal arteries as well as supraceliac collateral circulation in the case of high Leriche syndrome. The low or intermediate puncture of the aorta is preferable to facilitate caudad direction of the catheter and to diminish the risk of damaging other vessels or puncturing an organ. (orig.) [de

Erosion of the Silicone Peritoneal Dialysis Catheter with the Use of Gentamicin Cream at the Exit Site.

Science.gov (United States)

Gardezi, Ali I; Schlageter, Karen W; Foster, Dawn M; Astor, Brad C; Chan, Micah R; Waheed, Sana

Infection remains the leading complication of peritoneal dialysis (PD). Topical mupirocin and gentamicin are frequently used to prevent infections. Mupirocin ointment has been reported to cause damage to both polyurethane and silicone PD catheters. Gentamicin cream has not been associated with physical damage to catheters.A 64-year-old woman on PD developed relapsing peritonitis with Staphylococcus epidermidis. Because of a drainage problem and white discoloration at the exit site, which is known as " frosting," she underwent catheter exchange. The catheter was found to be fractured within the area of frosting. Four more patients with frosting of the catheter were identified. On further questioning, it was recognized that they were applying excessive amounts of gentamicin cream directly on the catheter surface rather than at the exit site. All patients in the program were educated about the correct method of topical antibiotic application. After the change in practice, no further cases of catheter frosting were identified.Polyurethane catheters can undergo oxidation, mineralization, and environmental stress cracking, leading to physical damage such frosting, ballooning, and fracture. Polyethylene glycol, a component of the mupirocin ointment base, is thought to cause plasticization of polyurethane, reducing its tensile strength. Similar damage has been observed in silicone catheters. Previous reports have not found gentamicin cream to cause that type of damage. We observed that excessive amounts of cream applied directly to the catheter surface can damage it. Damage did not recur once patients had been educated about the proper method of application.

Catheter-associated UTI

Science.gov (United States)

... UTI; Health care-associated UTI; Catheter-associated bacteriuria; Hospital acquired-UTI Images Bladder catheterization, female Bladder catheterization, male References Calfee DP. Prevention and control of health care-associated infections. In: Goldman L, Schafer AI, eds. Goldman's Cecil ...

Outcome of tunneled infusion catheters inserted via the right internal jugular vein

International Nuclear Information System (INIS)

Shin, Sung Wook; Do, Young Soo; Choo, Sung Wook; Yoo, Wi Kang; Choo, In Wook; Kim, Jae Hyung

2003-01-01

To assess the outcome of tunneled central venous catheter placement via the right internal jugular vein. Between June 2001 and May 2002, 670 consecutive Hickman catheters were placed in 654 patients via the right internal jugular vein. The procedural complications arising and follow-up data obtained from May to July 2002 were evaluated. The technical success rate for catheter placement was 99.9% (669/670). Procedural complications were limited to eight cases (1.2%), including three pneumothoraces, one early migration of the catheter, one clinically unimportant air embolism, one catheter injury, one catheter kinking and one primary malpositioning in the azygos vein. Catheter dwelling time ranged from 1 to 407 (mean 107.1) days. During the follow-up period, 416 catheter were removed for various reasons: treatment had ended (n=334), patients declined treatment or their drug regimen was changed (n=16), late complications arose (n=53), or other circumstances intervened (n=13). Late complications included 44 cases of catheter-related infection (6.6%), five of catheter migration (0.7%), two of catheter occlusion (0.3%), one of thrombophlebitis (0.15%), and one of catheter-related right atrial thrombosis (0.15%). Only one instance of symptomatic venous thrombosis or stenosis was noted, namely the one case of thrombophlebitis. Because the incidence of subsequent symptomatic venous thrombosis or stenosis is lower, the preferred route for tunneled central venous catheter placement is the right internal jugular vein

[Recording of ventricular pressure by conventional catheter manometer systems. Efficiency of several combinations of conventional catheters, modern transducers and catheter-flush systems (author's transl)].

Science.gov (United States)

Hellige, G

1976-01-01

The experimentally in vitro determined dynamic response characteristics of 38 catheter manometer systems were uniform in the worst case to 5 c.p.s. and optimally to 26 c.p.s. Accordingly, some systems are only satisfactory for ordinary pressure recording in cardiac rest, while better systems record dp/dt correct up to moderate inotropic stimulation of the heart. In the frequency range of uniform response (amplitude error less +/- 5%) the phase distortion is also negligible. In clinical application the investigator is often restricted to special type of cardiac catheter. In this case a low compliant transducer yields superior results. In all examined systems the combination with MSD 10 transducers is best, whereas the combination with P 23 Db transducers leads to minimal results. An inadequate system for recording ventricular pressure pulses leads in most cases to overestimations of dp/dtmax. The use of low frequency pass filters to attenuate higher frequency artefacts is, under clinical conditions, not suitable for extending the range of uniform frequency response. The dynamic response of 14 catheter manometer systems with two types of continuous self flush units was determined. The use of the P 37 flush unit in combination with small internal diameter catheters leads to serious error in ordinary pressure recording, due to amplitude distortion of the lower harmonics. The frequency response characteristics of the combination of an Intraflow flush system and MSD 10 transducer was similar to the non-flushing P 23 Db transducer feature.

Compatibility of electrolytically produced sodium hypochlorite solutions on long- term implanted dialysis catheters.

Science.gov (United States)

Mishkin, G J

2007-01-01

More than 20% of the world's population use a catheter for dialysis, despite guidelines limiting their use. Although the structure and design of the catheters differ by manufacturer, the material used in central venous catheters and peritoneal dialysis catheters are the same across manufacturers. Given the long-term use of these catheters in the dialysis population, the good compatibility of the antiseptics and disinfectants used on the catheters is imperative to prevent failure and cracking of the catheter material. Tensile strengths of commercially available catheters were measured after exposure to commonly used disinfectants. The tensile strength was then compared between the catheters by analyzing the displacement vs. force (N) curves produced during the evaluation. A total of 44 catheter lumens were evaluated. The electrolytically produced sodium hypochlorite solution, Alcavis 50/ExSept Plus, was the only solution shown to be compatible with all three catheter materials resulting in a deviation of less than 10% for each of the different catheter types. Electrolytically produced sodium hypochlorite solutions were the only solutions in this study that did not alter the physical properties of any of the catheters after long-term exposure.

Percutaneous untying of a knot in a retained Swan-Ganz catheter

International Nuclear Information System (INIS)

Bhatti, Waqar A.; Sinha, Sankar; Rowlands, Peter

2000-01-01

A patient was referred to us with a tightly knotted Swan-Ganz catheter. The catheter could not be removed by conventional simple methods. We describe a minimally invasive means of removal of the catheter using an Amplatz gooseneck snare and an angioplasty balloon. This allowed the Catheter to be removed without trauma.

Dialysis catheter-related septicaemia--focus on Staphylococcus aureus septicaemia

DEFF Research Database (Denmark)

Nielsen, J; Ladefoged, S D; Kolmos, H J

1998-01-01

BACKGROUND: Dialysis catheters are a common cause of nosocomial septicaemia in haemodialysis units usually due to staphylococci, of which Staphylococcus aureus is the most pathogenic. In this study, the epidemiology and pathogenesis of dialysis catheter-related infections were studied, and methods...... to infection were measured. After catheter insertion, all patients were screened for nasal carriage of S. aureus, and a culture was taken from the skin overlying the catheter insertion site. Once a week, cultures were taken from the insertion site and from the hub, and aerobic and anaerobic blood cultures were...... drawn from the catheter. If clinical signs of septicaemia occurred, peripheral blood cultures were also performed, when it was possible. RESULTS: The incidence of septicaemia was 49% (21/43) in patients, and 56% of all cases were caused by S. aureus. The mortality was 14% (3/21) and the incidence...

Radiological Tenckhoff catheter insertion for peritoneal dialysis: A cost-effective approach.

Science.gov (United States)

Lee, James; Mott, Nigel; Mahmood, Usman; Clouston, John; Summers, Kara; Nicholas, Pauline; Gois, Pedro Henrique França; Ranganathan, Dwarakanathan

2018-04-01

Radiological insertion of Tenckhoff catheters can be an alternative option for peritoneal dialysis access creation, as compared to surgical catheter insertion. This study will review the outcomes and complications of radiological Tenckhoff catheter insertion in a metropolitan renal service and compare costs between surgical and radiological insertion. Data were collected prospectively for all patients who had a Tenckhoff catheter insertion for peritoneal dialysis (PD) under radiological guidance at our hospital from May 2014 to November 2016. The type of catheter used and complications, including peri-catheter leak, exit site infection and peritonitis were reviewed. Follow-up data were also collected at points 3, 6 and 12 months from catheter insertion. Costing data were obtained from Queensland Health Electronic Reporting System (QHERS) data, average staff salaries and consumable contract price lists. In the 30-month evaluation period, 70 catheters were inserted. Two patients had an unsuccessful procedure due to the presence of abdominal adhesions. Seven patients had an episode of peri-catheter leak, and four patients had an exit site infection following catheter insertion. Peritonitis was observed in nine patients during the study period. The majority of patients (90%) remained on peritoneal dialysis at 3-month follow-up. The average costs of surgical and radiological insertion were noted to be AUD$7788.34 and AUD$1597.35, respectively. Radiological Tenckhoff catheter insertion for peritoneal dialysis appears to be an attractive and cost-effective option given less waiting periods for the procedure, the relatively low cost of insertion and comparable rates of complications. © 2017 The Royal Australian and New Zealand College of Radiologists.

Comparison of air-charged and water-filled urodynamic pressure measurement catheters.

Science.gov (United States)

Cooper, M A; Fletter, P C; Zaszczurynski, P J; Damaser, M S

2011-03-01

Catheter systems are utilized to measure pressure for diagnosis of voiding dysfunction. In a clinical setting, patient movement and urodynamic pumps introduce hydrostatic and motion artifacts into measurements. Therefore, complete characterization of a catheter system includes its response to artifacts as well its frequency response. The objective of this study was to compare the response of two disposable clinical catheter systems: water-filled and air-charged, to controlled pressure signals to assess their similarities and differences in pressure transduction. We characterized frequency response using a transient step test, which exposed the catheters to a sudden change in pressure; and a sinusoidal frequency sweep test, which exposed the catheters to a sinusoidal pressure wave from 1 to 30 Hz. The response of the catheters to motion artifacts was tested using a vortex and the response to hydrostatic pressure changes was tested by moving the catheter tips to calibrated heights. Water-filled catheters acted as an underdamped system, resonating at 10.13 ± 1.03 Hz and attenuating signals at frequencies higher than 19 Hz. They demonstrated significant motion and hydrostatic artifacts. Air-charged catheters acted as an overdamped system and attenuated signals at frequencies higher than 3.02 ± 0.13 Hz. They demonstrated significantly less motion and hydrostatic artifacts than water-filled catheters. The transient step and frequency sweep tests gave comparable results. Air-charged and water-filled catheters respond to pressure changes in dramatically different ways. Knowledge of the characteristics of the pressure-measuring system is essential to finding the best match for a specific application. Copyright © 2011 Wiley-Liss, Inc.

Embolization of brain arteriovenous malformations using tracker catheter

International Nuclear Information System (INIS)

Kim, Sun Yong; Son, Mi Young; Jang, Jae Chun; Hwang, Mi Soo; Park, Bok Hwan

1990-01-01

With the recent advance in micro catheters, steerable guide wires, balloons, embolic materials and digital subtraction angiography (DSA), as well as technical refinements in endovascular surgery, there has been a revolution in therapeutic strategies for cerebral arteriovenous malformations (AVMs). We have performed super selective angiography and embolization with Tracker micro catheter about 12 cases of brain AVMs for therapeutic and preoperative aims. This micro catheter and guide wire provided high selectivity of feeding artery, greater maneuverability and useful for deliver various embolus materials

Adverse effects associated with ethanol catheter lock solutions: a systematic review.

Science.gov (United States)

Mermel, Leonard A; Alang, Neha

2014-10-01

Antimicrobial lock therapy has been widely utilized internationally for the prevention and management of intravascular catheter-related bloodstream infections. One of the agents commonly utilized for lock therapy is ethanol. However, a systematic review of adverse events associated with ethanol locks has not been published. PubMed was searched to collect articles published from May 2003 through March 2014. The bibliographies of relevant articles were also reviewed. In vitro studies of the mechanical properties of catheters after ethanol immersion have revealed changes predominantly in polyurethane catheters and to a lesser extent in silicone and Carbothane catheters. An elution of polymers from polyurethane and Carbothane catheters has been observed at the ethanol concentrations used in ethanol lock therapy. Ethanol above a concentration of 28% leads to plasma protein precipitation. Ethanol locks were associated with catheter occlusion in 11 studies and independently increased the risk of thrombosis compared with heparin lock in a randomized trial. Six studies noted abnormalities in catheter integrity, including one case leading to catheter embolization. Of note, five of these studies involved silicone catheters. Ethanol lock use was associated with systemic side effects in 10 studies and possible side effects in one additional study. Four studies noted liver function test abnormalities, predominantly transaminase elevation, related to ethanol lock use. However, a prospective study did not find any difference in the risk of doubling the transaminase level above the normal range during use of ethanol locks compared with not using an ethanol lock. The use of ethanol locks has been associated with structural changes in catheters, as well as the elution of molecules from the catheter polymers. Clinical studies have revealed systemic toxicity, increased catheter occlusion and breaches in catheter integrity. © The Author 2014. Published by Oxford University Press on

Potential In Vivo UVC Disinfection of Catheter Lumens: Estimation of the Doses Received by the Blood Flow Outside the Catheter Tip Hole

DEFF Research Database (Denmark)

Bak, Jimmy; Jørgensen, Thomas Martini; Helfmann, Jurgen

2011-01-01

hole for administration of drugs, bloods or nutrients into the bloodstream. Even if the UVC light is strongly attenuated during its propagation through the catheter tube a fraction of the UVC launched into the catheter will escape through the exit hole and irradiate the blood. We demonstrate......We have demonstrated that it is possible to launch UVC LED light into bacterial contaminated polymer tubes/catheters and disinfect the intraluminal space of these tubes. This can be achieved by UVC treatment of the catheters on a regular basis. Catheters are in the distal end equipped with an exit...... by calculations that very small effective doses are exposed to the blood (ca 10(-4) J m(-2) ). This dosage level is very low compared with UVC doses reported from other therapeutic applications. The very short residence time of the blood constituents in the irradiated volume in front of the exit hole is the main...

The effect of elastic modulus on ablation catheter contact area.

Science.gov (United States)

Camp, Jon J; Linte, Cristian A; Rettmann, Maryam E; Sun, Deyu; Packer, Douglas L; Robb, Richard A; Holmes, David R

2015-02-21

Cardiac ablation consists of navigating a catheter into the heart and delivering RF energy to electrically isolate tissue regions that generate or propagate arrhythmia. Besides the challenges of accurate and precise targeting of the arrhythmic sites within the beating heart, limited information is currently available to the cardiologist regarding intricate electrode-tissue contact, which directly impacts the quality of produced lesions. Recent advances in ablation catheter design provide intra-procedural estimates of tissue-catheter contact force, but the most direct indicator of lesion quality for any particular energy level and duration is the tissue-catheter contact area, and that is a function of not only force, but catheter pose and material elasticity as well. In this experiment, we have employed real-time ultrasound (US) imaging to determine the complete interaction between the ablation electrode and tissue to accurately estimate contact, which will help to better understand the effect of catheter pose and position relative to the tissue. By simultaneously recording tracked position, force reading and US image of the ablation catheter, the differing material properties of polyvinyl alcohol cryogel [1] phantoms are shown to produce varying amounts of tissue depression and contact area (implying varying lesion quality) for equivalent force readings. We have shown that the elastic modulus significantly affects the surface-contact area between the catheter and tissue at any level of contact force. Thus we provide evidence that a prescribed level of catheter force may not always provide sufficient contact area to produce an effective ablation lesion in the prescribed ablation time.

Percutaneous Management of Postoperative Duodenal Stump Leakage with Foley Catheter

International Nuclear Information System (INIS)

Oh, Jung Suk; Lee, Hae Giu; Chun, Ho Jong; Choi, Byung Gil; Lee, Sang Hoon; Hahn, Seong Tai; Ohm, Joon Young

2013-01-01

Purpose: This study was designed to evaluate retrospectively the safety and efficacy of the percutaneous management of duodenal stump leakage with a Foley catheter after subtotal gastrectomy. Methods: Ten consecutive patients (M:F = 9:1, median age: 64 years) were included in this retrospective study. The duodenal stump leakages were diagnosed in all the patients within a median of 10 days (range, 6–20). At first, the patients underwent percutaneous drainage on the day of or the day after confirmation of the presence of duodenal stump leakage, and then the Foley catheters were replaced at a median of 9 days (range, 6–38) after the percutaneous drainage. Results: Foley catheters were placed successfully in the duodenal lumen of all the patients under a fluoroscopic guide. No complication was observed during and after the procedures in all the patients. All of the patients started a regular diet 1 day after the Foley catheter placement. The patients were discharged at a median of 7 days (range, 5–14) after the Foley catheter placement. The catheters were removed in an outpatient clinic 10–58 days (median, 28) after the Foley catheter placement. Conclusions: Fluoroscopy-guided percutaneous Foley catheter placement may be a safe and effective treatment option for postoperative duodenal stump leakage and may allow for shorter hospital stays, earlier oral intake, and more effective control of leakage sites

A flexible, highly sensitive catheter for high resolution manometry based on in-fibre Bragg gratings

International Nuclear Information System (INIS)

Bueley, Christopher; Wild, Peter M

2013-01-01

This work presents a fibre optic-based flexible catheter for high resolution manometry (HRM), with sensing pods located at a pitch of 10 mm and an overall diameter of 2.8 mm. In-fibre Bragg gratings act as the sensing elements within these sensing pods. Hydrodynamic pressure resolution of 0.2 mmHg is demonstrated in conjunction with insensitivity to occlusion pressure. This result is significant in the context of HRM where independent measurement of hydrodynamic pressure is clinically relevant. The sensing system is compact, robust and flexible. Crosstalk between individual sensors is characterized and a compensation scheme is developed and validated. (paper)

Indwelling urinary catheter management and catheter-associated urinary tract infection prevention practices in Nurses Improving Care for Healthsystem Elders hospitals.

Science.gov (United States)

Fink, Regina; Gilmartin, Heather; Richard, Angela; Capezuti, Elizabeth; Boltz, Marie; Wald, Heidi

2012-10-01

Indwelling urinary catheters (IUCs) are commonly used in hospitalized patients, especially elders. Catheter-associated urinary tract infections (CAUTIs) account for 34% of all health care associated infections in the United States, associated with excess morbidity and health care costs. Adherence to CAUTI prevention practices has not been well described. This study used an electronic survey to examine IUC care practices for CAUTI prevention in 3 areas-(1) equipment and alternatives and insertion and maintenance techniques; (2) personnel, policies, training, and education; and (3) documentation, surveillance, and removal reminders-at 75 acute care hospitals in the Nurses Improving the Care of Healthsystem Elders (NICHE) system. CAUTI prevention practices commonly followed included wearing gloves (97%), handwashing (89%), maintaining a sterile barrier (81%), and using a no-touch insertion technique (73%). Silver-coated catheters were used to varying degrees in 59% of the hospitals; 4% reported never using a catheter-securing device. Urethral meatal care was provided daily by 43% of hospitals and more frequently that that by 41% of hospitals. Nurses were the most frequently reported IUC inserters. Training in aseptic technique and CAUTI prevention at the time of initial nursing hire was provided by 64% of hospitals; however, only 47% annually validated competency in IUC insertion. Systems for IUC removal were implemented in 56% of hospitals. IUC documentation and routine CAUTI surveillance practices varied widely. Although many CAUTI prevention practices at NICHE hospitals are in alignment with evidence-based guidelines, there is room for improvement. Further research is needed to identify the effect of enhanced compliance with CAUTI prevention practices on the prevalence of CAUTI in NICHE hospitals. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Intravascular catheter-related infection – current concepts

African Journals Online (AJOL)

2006-08-28

Aug 28, 2006 ... prevented. ... blood from both the catheter and a peripheral site, may ... Given the important role of cutaneous microflora in the ... valvular heart disease (especially prosthetic valves) and ... be explained by high arterial flow around the catheter, ... vena cava or right atrium via the cephalic and basilar veins of ...

Balloon catheter dilatation in esophageal achalasia: long term follow-up

Energy Technology Data Exchange (ETDEWEB)

Shin, Cheol Yong; Park, Hyun Mee; Kim, So Eun; Lee, Shin Hyung; Kim, Seung Hyeon; Lee, Chang Joon [National Medical Center, Seoul (Korea, Republic of)

1994-12-15

To evaluate the clinical efficacy of balloon catheter dilatation in the treatment of esophageal achalasia. Seven patients(three males and four females) with esopha-geal achalasia were treated with balloon catheter dilatation. Balloon catheters of variable sizes were used depending on patient's conditions. The patients were followed up over a period of 12-39 months. Balloon catheter dilatation in esophageal achalasia was successful in all patients without esophageal perforation. All patients were relieved from dysphagia. Recurrence was not found in 5 patients on long term follow-up study, but was seen in 2 patients after 18 and 21 months, respectively. Balloon catheter dilatation was a safe and effective method in the treatment of esophageal achalasia with low recurrence rate of 29% on follow-up study.

Balloon catheter dilatation in esophageal achalasia: long term follow-up

International Nuclear Information System (INIS)

Shin, Cheol Yong; Park, Hyun Mee; Kim, So Eun; Lee, Shin Hyung; Kim, Seung Hyeon; Lee, Chang Joon

1994-01-01

To evaluate the clinical efficacy of balloon catheter dilatation in the treatment of esophageal achalasia. Seven patients(three males and four females) with esopha-geal achalasia were treated with balloon catheter dilatation. Balloon catheters of variable sizes were used depending on patient's conditions. The patients were followed up over a period of 12-39 months. Balloon catheter dilatation in esophageal achalasia was successful in all patients without esophageal perforation. All patients were relieved from dysphagia. Recurrence was not found in 5 patients on long term follow-up study, but was seen in 2 patients after 18 and 21 months, respectively. Balloon catheter dilatation was a safe and effective method in the treatment of esophageal achalasia with low recurrence rate of 29% on follow-up study

Innovating urinary catheter design: An introduction to the engineering challenge.

Science.gov (United States)

Murphy, Cathy

2018-05-01

Every day, people around the world rely on intermittent and indwelling urinary catheters to manage bladder dysfunction, but the potential or actual harm caused by these devices is well-recognised. Current catheter designs can cause urinary tract infection and septicaemia, bladder and urethral trauma and indwelling devices frequently become blocked. Furthermore, the devices can severely disrupt users' lives, limiting their daily activities and can be costly to manage for healthcare providers. Despite this, little significant design innovation has taken place in the last 80 years. In this article current catheter designs and their limitations are reviewed, common catheter-associated problems are outlined and areas of design ripe for improvement proposed. The potential to relieve the individual and economic burden of catheter use is high.

The dialysis catheter and infectious peritonitis in intermittent peritoneal dialysis

DEFF Research Database (Denmark)

Kolmos, Hans Jørn; Hemmeløff Andersen, Karl Erik; Hansen, Lise

1984-01-01

118 episodes of infectious peritonitis registered among 156 patients treated with intermittent peritoneal dialysis over a 5-yr period were analysed with special reference to potential routes of infection associated with the dialysis catheter. Peritonitis was randomly distributed among the patients......, and the change of keeping free of peritonitis declined exponentially with time. The main factor determining the individual number of episodes was the total space of time, in which a patient had been wearing a dialysis catheter, whereas the number of catheter disconnections played no significant role. A relative...... preponderance of cases due to Enterobacteriaceae was noted within the first week after catheter implantation. In contrast with this, peritonitis with skin microorganisms was not associated with the implantation of catheters....

Catheter fracture of intravenous ports and its management.

Science.gov (United States)

Wu, Ching-Yang; Fu, Jui-Ying; Feng, Po-Hao; Kao, Tsung-Chi; Yu, Sheng-Yueh; Li, Hao-Jui; Ko, Po-Jen; Hsieh, Hung-Chang

2011-11-01

Intravenous ports are widely used for oncology patients. However, catheter fractures may lead to the need for re-intervention. We aimed to identify the risk factors associated with catheter fractures. Between January 1 and December 31, 2006, we retrospectively reviewed the clinical data and plain chest films of 1,505 patients implanted with an intravenous port at Chang Gung Memorial Hospital. Different vascular sites were compared using the chi-square or Fisher's exact test for categorical variables, and the t test was used for continuous variables with normal distribution; P port type Arrow French (Fr.) 8.1 (P port and catheter removal is recommended. Female gender, intravenous port implantation via the subclavian route, and the Arrow Fr. 8.1 port were found to be risk factors. Patients with these risk factors should be monitored closely to avoid catheter fractures.

Two years experience with tunneled dialysis catheters in patients requiring haemodialysis

International Nuclear Information System (INIS)

Raheem, A.; Rana, A. I.; Ramzan, M.; Shah, R. A.; Mehmood, S. N.; Naseem, S.

2014-01-01

Objective: To look for survival rate and major reasons behind the failure of tunnelled dialysis catheters in patients on haemodialysis. Methods: The retrospective study was conducted at the Department of Interventional Radiology, Shifa International Hospital, Islamabad, and comprised records of 100 consecutive subjects from a list of patients in whom tunnelled cuffed catheters were placed from February 2009 to January 2011 and were followed up for two years. Data was collected on a proforma from the hospital database and medical records of patients. SPSS 19 was used for statistical analysis. Results: Of the total 122 catheters placed in 100 patients, 49(40.16%) were lost to follow-up. Of the remaining 73(59.83%) catheters, 38(52%) had achieved their desired function, while 35(48%) failed to achieve the target duration. Among the reasons of catheter failure, infection was the commonest at 13(37.14%) with infection rate of 0.24 per 1000 catheter days. According to Kaplan Meier analysis, catheter survival rates at 60, 90 and 180 days were 89%, 77% and 64% respectively. Mean effective duration of catheter was 129+-117 days. Conclusion: Tunnelled dialysis catheters can be safely used as vascular access till the maturation of fistula and may be an alternative to Arterio-Venous Fistula or graft for long-term vascular access if indicated. (author)

An experimental study about efficacy of the drain catheters

Energy Technology Data Exchange (ETDEWEB)

Ahn, Bum Gyu; Nho, Joon Young; Woo, Hyo Cheol; Hwang, Woo Cheol; Park, Choong Ki; Yoon, Jong Sup [Hallym University College of Medicine, Seoul (Korea, Republic of)

1993-09-15

Although percutaneous abscess drainage has become and accepted alternative from of therapy for selected patients with abscess, it is well known that there are several factors in the failure of adequate drainage such as pre- and post-procedural management, technique itself, various features of abscess, and selection and application of catheters. Among these factors, we made an experiment about drainage efficacy of commonly used various catheters with different viscosities of water-glycerin solution under the two different pressure gradients. The experimental values of flow rate were very lower than the calculated values. An efficacy of experimental value was 4-14%. Because the inner diameter of fittings and stopcocks was usually smaller than the inner diameter of catheters, these factors also affected the drain efficacy. Finally, we thought that it will be very helpful to the treatment of patient as well as to study about the catheter drainage, if the drain efficacy of individual catheters has been notified.

De-implementation strategy to Reduce the Inappropriate use of urinary and intravenous CATheters: study protocol for the RICAT-study.

Science.gov (United States)

Laan, Bart J; Spijkerman, Ingrid J B; Godfried, Mieke H; Pasmooij, Berend C; Maaskant, Jolanda M; Borgert, Marjon J; Opmeer, Brent C; Vos, Margreet C; Geerlings, Suzanne E

2017-01-10

Urinary and (peripheral and central) intravenous catheters are widely used in hospitalized patients. However, up to 56% of the catheters do not have an appropriate indication and some serious complications with the use of these catheters can occur. The main objective of our quality improvement project is to reduce the use of catheters without an appropriate indication by 25-50%, and to evaluate the affecting factors of our de-implementation strategy. In a multicenter, prospective interrupted time series analysis, several interventions to avoid inappropriate use of catheters will be conducted in seven hospitals in the Netherlands. Firstly, we will define a list of appropriate indications for urinary and (peripheral and central) intravenous catheters, which will restrict the use of catheters and urge catheter removal when the indication is no longer appropriate. Secondly, after the baseline measurements, the intervention will take place, which consists of a kick-off meeting, including a competitive feedback report of the baseline measurements, and education of healthcare workers and patients. Additional strategies based on the baseline data and local conditions are optional. The primary endpoint is the percentage of catheters with an inappropriate indication on the day of data collection before and after the de-implementation strategy. Secondary endpoints are catheter-related infections or other complications, catheter re-insertion rate, length of hospital (and ICU) stay and mortality. In addition, the cost-effectiveness of the de-implementation strategy will be calculated. This study aims to reduce the use of urinary and intravenous catheters with an inappropriate indication, and as a result reduce the catheter-related complications. If (cost-) effective it provides a tool for a nationwide approach to reduce catheter-related infections and other complications. Dutch trial registry: NTR6015 . Registered 9 August 2016.

Fecal containment in bedridden patients: economic impact of 2 commercial bowel catheter systems.

Science.gov (United States)

Kowal-Vem, Areta; Poulakidas, Stathis; Barnett, Barbara; Conway, Deborah; Culver, Daniel; Ferrari, Michelle; Potenza, Bruce; Koenig, Michael; Mah, John; Majewski, Mary; Morris, Linda; Powers, Jan; Stokes, Elizabeth; Tan, Michael; Salstrom, Sara-Jane; Zaletel, Cindy; Ambutas, Shirley; Casey, Kathleen; Stein, Jayne; DeSane, Mary; Berry, Kathy; Konz, Elizabeth C; Riemer, Michael R; Cullum, Malford E

2009-05-01

Fecal contamination is a major challenge in patients in acute/critical care settings that is associated with increased cost of care and supplies and with development of pressure ulcers, incontinence dermatitis, skin and soft tissue infections, and urinary tract infections. To assess the economic impact of fecal containment in bedridden patients using 2 different indwelling bowel catheters and to compare infection rates between groups. A multicenter, observational study was done at 12 US sites (7 that use catheter A, 5 that use catheter B). Patients were followed from insertion of an indwelling bowel catheter system until the patient left the acute/critical care unit or until 29 days after enrollment, whichever came first. Demographic data, frequency of bedding/dressing changes, incidence of infection, and Braden scores (risk of pressure ulcers) were recorded. The study included 146 bedridden patients (76 with catheter A, 70 with catheter B) who had similar Braden scores at enrollment. The rate of bedding/dressing changes per day differed significantly between groups (1.20 for catheter A vs 1.71 for catheter B; P = .004). According to a formula that accounted for personnel resources and laundry cycle costs, catheter A cost $13.94 less per patient per day to use than did catheter B. Catheter A was less likely than was catheter B to be removed during the observational period (P = .03). Observed infection rates were low. Catheter A may be more cost-effective than catheter B because it requires fewer unscheduled linen changes per patient day.

Silicone Foley′s catheter: A useful splint in ear surgeries

Directory of Open Access Journals (Sweden)

Karanth Siddharth

2008-01-01

Full Text Available Maintenance of ear projection and post auricular sulcus in staged ear reconstruction in microtia is a trying problem. So also is the maintenance of the patency of the external auditory meatus following recanalization and meatoplasty. Numerous splints and dressing techniques have been described for the above situations. Some of the problems encountered include the availability of the materials, cost, expertise in fabrication and compliance. Aims: To devise a simple, reliable, inexpensive and readily available splint for the maintenance of post auricular sulcus and external auditory meatus opening. Settings and Design: A silicone catheter is made out of a soft and inert material that doesn′t cause tissue necrosis or any loss of skin graft. The basic design is that of a simple, self-retaining type of splint that doesn′t dislodge and can be prepared within minutes on the operating table. Materials and Methods: This splint has been used in four cases of microtia reconstruction and one case of congenital external auditory meatus stenosis between June 2006 and August 2007. A 14 or 16 Fr silicone Foley′s catheter was used. The proximal end of a catheter of required length was retained and the distal part was cut off. The catheter was looped into a circle around the base of the reconstructed ear and secured in position with a suture. A similar construct was used in cases of external auditory meatus reconstruction or recanalization. The funnel-shaped distal drainage end was sutured to the circular frame near the region of the tragus. This funnel was inserted into the external auditory canal. Results: The catheter was found to sit snugly in the newly created sulcus, thereby maintaining the sulcus and ear projection. It aided in maintaining the meatal opening of a satisfactory diameter in the case of external auditory canal recanalization. It was never found to slip or get dislodged in any of the cases. There was no skin graft loss or tissue necrosis

Healthcare resource consumption for intermittent urinary catheterisation: cost-effectiveness of hydrophilic catheters and budget impact analyses.

Science.gov (United States)

Rognoni, Carla; Tarricone, Rosanna

2017-01-17

This study presents a cost-effectiveness analysis comparing hydrophilic coated to uncoated catheters for patients performing urinary intermittent catheterisation. A national budget impact analysis is also included to evaluate the impact of intermittent catheterisation for management of bladder dysfunctions over a period of 5 years. A Markov model (lifetime horizon, 1 year cycle length) was developed to project health outcomes (life years and quality-adjusted life years) and economic consequences related to patients using hydrophilic coated or uncoated catheters. The model was populated with catheter-related clinical efficacy data retrieved from randomised controlled trials and quality-of-life data (utility weights) from the literature. Cost data (EUR, 2015) were estimated on the basis of healthcare resource consumption derived from an e-survey addressed to key opinion leaders in the field. Italian Healthcare Service perspective. Patients with spinal cord injury performing intermittent urinary catheterisation in the home setting. Incremental cost-effectiveness and cost-utility ratios (ICER and ICUR) of hydrophilic coated versus uncoated catheters and associated healthcare budget impact. The base-case ICER and ICUR associated with hydrophilic coated catheters were €20 761 and €24 405, respectively. This implies that hydrophilic coated catheters are likely to be cost-effective in comparison to uncoated ones, as proposed Italian threshold values range between €25 000 and €66 400. Considering a market share at year 5 of 89% hydrophilic catheters and 11% uncoated catheters, the additional cost for Italy is approximately €12 million in the next 5 years (current market share scenario for year 0: 80% hydrophilic catheters and 20% uncoated catheters). Considered over a lifetime, hydrophilic coated catheters are potentially a cost-effective choice in comparison to uncoated ones. These findings can assist policymakers in evaluating intermittent

Percutaneous catheter drainage of intrapulmonary fluid collection

International Nuclear Information System (INIS)

Park, E. D.; Kim, H. J.; Choi, P. Y.; Jung, S. H.

1994-01-01

With the success of percutaneous abdominal abscess drainage, attention is now being focused on the use of similar techniques in the thorax. We studied to evaluate the effect of percutaneous drainage in parenchymal fluid collections in the lungs. We performed percutaneous drainage of abscesses and other parenchymal fluid collections of the lungs in 15 patients. All of the procedures were performed under the fluoroscopic guidance with an 18-gauge Seldinger needle and coaxial technique with a 8-10F drainage catheter. Among 10 patients with lung abscess, 8 patients improved by percutaneous catheter drainage. In one patient, drainage was failed by the accidental withdrawal of the catheter before complete drainage. One patient died of sepsis 5 hours after the procedure. Among three patients with complicated bulla, successful drainage was done in two patients, but in the remaining patient, the procedure was failed. In one patient with intrapulmonary bronchogenic cyst, the drainage was not successful due to the thick internal contents. In one patient with traumatic hematoma, after the drainage of old blood clots, the signs of infection disappeared. Overally, of 14 patients excluding one who died, 11 patients improved with percutaneous catheter drainage and three patients did not. There were no major complications during and after the procedure. We conclude that percutaneous catheter drainage is effective and safe procedure for the treatment of parenchymal fluid collections of the lung in patients unresponsive to the medical treatment

Percutaneous catheter drainage of intrapulmonary fluid collection

Energy Technology Data Exchange (ETDEWEB)

Park, E. D.; Kim, H. J.; Choi, P. Y.; Jung, S. H. [Gyeongsang National University Hospital, Chinju (Korea, Republic of)

1994-01-15

With the success of percutaneous abdominal abscess drainage, attention is now being focused on the use of similar techniques in the thorax. We studied to evaluate the effect of percutaneous drainage in parenchymal fluid collections in the lungs. We performed percutaneous drainage of abscesses and other parenchymal fluid collections of the lungs in 15 patients. All of the procedures were performed under the fluoroscopic guidance with an 18-gauge Seldinger needle and coaxial technique with a 8-10F drainage catheter. Among 10 patients with lung abscess, 8 patients improved by percutaneous catheter drainage. In one patient, drainage was failed by the accidental withdrawal of the catheter before complete drainage. One patient died of sepsis 5 hours after the procedure. Among three patients with complicated bulla, successful drainage was done in two patients, but in the remaining patient, the procedure was failed. In one patient with intrapulmonary bronchogenic cyst, the drainage was not successful due to the thick internal contents. In one patient with traumatic hematoma, after the drainage of old blood clots, the signs of infection disappeared. Overally, of 14 patients excluding one who died, 11 patients improved with percutaneous catheter drainage and three patients did not. There were no major complications during and after the procedure. We conclude that percutaneous catheter drainage is effective and safe procedure for the treatment of parenchymal fluid collections of the lung in patients unresponsive to the medical treatment.

Per-rectal portal scintigraphy in chronic liver diseases

International Nuclear Information System (INIS)

Frusciante, V.; Barbano, F.; Btuno, M.; Facciorusso, D.; Tonti, P.; Giacobbe, A.; Andriulli, A.; Vettori, P.G.P.

1993-01-01

Portal circulation has been evaluated by per-rectal portal scintigraphy in 21 controls and in 30 pts affected by chronic liver diseases. Tc99m-pertechnetate (10 mci) was given through a Nelaton's catheter in the upper rectum; a per-rectal portal shunt index (SI) was calculated. A relevant overlap is evident between controls and CHP pts; no overlap exists between controls and B or C graded cirrhosis. We conclude that the technique may be suggested to monitor the course of chronic liver diseases and different therapeutic regimens. (orig.) [de

Dialysis catheter-related superior vena cava syndrome with patent vena cava: Long term efficacy of unilateral viatorr stent-graft avoiding catheter manipulation

Energy Technology Data Exchange (ETDEWEB)

Quaretti, Pietro; Galli, Franco; Maramarco, Lorenzo Paplo; Corti, Riccardo; Leati, Giovanni; Fiorina, Ilaria; Maestri, Marcello [IRCCS Policlinico San Matteo Foundation, Pavia (Italy)

2014-06-15

Central venous catheters are the most frequent causes of benign central vein stenosis. We report the case of a 79-year-old woman on hemodialysis through a twin catheter in the right internal jugular vein, presenting with superior vena cava (SVC) syndrome with patent SVC. The clinically driven endovascular therapy was conducted to treat the venous syndrome with a unilateral left brachiocephalic stent-graft without manipulation of the well-functioning catheter. The follow-up was uneventful until death 94 months later.

Dialysis catheter-related superior vena cava syndrome with patent vena cava: Long term efficacy of unilateral viatorr stent-graft avoiding catheter manipulation

International Nuclear Information System (INIS)

Quaretti, Pietro; Galli, Franco; Maramarco, Lorenzo Paplo; Corti, Riccardo; Leati, Giovanni; Fiorina, Ilaria; Maestri, Marcello

2014-01-01

Central venous catheters are the most frequent causes of benign central vein stenosis. We report the case of a 79-year-old woman on hemodialysis through a twin catheter in the right internal jugular vein, presenting with superior vena cava (SVC) syndrome with patent SVC. The clinically driven endovascular therapy was conducted to treat the venous syndrome with a unilateral left brachiocephalic stent-graft without manipulation of the well-functioning catheter. The follow-up was uneventful until death 94 months later.

Multiple Coaxial Catheter System for Reliable Access in Interventional Stroke Therapy

International Nuclear Information System (INIS)

Kulcsar, Zsolt; Yilmaz, Hasan; Bonvin, Christophe; Lovblad, Karl O.; Ruefenacht, Daniel A.

2010-01-01

In some patients with acute cerebral vessel occlusion, navigating mechanical thrombectomy systems is difficult due to tortuous anatomy of the aortic arch, carotid arteries, or vertebral arteries. Our purpose was to describe a multiple coaxial catheter system used for mechanical revascularization that helps navigation and manipulations in tortuous vessels. A triple or quadruple coaxial catheter system was built in 28 consecutive cases presenting with acute ischemic stroke. All cases were treated by mechanical thrombectomy with the Penumbra System. In cases of unsuccessful thrombo-aspiration, additional thrombolysis or angioplasty with stent placement was used for improving recanalization. The catheter system consisted of an outermost 8-Fr and an intermediate 6-Fr guiding catheter, containing the inner Penumbra reperfusion catheters. The largest, 4.1-Fr, reperfusion catheter was navigated over a Prowler Select Plus microcatheter. The catheter system provided access to reach the cerebral lesions and provided stability for the mechanically demanding manipulations of thromboaspiration and stent navigation in all cases. Apart from their mechanical role, the specific parts of the system could also provide access to different types of interventions, like carotid stenting through the 8-Fr guiding catheter and intracranial stenting and thrombolysis through the Prowler Select Plus microcatheter. In this series, there were no complications related to the catheter system. In conclusion, building up a triple or quadruple coaxial system proved to be safe and efficient in our experience for the mechanical thrombectomy treatment of acute ischemic stroke.

Septic Thrombophlebitis of the Cephalic Vein Caused by a Peripherally Inserted Venous Catheter

Directory of Open Access Journals (Sweden)

M Mirmohammadsadeghi

2005-07-01

Full Text Available Septic thrombophlebitis of a vein is a rare but life-threatening complication of an intravascular (IV catheter placed percutaneously in the veins. Most published clinical experiences with IV catheters, mainly in the outpatient settings, have reported very low rates of catheter-related bloodstream infection compared to rates with central venous catheters placed in a subclavian or internal jugular vein. Most of the complications reported with IV catheters have been non-infectious, particularly sterile phlebitis or thrombosis. We report a case of cephalic vein suppurative thrombophlebitis from an intravascular catheter and offer guidelines for diagnosis and management of this complication. Key words: Septic thrombophlebitis, Intravascular catheter, Suppurative thrombophlebitis

Radiologic interventional retrieval of retained central venous catheter fragment in prematurity: case report

International Nuclear Information System (INIS)

Park, Jee Won; Jo, Jung Hyun; Park, Byeong Ho

2007-01-01

The fracture of a central venous catheter is a rare but potentially serious complication. Moreover, removal of the broken catheter pieces is considerably challenging, especially for premature infants. We report 3 case studies of the percutaneous transcatheter retrieval of broken catheter parts in 3 premature infants. We confirmed the location of the catheter fragments via a DSA venogram with diluted contrast media. Using the minimum amount of contrast, and extreme caution, we made certain no contrast-induced nephrotoxicity of air embolism occurred during catheter manipulation. In addition, when the broken fragment was curled or attached to the cardiac wall, we used a hook-shaped catheter to facilitate the capturing of the catheter with a loopsnare. This report demonstrates the feasibility of removing a retained catheter fragment in a premature infant using a percutaneous transcatheter approach

Effect of Foley catheters on seed positions and urethral dose in 125I and 103Pd prostate implants

International Nuclear Information System (INIS)

Brezovich, Ivan A.; Pareek, Prem N.; Duan, Jun; Fiveash, John

2001-01-01

Purpose: To estimate the perturbation of seed position and urethral dose, subsequent to withdrawal of urethral catheters. Methods and Materials: A mathematical model based on the volume incompressibility of tissues was used to compute seed positions and doses following removal of the Foley. The model assumed that the central axis of the urethra remains stationary, and that prostate tissue and seeds move radially toward the center of the urethra to fill the void left by the catheter. Seed motion has also been measured using transrectal ultrasound. Results: Based on the computations, seeds located originally close to the urethra travel relatively large distances toward the urethra upon Foley removal, whereas seeds located further away move substantially less. This seed motion leads to higher urethral doses than shown in a standard treatment plan. Dose enhancements increase with catheter size, decrease with increasing prostate volume, are more pronounced for 103 Pd than for 125 I, and range between 3.5% and 32.4%. Postimplant dosimetry is equally affected if images are taken with urethral catheters in place, showing lower urethral doses than actually delivered. Preliminary ultrasound based measurements of seed motion agree with the theory. Conclusion: During the implantation procedure, 12 fr or smaller urethral catheters are preferable to larger diameter catheters if urine drainage is sufficient. Treatment planners should avoid planning seeds at 5 mm or closer from the urethra. Special caution is indicated in prostates having about 20 cm 3 or smaller volumes, and when 103 Pd is used. Postimplant dosimetry is susceptible to the same errors

Foley Catheter versus Vaginal Misoprostol for Labour Induction

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Nasreen Noor

2015-01-01

Full Text Available Objectives. To compare the efficacy and safety of intravaginal misoprostol with transcervical Foley catheter for labour induction. Material and Methods. One hundred and four women with term gestation, with Bishop score < 4, and with various indications for labour induction were randomly divided into two groups. In Group I, 25 μg of misoprostol tablet was placed intravaginally, 4 hourly up to maximum 6 doses. In Group II, Foley catheter 16F was placed through the internal os of the cervix under aseptic condition and then inflated with 50 cc of sterile saline. Statistical analysis was done using SPSS software. Results. The induction to delivery interval was 14.03 ± 7.61 hours versus 18.40 ± 8.02 hours (p<0.01. The rate of vaginal delivery was 76.7% versus 56.8% in misoprostol and transcervical Foley catheter group, respectively. Uterine hyperstimulation was more common with misoprostol. Neonatal outcome was similar in both the groups. Conclusion. Intravaginal misoprostol is associated with a shorter induction to delivery interval as compared to Foley’s catheter and it increases the rate of vaginal delivery in cases of unripe cervix at term. Transcervical Foley catheter is associated with a lower incidence of uterine hyperstimulation during labour.

Catheter-based time-gated near-infrared fluorescence/OCT imaging system

Science.gov (United States)

Lu, Yuankang; Abran, Maxime; Cloutier, Guy; Lesage, Frédéric

2018-02-01

We developed a new dual-modality intravascular imaging system based on fast time-gated fluorescence intensity imaging and spectral domain optical coherence tomography (SD-OCT) for the purpose of interventional detection of atherosclerosis. A pulsed supercontinuum laser was used for fluorescence and OCT imaging. A double-clad fiber (DCF)- based side-firing catheter was designed and fabricated to have a 23 μm spot size at a 2.2 mm working distance for OCT imaging. Its single-mode core is used for OCT, while its inner cladding transports fluorescence excitation light and collects fluorescent photons. The combination of OCT and fluorescence imaging was achieved by using a DCF coupler. For fluorescence detection, we used a time-gated technique with a novel single-photon avalanche diode (SPAD) working in an ultra-fast gating mode. A custom-made delay chip was integrated in the system to adjust the delay between the excitation laser pulse and the SPAD gate-ON window. This technique allowed to detect fluorescent photons of interest while rejecting most of the background photons, thus leading to a significantly improved signal to noise ratio (SNR). Experiments were carried out in turbid media mimicking tissue with an indocyanine green (ICG) inclusion (1 mM and 100 μM) to compare the time-gated technique and the conventional continuous detection technique. The gating technique increased twofold depth sensitivity, and tenfold SNR at large distances. The dual-modality imaging capacity of our system was also validated with a silicone-based tissue-mimicking phantom.

Hemodialysis Catheter Heat Transfer for Biofilm Prevention and Treatment.

Science.gov (United States)

Richardson, Ian P; Sturtevant, Rachael; Heung, Michael; Solomon, Michael J; Younger, John G; VanEpps, J Scott

2016-01-01

Central line-associated bloodstream infections (CLABSIs) are not easily treated, and many catheters (e.g., hemodialysis catheters) are not easily replaced. Biofilms (the source of infection) on catheter surfaces are notoriously difficult to eradicate. We have recently demonstrated that modest elevations of temperature lead to increased staphylococcal susceptibility to vancomycin and significantly soften the biofilm matrix. In this study, using a combination of microbiological, computational, and experimental studies, we demonstrate the efficacy, feasibility, and safety of using heat as an adjuvant treatment for infected hemodialysis catheters. Specifically, we show that treating with heat in the presence of antibiotics led to additive killing of Staphylococcus epidermidis with similar trends seen for Staphylococcus aureus and Klebsiella pneumoniae. The magnitude of temperature elevation required is relatively modest (45-50°C) and similar to that used as an adjuvant to traditional cancer therapy. Using a custom-designed benchtop model of a hemodialysis catheter, positioned with tip in the human vena cava as well as computational fluid dynamic simulations, we demonstrate that these temperature elevations are likely achievable in situ with minimal increased in overall blood temperature.

Infection and natural history of emergency department-placed central venous catheters.

Science.gov (United States)

LeMaster, Christopher H; Schuur, Jeremiah D; Pandya, Darshan; Pallin, Daniel J; Silvia, Jennifer; Yokoe, Deborah; Agrawal, Ashish; Hou, Peter C

2010-11-01

Central line-associated bloodstream infection (CLABSI, hereafter referred to in this paper as "bloodstream infection") is a leading cause of hospital-acquired infection. To our knowledge, there are no previously published studies designed to determine the rate of bloodstream infection among central venous catheters placed in the emergency department (ED). We design a retrospective chart review methodology to determine bloodstream infection and duration of catheterization for central venous catheters placed in the ED. Using hospital infection control, administrative, and ED billing databases, we identified patients with central venous catheters placed in the ED between January 1, 2007, and December 31, 2008, at one academic, urban ED with an annual census of 57,000. We performed a structured, explicit chart review to determine duration of catheterization and confirm bloodstream infection. We screened 4,251 charts and identified 656 patients with central venous catheters inserted in the ED, 3,622 catheter-days, and 7 bloodstream infections. The rate of bloodstream infection associated with central venous catheters placed in the ED was 1.93 per 1,000 catheter-days (95% confidence interval 0.50 to 3.36). The mean duration of catheterization was 5.5 days (median 4; range 1 to 29 days). Among infected central venous catheters, the mean duration of catheterization was 8.6 days (median 7; range 2 to 19 days). A total of 667 central venous catheters were placed in the internal jugular (392; 59%), subclavian (145; 22%), and femoral (130; 19%) veins. The sensitivity of using ED procedural billing code for identifying ED-placed central venous catheters among patients subsequently admitted to any ICU was 74.9% (95% confidence interval 71.4% to 78.3%). The rate of ED bloodstream infection at our institution is similar to current rates in ICUs. Central venous catheters placed in the ED remain in admitted patients for a substantial period. Copyright © 2010 American College of

Detection of electrophysiology catheters in noisy fluoroscopy images

NARCIS (Netherlands)

Franken, E.M.; Rongen, P.M.J.; Almsick, van M.A.; Haar Romenij, ter B.M.

2006-01-01

Cardiac catheter ablation is a minimally invasive medical procedure to treat patients with heart rhythm disorders. It is useful to know the positions of the catheters and electrodes during the intervention, e.g. for the automatization of cardiac mapping. Our goal is therefore to develop a robust

Towards modeling of cardiac micro-structure with catheter-based confocal microscopy: a novel approach for dye delivery and tissue characterization.

Science.gov (United States)

Lasher, Richard A; Hitchcock, Robert W; Sachse, Frank B

2009-08-01

This work presents a methodology for modeling of cardiac tissue micro-structure. The approach is based on catheter-based confocal imaging systems, which are emerging as tools for diagnosis in various clinical disciplines. A limitation of these systems is that a fluorescent marker must be available in sufficient concentration in the imaged region. We introduce a novel method for the local delivery of fluorescent markers to cardiac tissue based on a hydro-gel carrier brought into contact with the tissue surface. The method was tested with living rabbit cardiac tissue and applied to acquire three-dimensional image stacks with a standard inverted confocal microscope and two-dimensional images with a catheter-based confocal microscope. We processed these image stacks to obtain spatial models and quantitative data on tissue microstructure. Volumes of atrial and ventricular myocytes were 4901 +/- 1713 and 10 299 +/-3598 mum (3) (mean+/-sd), respectively. Atrial and ventricular myocyte volume fractions were 72.4 +/-4.7% and 79.7 +/- 2.9% (mean +/-sd), respectively. Atrial and ventricular myocyte density was 165 571 +/- 55 836 and 86 957 +/- 32 280 cells/mm (3) (mean+/-sd), respectively. These statistical data and spatial descriptions of tissue microstructure provide important input for modeling studies of cardiac tissue function. We propose that the described methodology can also be used to characterize diseased tissue and allows for personalized modeling of cardiac tissue.

Intravascular (catheter) MR imaging

International Nuclear Information System (INIS)

Cohen, A.M.; Hurst, G.C.; Katz, D.E.; Dverk, J.L.; Wiesen, E.J.; Czerski, L.W.; Malaya, R.; Bellon, E.M.

1989-01-01

Intravascular MR probes allow excellent spatial resolution and have the potential to detect arterial wall microstructure. Ultrasonic intravascular probes suggest that detailed morphologic information can assist clinical decision making. Catheter MR probes of 2--7 mm outside diameter (OD) were built of copper wire, Teflon, and parts from standard commercial catheters. The probes were connected to the surface coil receiver input of our Picker VISTA 2055HP 1.5-T imaging system. The extant (linear) body coil was used for transmit. Phantoms were constructed of coaxial glass MR tubes, filled with doped water. Watanabe rabbit aorta and human autopsy iliac artery specimens were examined within 4 hours of excision or stored by freezing. In vivo iliac arteries in dogs under general anesthesia were imaged, with percutaneous placement of the probe. Results are presented

Catheter Removal versus Retention in the Management of Catheter-Associated Enterococcal Bloodstream Infections

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Jonas Marschall

2013-01-01

Full Text Available BACKGROUND: Enterococci are an important cause of central venous catheter (CVC-associated bloodstream infections (CA-BSI. It is unclear whether CVC removal is necessary to successfully manage enterococcal CA-BSI.

Cost-effectiveness of a central venous catheter care bundle.

Directory of Open Access Journals (Sweden)

Kate A Halton

Full Text Available BACKGROUND: A bundled approach to central venous catheter care is currently being promoted as an effective way of preventing catheter-related bloodstream infection (CR-BSI. Consumables used in the bundled approach are relatively inexpensive which may lead to the conclusion that the bundle is cost-effective. However, this fails to consider the nontrivial costs of the monitoring and education activities required to implement the bundle, or that alternative strategies are available to prevent CR-BSI. We evaluated the cost-effectiveness of a bundle to prevent CR-BSI in Australian intensive care patients. METHODS AND FINDINGS: A Markov decision model was used to evaluate the cost-effectiveness of the bundle relative to remaining with current practice (a non-bundled approach to catheter care and uncoated catheters, or use of antimicrobial catheters. We assumed the bundle reduced relative risk of CR-BSI to 0.34. Given uncertainty about the cost of the bundle, threshold analyses were used to determine the maximum cost at which the bundle remained cost-effective relative to the other approaches to infection control. Sensitivity analyses explored how this threshold alters under different assumptions about the economic value placed on bed-days and health benefits gained by preventing infection. If clinicians are prepared to use antimicrobial catheters, the bundle is cost-effective if national 18-month implementation costs are below $1.1 million. If antimicrobial catheters are not an option the bundle must cost less than $4.3 million. If decision makers are only interested in obtaining cash-savings for the unit, and place no economic value on either the bed-days or the health benefits gained through preventing infection, these cost thresholds are reduced by two-thirds. CONCLUSIONS: A catheter care bundle has the potential to be cost-effective in the Australian intensive care setting. Rather than anticipating cash-savings from this intervention, decision

Temperature-controlled irrigated tip radiofrequency catheter ablation

DEFF Research Database (Denmark)

Petersen, H H; Chen, X; Pietersen, Adrian

1998-01-01

INTRODUCTION: In patients with ventricular tachycardias due to structural heart disease, catheter ablation cures radiofrequency ablation. Irrigated tip radiofrequency ablation using power control and high infusion rates enlarges lesion......: We conclude that temperature-controlled radiofrequency ablation with irrigated tip catheters using low target temperature and low infusion rate enlarges lesion size without increasing the incidence of cratering and reduces coagulum formation of the tip....

More than just a urinary catheter — Haemorrhage control by using a Foley catheter in a penetrating aortic root injury

Directory of Open Access Journals (Sweden)

Adel Elmoghrabi

2016-08-01

Full Text Available The prevalence of great vessel injuries in thoracic trauma is reported at 0.3–10%, predominantly due to a penetrating mechanism. Thoracic aortic injuries, more specifically those within proximity of the aortic root are challenging to manage and unceasing bleeding hampers adequate visualisation for performing repair. We report a case of a 31-year-old male that presented to the emergency department 1 h after sustaining a stab wound injury within proximity of the left upper sternal border. Vital signs were stable on presentation. Physical examination revealed a 1.5 cm laceration in the 3rd intercostal space. Chest X-ray revealed a small left pneumothorax, FAST scan was negative, and CT of the chest revealed left sided haemopneumothorax and haemopericardium. The patient was emergently transferred to the operating room where median thoracotomy was performed. A significant amount of bleeding was observed originating from a 1 cm laceration of the aortic root. Bleeding was controlled using a Foley catheter after unsuccessful attempts of digital compression, and the laceration was repaired using pledgeted sutures. Postoperative echocardiography and CT scan of the chest revealed normal cardiac functions with resolution of haemopericardium and haemopneumothorax, and the patient was discharged in a stable condition. High index of suspicion should be maintained for injury to the great vessels in patients with penetrating chest injuries, despite apparent haemodynamic stability. In this case, balloon tamponade using a Foley catheter served as a quick and simple technique that resulted in an almost bloodless field, facilitating adequate visualisation for definitive repair. Although the use of this technique has been previously described, this report serves as a reminder that a Foley catheter can be successfully used for balloon catheter tamponade in injuries to the aortic root. Keywords: Aortic root, Injury, Foley's catheter, Balloon catheter, Aorta

Remote Hemorrhage after Burr Hole Drainage of Chronic Subdural Hematoma.

Science.gov (United States)

Kim, Chang Hyeun; Song, Geun Sung; Kim, Young Ha; Kim, Young Soo; Sung, Soon Ki; Son, Dong Wuk; Lee, Sang Weon

2017-10-01

Chronic subdural hematoma (CSDH) and symptomatic subdural hygroma are common diseases that require neurosurgical management. Burr hole trephination is the most popular surgical treatment for CSDH and subdural hygroma because of a low recurrence rate and low morbidity compared with craniotomy with membranectomy, and twist-drill craniotomy. Many reports suggest that placing a catheter in the subdural space for drainage can further reduce the rate of recurrence; however, complications associated with this type of drainage include acute subdural hematoma, cortical injury, and infection. Remote hemorrhage due to overdrainage of cerebrospinal fluid (CSF) is another possible complication of burr hole trephination with catheter drainage that has rarely been reported. Here, we present 2 cases of remote hemorrhages following burr hole trephination with catheter drainage for the treatment of CSDH and symptomatic subdural hygroma. One patient developed intracerebral hemorrhage and subarachnoid hemorrhage in the contralateral hemisphere, while another patient developed remote hemorrhage 3 days after the procedure due to the sudden drainage of a large amount of subdural fluid over a 24-hour period. These findings suggest that catheter drainage should be carefully monitored to avoid overdrainage of CSF after burr hole trephination.

Needle catheter duodenostomy: a technique for duodenal alimentation of birds.

Science.gov (United States)

Goring, R L; Goldman, A; Kaufman, K J; Roberts, C; Quesenberry, K E; Kollias, G V

1986-11-01

A technique for duodenal alimentation (needle catheter duodenostomy) of birds was developed, using the domestic pigeon (Columba livia) as the experimental model. A needle catheter was inserted into the descending duodenum of 5 pigeons and was secured to the body wall and dorsum of each bird. A liquid diet was administered daily (in equal amounts of 0, 4, 8, 12, and 16 hours) for 14 days without adverse effects. On day 15, the catheters were removed, and the birds immediately resumed normal consumption of a pigeon ration and water diet. Although 4 of the 5 birds had minor weight loss, dietary alterations probably could be used on an individual basis to alleviate this problem. After oral alimentation was resumed, the 5 birds exceeded their initial body weight within 7 days. Four weeks after catheter removal, positive-contrast radiographic evaluations indicated that the duodenum of each pigeon appeared normal. Needle catheter duodenostomy was a viable method of alimentation in the domestic pigeon. This technique should be applicable for other avian species requiring bypass of the upper gastrointestinal tract proximal to the region of catheter insertion in the duodenum.

A novel suture method to place and adjust peripheral nerve catheters

DEFF Research Database (Denmark)

Rothe, C.; Steen-Hansen, C.; Madsen, M. H.

2015-01-01

We have developed a peripheral nerve catheter, attached to a needle, which works like an adjustable suture. We used in-plane ultrasound guidance to place 45 catheters close to the femoral, saphenous, sciatic and distal tibial nerves in cadaver legs. We displaced catheters after their initial...

Using an indwelling catheter for the domiciliary management of malignant effusions

Directory of Open Access Journals (Sweden)

Ramkumar P

2003-01-01

Full Text Available Background: Many patients with malignant pleural effusions and ascites require repeated hospital visits for paracentesis. Materials and Methods: Patients and caregivers were taught to drain malignant effusions at home, using an indwelling catheter inserted into the pleural/ peritoneal cavity. The catheter, (ARROW 14 wire gauge with three additional side holes made to prevent blockage was inserted using the Seldenger technique for central venous cannulation and secured with a stitch. A three way stopcock was used to regulate fluid drainage. The caregiver was taught to do biweekly dressings with antiseptic ointment. Results: The catheter has been used in 200 patients over a period of five years. Two patients developed infections in the pleural cavity, which were managed with antibiotics. Two patients needed catheter change because of blockage. Other patients retained the catheter till last follow up or death. The procedure can be carried out as a day case. This article describes practical guidelines for inserting and maintaining the catheter.

Three-dimensional tracking of cardiac catheters using an inverse geometry x-ray fluoroscopy system

International Nuclear Information System (INIS)

Speidel, Michael A.; Tomkowiak, Michael T.; Raval, Amish N.; Van Lysel, Michael S.

2010-01-01

Purpose: Scanning beam digital x-ray (SBDX) is an inverse geometry fluoroscopic system with high dose efficiency and the ability to perform continuous real-time tomosynthesis at multiple planes. This study describes a tomosynthesis-based method for 3D tracking of high-contrast objects and present the first experimental investigation of cardiac catheter tracking using a prototype SBDX system. Methods: The 3D tracking algorithm utilizes the stack of regularly spaced tomosynthetic planes that are generated by SBDX after each frame period (15 frames/s). Gradient-filtered versions of the image planes are generated, the filtered images are segmented into object regions, and then a 3D coordinate is calculated for each object region. Two phantom studies of tracking performance were conducted. In the first study, an ablation catheter in a chest phantom was imaged as it was pulled along a 3D trajectory defined by a catheter sheath (10, 25, and 50 mm/s pullback speeds). SBDX tip tracking coordinates were compared to the 3D trajectory of the sheath as determined from a CT scan of the phantom after the registration of the SBDX and CT coordinate systems. In the second study, frame-to-frame tracking precision was measured for six different catheter configurations as a function of image noise level (662-7625 photons/mm 2 mean detected x-ray fluence at isocenter). Results: During catheter pullbacks, the 3D distance between the tracked catheter tip and the sheath centerline was 1.0±0.8 mm (mean ±one standard deviation). The electrode to centerline distances were comparable to the diameter of the catheter tip (2.3 mm), the confining sheath (4 mm outside diameter), and the estimated SBDX-to-CT registration error (±0.7 mm). The tip position was localized for all 332 image frames analyzed and 83% of tracked positions were inside the 3D sheath volume derived from CT. The pullback speeds derived from the catheter trajectories were within 5% of the programed pullback speeds. The

The left atrial catheter: its uses and complications.

Science.gov (United States)

Leitman, B S; Naidich, D P; McGuinness, G; McCauley, D I

1992-11-01

The authors describe the radiographic appearance of the left atrial catheter, a widely used postsurgical intracardiac device. Recognition of the characteristic appearance of this catheter should be of value in detection of potential complications, including line fracture with resultant retention and/or embolization, infection, prosthetic valve dysfunction, and even cardiac tamponade.

A prototype catheter designed for ultraviolet C disinfection

DEFF Research Database (Denmark)

Bak, Jimmy; Begovic, Tanja

2013-01-01

UVC light exposure, sampling and plate counting. Findings Two minutes of UVC exposure was sufficient to obtain 4 log10 disinfection for the full-length prototype catheter. This exposure corresponds to ∼40 mJ/cm2 at the catheter tip and indicates that even shorter exposure times can be achieved...

Early catheter removal after radical retropubic prostatectomy: long-term followup.

Science.gov (United States)

Koch, Michael O; Nayee, Anish H; Sloan, James; Gardner, Thomas; Wahle, Greg R; Bihrle, Richard; Foster, Richard S

2003-06-01

We examine the complication and continence rates with early catheter removal (day 3 or 4) after radical retropubic prostatectomy. A total of 365 patients with localized prostate cancer underwent radical retropubic prostatectomy at Indiana University Hospital with planned urethral catheter removal before discharge home. Low pressure cystograms were performed on postoperative day 3 or 4 to determine if catheter removal was possible. A subset of patients were analyzed using a validated prostate cancer specific questionnaire (University of California, Los Angeles Prostate Cancer Symptom Index) to determine quality of life outcomes. The catheter was removed on postoperative day 3 or 4 in 263 patients (72%). The reasons for leaving the catheter indwelling were significant leak on cystogram or excessive suprapubic drainage (21%), extensive bladder neck reconstruction (1%) and prolonged hospitalization because of an ileus or other complicating factor (6%). Thirteen patients (3.6%) were either unable to void after catheter removal or presented with retention (not associated with hematuria or clots) after hospital discharge, requiring reinsertion of the Foley catheter. A total of 41 patients (11%) had either an early or late complication (excluding incontinence). There were 3 complications (0.8%) that were considered major because they were potentially life threatening or required a return to the operating room. A pelvic abscess developed in 2 patients and a lymphocele in 1, which required percutaneous drainage. After at least 6 months (mean 20.9 months) 140 patients (89.2%) and 14 (8.9%) reported excellent and good continence, respectively. The patient questionnaire demonstrated bother scores to be minimal to no bother for 95% to 98% of patients at 6 and 12 months. This study confirms that it is safe to remove catheters in most patients 3 to 4 days after prostatectomy if a cystogram demonstrates no extravasation. Complication rates and continence rates with this approach

Cost savings from reduced catheter-related bloodstream infection after simulation-based education for residents in a medical intensive care unit.

Science.gov (United States)

Cohen, Elaine R; Feinglass, Joe; Barsuk, Jeffrey H; Barnard, Cynthia; O'Donnell, Anna; McGaghie, William C; Wayne, Diane B

2010-04-01

Interventions to reduce preventable complications such as catheter-related bloodstream infections (CRBSI) can also decrease hospital costs. However, little is known about the cost-effectiveness of simulation-based education. The aim of this study was to estimate hospital cost savings related to a reduction in CRBSI after simulation training for residents. This was an intervention evaluation study estimating cost savings related to a simulation-based intervention in central venous catheter (CVC) insertion in the Medical Intensive Care Unit (MICU) at an urban teaching hospital. After residents completed a simulation-based mastery learning program in CVC insertion, CRBSI rates declined sharply. Case-control and regression analysis methods were used to estimate savings by comparing CRBSI rates in the year before and after the intervention. Annual savings from reduced CRBSIs were compared with the annual cost of simulation training. Approximately 9.95 CRBSIs were prevented among MICU patients with CVCs in the year after the intervention. Incremental costs attributed to each CRBSI were approximately $82,000 in 2008 dollars and 14 additional hospital days (including 12 MICU days). The annual cost of the simulation-based education was approximately $112,000. Net annual savings were thus greater than $700,000, a 7 to 1 rate of return on the simulation training intervention. A simulation-based educational intervention in CVC insertion was highly cost-effective. These results suggest that investment in simulation training can produce significant medical care cost savings.

A system for visualization and automatic placement of the endoclamp balloon catheter

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Furtado, Hugo; Stüdeli, Thomas; Sette, Mauro; Samset, Eigil; Gersak, Borut

2010-02-01

The European research network "Augmented Reality in Surgery" (ARIS*ER) developed a system that supports minimally invasive cardiac surgery based on augmented reality (AR) technology. The system supports the surgical team during aortic endoclamping where a balloon catheter has to be positioned and kept in place within the aorta. The presented system addresses the two biggest difficulties of the task: lack of visualization and difficulty in maneuvering the catheter. The system was developed using a user centered design methodology with medical doctors, engineers and human factor specialists equally involved in all the development steps. The system was implemented using the AR framework "Studierstube" developed at TU Graz and can be used to visualize in real-time the position of the balloon catheter inside the aorta. The spatial position of the catheter is measured by a magnetic tracking system and superimposed on a 3D model of the patient's thorax. The alignment is made with a rigid registration algorithm. Together with a user defined target, the spatial position data drives an actuator which adjusts the position of the catheter in the initial placement and corrects migrations during the surgery. Two user studies with a silicon phantom show promising results regarding usefulness of the system: the users perform the placement tasks faster and more accurately than with the current restricted visual support. Animal studies also provided a first indication that the system brings additional value in the real clinical setting. This work represents a major step towards safer and simpler minimally invasive cardiac surgery.

First reported case of Staphylococcus condimenti infection associated with catheter-related bacteraemia

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Y. Misawa

2015-01-01

Full Text Available We report a case of a patient who experienced a catheter-related bloodstream infection caused by Staphylococcus condimenti, which was first isolated from soy sauce mash. This is the first reported case of human infection. Although blood culture isolates and the catheter tip tube did not reveal coagulase or clumping factor, false-positive results were obtained from latex agglutination tests for clumping factor and protein A due to self-agglutination. Care is needed when performing only latex agglutination test without a coagulase test. Further studies are needed to determine the pathogenic potential of S. condimenti based on appropriate identification.

Micrococcus-associated central venous catheter infection in patients with pulmonary arterial hypertension.

Science.gov (United States)

Oudiz, Ronald J; Widlitz, Allison; Beckmann, X Joy; Camanga, Daisy; Alfie, Jose; Brundage, Bruce H; Barst, Robyn J

2004-07-01

To determine the incidence of catheter-related infection in patients with pulmonary arterial hypertension (PAH) receiving epoprostenol (EPO), and to note an etiologic role for Micrococcus spp, which is rarely reported as a pathogen in the medical literature. Observational study. Two PAH specialty treatment centers, Harbor-UCLA Medical Center (Torrance, CA), and the College of Physicians and Surgeons, Columbia University (New York, NY). A total of 192 patients with PAH receiving continuous therapy with IV EPO. From 1987 to 2000, 192 patients with PAH received infusions of EPO via central venous catheter. Catheter care included regular dressing changes with dry gauze using a sterile procedure, without the use of flushes. Patients were asked to report on known infections and treatments, and symptoms. All infections were verified by a telephone call to the patient, care provider, and microbiology laboratory whenever possible. There were 335,285 catheter days (mean +/- SD, 1,325 +/- 974 catheter days). There were 88 clinical catheter infections with 51 blood culture-positive infections, necessitating catheter removal in 38 instances. The following pathogens were isolated: Staphylococcus aureus (25); Micrococcus spp (14); mixed flora (3); coagulase-negative Staphylococcus spp (2); Corynebacterium spp (2); Serratia marcessens (1); Enterobacter spp (1); Pseudomonas aeruginosa (1); enterococci (1); and unidentified Gram-positive cocci (1). The catheter infection rate was 0.26 per 1,000 catheter days. The use of long-term therapy with continuous EPO appears to be associated with a low incidence of catheter-related infections. Micrococcus spp were the second most common etiologic agent. Caregivers managing patients with PAH must be aware of the risk of catheter infection, as it may contribute to the morbidity and mortality associated with the use of EPO. When isolated, Micrococcus spp should not be viewed as a contaminant, but rather as a true pathogen that may require

Asymptomatic Ventricular Pre-excitation: Between Sudden Cardiac Death and Catheter Ablation.

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Brugada, Josep; Keegan, Roberto

2018-03-01

Debate about the best clinical approach to the management of asymptomatic patients with ventricular pre-excitation and advice on whether or not to invasively stratify and ablate is on-going. Weak evidence about the real risk of sudden cardiac death and the potential benefit of catheter ablation has probably prevented the clarification of action in this not infrequent and sometimes conflicting clinical situation. After analysing all available data, real evidence-based medicine could be the alternative strategy for managing this group of patients. According to recent surveys, most electrophysiologists invasively stratify. Based on all accepted risk factors - younger age, male, associated structural heart disease, posteroseptal localisation, ability of the accessory pathway to conduct anterogradely at short intervals of ≤250 milliseconds and inducibility of sustained atrioventricular re-entrant tachycardia and/or atrial fibrillation - a shared decisionmaking process on catheter ablation is proposed.

Urinary catheterization diary – A useful tool in tracking causes of non-deflating Foley catheter

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C.O. Okorie

2015-06-01

Conclusions: Most urinary catheters marketed in developing countries are unidentifiable after unpacking. A catheterization diary is a useful tool for solving catheter-related problems, and its application in health-care facilities should be encouraged. Companies marketing Foley catheters should print the catheter name on both the catheter packaging and on the catheter itself.

Microbiocidal effects of various taurolidine containing catheter lock solutions

NARCIS (Netherlands)

Olthof, E.D.; Nijland, R van; Gulich, A.F.; Wanten, G.J.A.

2015-01-01

BACKGROUND & AIMS: We have recently shown that a catheter lock solution containing taurolidine dramatically decreases catheter-related bloodstream infections (CRBSI) in patients on home parenteral nutrition (HPN) when compared to heparin. Since several taurolidine formulations are commercially

Empyema and Effusion: Outcome of Image-Guided Small-Bore Catheter Drainage

International Nuclear Information System (INIS)

Keeling, A. N.; Leong, S.; Logan, P. M.; Lee, M. J.

2008-01-01

Empyema and complicated pleural effusion represent common medical problems. Current treatment options are multiple. The purpose of this study was to access the outcome of image-guided, small-bore catheter drainage of empyema and effusion. We evaluated 93 small-bore catheters in 82 patients with pleural effusion (n = 30) or empyema (n = 52), over a 2-year period. Image guidance was with ultrasound (US; n = 56) and CT (n = 37). All patients were followed clinically, with catheter dwell times, catheter outcome, pleural fluid outcome, reinsertion rates, and need for urokinase or surgery recorded. Ninety-three small-bore chest drains (mean=10.2 Fr; range, 8.2-12.2 Fr) were inserted, with an average dwell time of 7.81 days for empyemas and 7.14 days for effusions (p > 0.05). Elective removal rates (73% empyema vs 86% effusions) and dislodgement rates (12% empyema vs 13% effusions) were similar for both groups. Eight percent of catheters became blocked and 17% necessitated reinsertion in empyemas, with no catheters blocked or requiring reinsertion in effusions (p < 0.05). Thirty-two patients (51%) required urokinase in the empyema group, versus 2 patients (6%) in the effusion group (p < 0.05). All treatment failures, requiring surgery, occurred in the empyema group (19%; n = 12; p < 0.05). In conclusion, noninfected pleural collections are adequately treated with small-bore catheters, however, empyemas have a failure rate of 19%. The threshold for using urokinase and larger-bore catheters should be low in empyema

Hematologic patients' clinical and psychosocial experiences with implanted long-term central venous catheter

DEFF Research Database (Denmark)

Møller, Tom; Adamsen, Lis

2010-01-01

A significant decrease in catheter-related infections was demonstrated in our earlier randomized controlled trial of central venous catheter (CVC) care in hematologic patients.......A significant decrease in catheter-related infections was demonstrated in our earlier randomized controlled trial of central venous catheter (CVC) care in hematologic patients....

COST ANALYSIS OF PERIPHERALLY INSERTED CENTRAL CATHETER IN PEDIATRIC PATIENTS.

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Dong, Zhaoxin; Connolly, Bairbre L; Ungar, Wendy J; Coyte, Peter C

2018-01-01

A peripherally inserted central catheter (PICC) is a useful option in providing secure venous access, which enables patients to be discharged earlier with the provision of home care. The objective was to identify the costs associated with having a PICC from a societal perspective, and to identify factors that are associated with total PICC costs. Data were obtained from a retrospective cohort of 469 hospitalized pediatric patients with PICCs inserted. Both direct and indirect costs were estimated from a societal perspective. Insertion costs, complication costs, nurse and physician assessment costs, inpatient ward costs, catheter removal costs, home care costs, travel costs, and the cost associated with productivity losses incurred by parents were included in this study. Based on catheter dwell time, the median total cost associated with a PICC per patient per day (including inpatient hospital costs) was $3,133.5 ($2,210.7-$9,627.0) in 2017 Canadian dollars ($1.00USD = $1.25CAD in 2017). The adjusted mean cost per patient per day was $2,648.2 ($2,402.4-$2,920.4). Excluding inpatient ward costs, the median total and adjusted costs per patient per day were $198.8 ($91.8-$2,475.8) and $362.7($341.0-$386.0), respectively. Younger age, occurrence of complications, more catheter dwell days, wards with more intensive care, and the absence of home care were significant factors associated with higher total PICC costs. This study has demonstrated the costs associated with PICCs. This information may be helpful for healthcare providers to understand PICC related cost in children and resource implications.

A catheter friction tester using balance sensor: Combined evaluation of the effects of mechanical properties of tubing materials and surface coatings.

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Røn, Troels; Jacobsen, Kristina Pilgaard; Lee, Seunghwan

2018-04-24

In this study, we introduce a new experimental approach to characterize the forces emerging from simulated catherization. This setup allows for a linear translation of urinary catheters in vertical direction as controlled by an actuator. By employing silicone-based elastomer with a duct of comparable diameter with catheters as urethra model, sliding contacts during the translation of catheters along the duct is generated. A most unique design and operation feature of this setup is that a digital balance was employed as the sensor to detect emerging forces from simulated catherization. Moreover, the possibility to give a variation in environment (ambient air vs. water), clearance, elasticity, and curvature of silicone-based urethra model allows for the detection of forces arising from diverse simulated catherization conditions. Two types of commercially available catheters varying in tubing materials and surface coatings were tested together with their respective uncoated catheter tubing. The first set of testing on the catheter samples showed that this setup can probe the combined effect from flexural strain of bulk tubing materials and slipperiness of surface coatings, both of which are expected to affect the comfort and smooth gliding in clinical catherization. We argue that this new experimental setup can provide unique and valuable information in preclinical friction testing of urinary catheters. Copyright © 2018 Elsevier Ltd. All rights reserved.

Chronic urinary tract infections in patients with spinal cord lesions - biofilm infection with need for long-term antibiotic treatment.

Science.gov (United States)

Tofte, Nete; Nielsen, Alex C Y; Trøstrup, Hannah; Andersen, Christine B; Von Linstow, Michael; Hansen, Birgitte; Biering-Sørensen, Fin; Høiby, Niels; Moser, Claus

2017-04-01

Patients suffering from spinal cord injuries resulting in complete or incomplete paraplegia or tetraplegia are highly disposed to frequent, recurrent or even chronic urinary tract infections (UTIs). The reason for the increased risk of acquiring UTIs is multifactorial, including reduced sensation of classical UTI symptoms, incomplete bladder emptying, frequent catheterizations or chronic urinary tract catheters. Biofilms in relation to UTIs have been shown both on catheters, on concrements or as intracellular bacterial communities (IBCs). Due to the increased risk of acquiring recurrent or chronic UTIs and frequent antibiotic treatments, patients experience an increased risk of being infected with antibiotic-resistant bacteria like extended-spectrum β-lactamase-producing Escherichia coli or Klebsiella spp., but also bacteria like Pseudomonas aeruginosa inherently resistant to several antibiotics. Diagnosing the UTI can also be challenging, especially distinguishing harmless colonization from pathogenic infection. Based on a previous study showing activation of humoral immune response toward UTI pathogens in patients with spinal cord lesions (SCL), the present mini review is an evaluation of using antibody response as an indicator of chronic biofilm UTI. In addition, we evaluated the effect of long-term treatment with antibiotics in patients with SCLs and chronic UTI, defined by culturing of a uropathogen in the urine and elevated specific precipitating antibodies against the same uropathogen in a blood sample. Elimination of chronic UTI, decrease in specific precipitating antibody values and avoiding selection of new multidrug-resistant (MDR) uropathogens were the primary markers for effect of treatment. The results of this evaluation suggest that the long-term treatment strategy in SCL patients with chronic UTI may be effective; however, randomized prospective results are needed to confirm this. © 2017 APMIS. Published by John Wiley & Sons Ltd.

Minimizing Hemodialysis Catheter Dysfunction: An Ounce of Prevention

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Timmy Lee

2012-01-01

Full Text Available The maintenance of tunneled catheter (TC patency is critical for the provision of adequate hemodialysis in patients who are TC-dependent. TC dysfunction results in the need for costly and inconvenient interventions, and reduced quality of life. Since the introduction of TCs in the late 1980s, heparin catheter lock has been the standard prophylactic regimen for the prevention of TC dysfunction. More recently, alternative catheter locking agents have emerged, and in some cases have shown to be superior to heparin lock with respect to improving TC patency and reducing TC-associated infections. These include citrate, tissue plasminogen activator, and a novel agent containing sodium citrate, methylene blue, methylparaben, and propylparaben. In addition, prophylaxis using oral anticoagulants/antiplatelet agents, including warfarin, aspirin, ticlodipine, as well as the use of modified heparin-coated catheters have also been studied for the prevention of TC dysfunction with variable results. The use of oral anticoagulants and/or antiplatelet agents as primary or secondary prevention of TC dysfunction must be weighed against their potential adverse effects, and should be individualized for each patient.

Predicting success of catheter drainage in infected necrotizing pancreatitis

NARCIS (Netherlands)

Hollemans, Robbert A.; Bollen, Thomas L.; Van Brunschot, Sandra; Bakker, Olaf J.; Ali, Usama Ahmed; Van Goor, Harry; Boermeester, Marja A.; Gooszen, Hein G.; Besselink, Marc G.; Van Santvoort, Hjalmar C.

2016-01-01

Introduction: At least 30% of patients with infected necrotizing pancreatitis are successfully treated with catheter drainage alone. It is currently not possible to predict which patients also need necrosectomy. We evaluated predictive factors for successful catheter drainage. Methods: This was a

Predicting Success of Catheter Drainage in Infected Necrotizing Pancreatitis

NARCIS (Netherlands)

Hollemans, R.A.; Bollen, T.L.; Brunschot, S. van; Bakker, O.J.; Ali, U. Ahmed; Goor, H. van; Boermeester, M.A.; Gooszen, H.G.; Besselink, M.G.; Santvoort, H.C. van

2016-01-01

INTRODUCTION: At least 30% of patients with infected necrotizing pancreatitis are successfully treated with catheter drainage alone. It is currently not possible to predict which patients also need necrosectomy. We evaluated predictive factors for successful catheter drainage. METHODS: This was a

Qureshi-5 Catheter for Complex Supra- and Abdominal-Aortic Catheterization.

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Qureshi, Adnan I; Xiao, WeiGang; Liu, HongLiang

2015-10-01

The use of previously described catheter technique was expanded to complex supra- and abdominal- aortic catheterizations. A new (Qureshi 5) catheter with curved shape at the distal end that has two lumens was used. One of lumens can accommodate a 0.035-inch guide wire and the second lumen can accommodate a 0.018-inch guide wire and terminates at the beginning of the distal curve of the first lumen. The manipulation and engagement of the curved distal end catheter was facilitated by rotation and movement of the J-shaped 0.018-inch guide wire extended coaxial and beyond the distal end of catheter. Subsequently, either contrast was injected or a 0.035-inch guide wire advanced into the target artery. The catheters were used in one patient to perform diagnostic cerebral and abdominal angiography through a 6F introducer sheath placed in the right common femoral artery. The catheterization was complex because of severe tortuosity of arch and descending aorta secondary to kyphosis. The left and right internal carotid arteries and left and right vertebral arteries, left renal artery, and superior mesenteric artery were catheterized in patient (fluoroscopy time 19:46 min). No complications were observed in the patient. The Qureshi-5 catheter was successful in complex supra- and abdominal-aortic catheterizations.

WE-G-17A-05: Real-Time Catheter Localization Using An Active MR Tracker for Interstitial Brachytherapy

Energy Technology Data Exchange (ETDEWEB)

Wang, W; Damato, A; Viswanathan, A; Cormack, R [Dana Farber Cancer Institute / Brigham and Women' s Hospital, Boston, MA (United States); Harvard Medical School, Boston, MA (United States); Penzkofer, T; Schmidt, E [Brigham and Women' s Hospital, Boston, MA (United States); Pan, L; Gilson, W [Siemens Corporation, Corporate Technology, Baltimore, MD (United States); Seethamraju, R [Siemens Healthcare, Boston, MA (United States)

2014-06-15

Purpose: To develop a novel active MR-tracking system which can provide accurate and rapid localization of brachytherapy catheters, and assess its reliability and spatial accuracy in comparison to standard catheter digitization using MR images. Methods: An active MR tracker for brachytherapy was constructed by adding three printed-circuit micro-coils to the shaft of a commercial metallic stylet. A gel phantom with an embedded framework was built, into which fifteen 14-Gauge catheters were placed, following either with parallel or crossed paths. The tracker was inserted sequentially into each catheter, with MR-tracking running continuously. Tracking was also performed during the tracker's removal from each catheter. Catheter trajectories measured from the insertion and the removal procedures using the same micro-coil were compared, as well as trajectories obtained using different micro-coils. A 3D high-resolution MR image dataset of the phantom was acquired and imported into a treatment planning system (TPS) for catheter digitization. A comparison between MR-tracked positions and positions digitized from MR images by TPS was performed. Results: The MR tracking shows good consistency for varying catheter paths and for all micro-coils (mean difference ∼1.1 mm). The average distance between the MR-tracking trajectory and catheter digitization from the MR images was 1.1 mm. Ambiguity in catheter assignment from images due to crossed paths was resolved by active tracking. When tracking was interleaved with imaging, real-time images were continuously acquired at the instantaneous tip positions and displayed on an external workstation. Conclusion: The active MR tracker may be used to provide an independent measurement of catheter location in the MR environment, potentially eliminating the need for subsequent CT. It may also be used to control realtime imaging of catheter placement. This will enable MR-based brachytherapy planning of interstitial implants without

WE-G-17A-05: Real-Time Catheter Localization Using An Active MR Tracker for Interstitial Brachytherapy

International Nuclear Information System (INIS)

Wang, W; Damato, A; Viswanathan, A; Cormack, R; Penzkofer, T; Schmidt, E; Pan, L; Gilson, W; Seethamraju, R

2014-01-01

Purpose: To develop a novel active MR-tracking system which can provide accurate and rapid localization of brachytherapy catheters, and assess its reliability and spatial accuracy in comparison to standard catheter digitization using MR images. Methods: An active MR tracker for brachytherapy was constructed by adding three printed-circuit micro-coils to the shaft of a commercial metallic stylet. A gel phantom with an embedded framework was built, into which fifteen 14-Gauge catheters were placed, following either with parallel or crossed paths. The tracker was inserted sequentially into each catheter, with MR-tracking running continuously. Tracking was also performed during the tracker's removal from each catheter. Catheter trajectories measured from the insertion and the removal procedures using the same micro-coil were compared, as well as trajectories obtained using different micro-coils. A 3D high-resolution MR image dataset of the phantom was acquired and imported into a treatment planning system (TPS) for catheter digitization. A comparison between MR-tracked positions and positions digitized from MR images by TPS was performed. Results: The MR tracking shows good consistency for varying catheter paths and for all micro-coils (mean difference ∼1.1 mm). The average distance between the MR-tracking trajectory and catheter digitization from the MR images was 1.1 mm. Ambiguity in catheter assignment from images due to crossed paths was resolved by active tracking. When tracking was interleaved with imaging, real-time images were continuously acquired at the instantaneous tip positions and displayed on an external workstation. Conclusion: The active MR tracker may be used to provide an independent measurement of catheter location in the MR environment, potentially eliminating the need for subsequent CT. It may also be used to control realtime imaging of catheter placement. This will enable MR-based brachytherapy planning of interstitial implants without

WE-A-17A-03: Catheter Digitization in High-Dose-Rate Brachytherapy with the Assistance of An Electromagnetic (EM) Tracking System

Energy Technology Data Exchange (ETDEWEB)

Damato, AL; Bhagwat, MS; Buzurovic, I; Devlin, PM; Friesen, S; Hansen, JL; Kapur, T; Lee, LJ; Mehrtash, A; Nguyen, PL; O' Farrell, D; Wang, W; Viswanathan, AN; Cormack, RA [Brigham and Women' s Hospital, Boston, MA (United States)

2014-06-15

Purpose: To investigate the use of a system using EM tracking, postprocessing and error-detection algorithms for measuring brachytherapy catheter locations and for detecting errors and resolving uncertainties in treatment-planning catheter digitization. Methods: An EM tracker was used to localize 13 catheters in a clinical surface applicator (A) and 15 catheters inserted into a phantom (B). Two pairs of catheters in (B) crossed paths at a distance <2 mm, producing an undistinguishable catheter artifact in that location. EM data was post-processed for noise reduction and reformatted to provide the dwell location configuration. CT-based digitization was automatically extracted from the brachytherapy plan DICOM files (CT). EM dwell digitization error was characterized in terms of the average and maximum distance between corresponding EM and CT dwells per catheter. The error detection rate (detected errors / all errors) was calculated for 3 types of errors: swap of two catheter numbers; incorrect catheter number identification superior to the closest position between two catheters (mix); and catheter-tip shift. Results: The averages ± 1 standard deviation of the average and maximum registration error per catheter were 1.9±0.7 mm and 3.0±1.1 mm for (A) and 1.6±0.6 mm and 2.7±0.8 mm for (B). The error detection rate was 100% (A and B) for swap errors, mix errors, and shift >4.5 mm (A) and >5.5 mm (B); errors were detected for shifts on average >2.0 mm (A) and >2.4 mm (B). Both mix errors associated with undistinguishable catheter artifacts were detected and at least one of the involved catheters was identified. Conclusion: We demonstrated the use of an EM tracking system for localization of brachytherapy catheters, detection of digitization errors and resolution of undistinguishable catheter artifacts. Automatic digitization may be possible with a registration between the imaging and the EM frame of reference. Research funded by the Kaye Family Award 2012.

Catheter design optimization for practical intravascular photoacoustic imaging (IVPA) of vulnerable plaques

Science.gov (United States)

Iskander-Rizk, Sophinese; Wu, Min; Springeling, Geert; Mastik, Frits; Beurskens, Robert H. S. H.; van der Steen, Antonius F. W.; van Soest, Gijs

2018-02-01

Intravascular photoacoustic/ultrasound imaging (IVPA/US) can image the structure and composition of atherosclerotic lesions identifying lipid-rich plaques ex vivo and in vivo. In the literature, multiple IVPA/US catheter designs were presented and validated both in ex-vivo models and preclinical in-vivo situations. Since the catheter is a critical component of the imaging system, we discuss here a catheter design oriented to imaging plaque in a realistic and translatable setting. We present a catheter optimized for light delivery, manageable flush parameters and robustness with reduced mechanical damage risks at the laser/catheter joint interface. We also show capability of imaging within sheath and in water medium.

Peripherally inserted central catheters. Guidewire versus nonguidewire use: a comparative study.

Science.gov (United States)

Loughran, S C; Edwards, S; McClure, S

1992-01-01

To date, no research articles have been published that explore the practice of using guidewires for placement of peripherally inserted central catheters. The literature contains speculations regarding the pros and cons of guidewire use. However, no studies to date have compared patient outcomes when peripherally inserted central catheter lines are inserted with and without guidewires. To examine the use of guidewires for peripherally inserted central lines, a comparative study was conducted at two acute care facilities, one using guidewires for insertion and one inserting peripherally inserted central catheter lines without guidewires. 109 catheters were studied between January 1, 1990 and January 1, 1991. The primary focus of this study was to examine whether guidewire use places patients at higher risk for catheter-related complications, particularly phlebitis. No significant differences in phlebitis rates between the two study sites were found. Other catheter-related and noncatheter-related complications were similar between the two facilities. The results of this study do not support the belief that guidewire use increases complication rates.

Successful Use of Modified Suprapubic Catheter to Rescue Prostatorectal Fistula

Directory of Open Access Journals (Sweden)

Yi-Chun Chiu

2008-06-01

Full Text Available Prostatorectal fistula is a complication following radiotherapy. It remains a clinical challenge to treat because most patients experience a poor quality of life. This case report discusses a modified suprapubic catheter for use in a patient with a prostatorectal fistula that developed after radiotherapy for localized prostate cancer. It is an inexpensive, easily available, and more patient-tolerable catheter that improves quality of life. Herein, we describe the development of this catheter.

Longer Duration of Urinary Catheterization Increases Catheter-Associated Urinary Tract Infection in PICU.

Science.gov (United States)

Fukuoka, Kahoru; Furuichi, Mihoko; Ito, Kenta; Morikawa, Yoshihiko; Watanabe, Ichiro; Shimizu, Naoki; Horikoshi, Yuho

2018-06-13

Catheter-associated urinary tract infections account for 30% of healthcare-associated infections. To date, few studies have addressed pediatric catheter-associated urinary tract infection in PICUs. The aim of our study was to assess the risk of catheter-associated urinary tract infection in relation to the duration of catheterization in the PICU. Retrospective cohort study. PICU at a tertiary children's hospital. Our study was conducted between April 2012 and June 2015 at Tokyo Metropolitan Children's Medical Center in Japan. Children in the PICU with an urethral catheter were included. Catheter-associated urinary tract infection cases were defined according to the National Healthcare Safety Network criteria. The patients' demographic data and isolated organisms were reviewed. Duration of catheterization and the catheter-associated urinary tract infection occurrence rate were analyzed. None. Among 1,890 catheterizations, 23 catheter-associated urinary tract infection cases were identified. The overall occurrence rate was 2.35/1,000 catheter-days. Among the patients with catheter-associated urinary tract infection, 13 were boys. The median age was 11 months (interquartile range, 7-35 mo), and the median duration of catheterization was 7 days (interquartile range, 5-12 d). The isolated bacteria were Escherichia coli (26.5%), Enterococcus faecalis (17.6%), and Klebsiella pneumoniae (11.8%). Two species were isolated in each of 11 cases (47.8%). Each additional day of catheterization increased the risk of catheter-associated urinary tract infection (odds ratio, 1.06; 95% CI, 1.02-1.10, and odds ratio adjusted for contact precaution status and surgical procedures was 1.05; 95% CI, 1.01-1.09). Longer duration of catheterization increased the risk of catheter-associated urinary tract infection by 5% each day at the PICU. Prompt removal of the urethral catheter is strongly recommended whenever feasible.

Intra-operative placement of catheters for interstitial microwave-induced hyperthermia and iridium brachytherapy

International Nuclear Information System (INIS)

Coughlin, C.T.; Wong, T.Z.; Strohbehn, J.W.; Colacchio, T.A.; Belch, R.Z.; Sutton, J.E. Jr.; Douple, E.B.

1984-01-01

The authors have previously described a system for delivery of microwave-induced hyperthermia utilizing flexible coaxial cables that are modified to serve as microwave antennas. These small (--1.6mm o.d.) antennas ae introduced into 2mm o.d. nylon catheters implanted in the tumor. This system has been further modified for use in the treatment of surgically unresectible abdominal, pelvic, and head and neck tumors. The modifications are described that were used to treat two pelvic, one upper abdominal, and one base of tongue tumor. The nylon catheters are implanted during surgery. After a short recovery period, the microwave antennas are inserted and the tumor region is heated for --1hr. The antennas are removed, iridium-192 seeds are placed in the catheters, 2800 - 5000 rad (CGy) doses are delivered, followed by a 1hr hyperthermia treatment. The temperature distributions and future applications are discussed

Percutaneous transvenous retrieval of CVP catheter emboli in S. V. C.-A case report-

International Nuclear Information System (INIS)

Zeon, Seok Kil; Lee, Deock Hee; Kim, Hong; Kim, Ok Bae

1987-01-01

The increasing use of the indwelling venous catheters and cardiovascular catheters has led to many iatrogenic complications. One of the most serious complications is catheter embolization, caused by inadvertent fracture of a fragment of catheter remaining within cardiovascular systems. In the catheter embolization, there are serious consequence such as thromboembolism, sepsis, cardiac arrhythmia and others. Fisher and Ferreyro (1978) reported a 71% incidence of serious morbidity or death following to intravascular foreign bodies in patients without removal. The authors experienced a case of retained central venous pressure monitoring catheter (CVP catheter) fragment extending from superior vena cava to hepatic segment of inferior vena cava. CVP catheter wa introduced into right subclavian venous route for hyperalimentation, because of poor general condition for operation of afferent loop syndrome following to resection of the gastric carcinoma with Billoth II operation (5 years age). On attempting removal of CVP catheter on recovery from afferent loop syndrome, a large portion of the CVP catheter was cut off in S.V.C. Percutaneous puncture of right femoral vein with Seldinger technique was done and 9F introducer sheath was indwelled. The helical basket of Dotter intravascular retriever set was advance through the sheath up to retained CVP catheter, and it was grasped. The retrieved CVP catheter fragment showed several tiny blood clots on surface. The patient was uneventfully recovered and was discharged asymptomatic on second day of the procedure.

[Coronary angioplasty with the Monorail system via 6 French diagnostic catheters].

Science.gov (United States)

Villavicencio, R; González, H; López, J; Zavala, E; Ban Hayashi, E B; Gaspar, J; Gil, M; Martínez Ríos, M A

1994-01-01

We studied the use of "Monorail" system with Express (Scimed) balloon catheters for coronary angioplasty through 6 French (F) "high-flow" diagnostic catheters (Novoste, USCI). Prospectively, from July 1992 to January 1993, angioplasty of 31 lesions in 24 patients was attempted (1.3 lesions/procedure). Twenty procedures were of a single lesion and four were multi-vessel angioplasty. Fourteen lesions were in the left anterior descending or in its branches, 10 in the left circumflex or in its branches, 6 in the right coronary artery, and one in the distal anastomosis of an internal mammary artery graft. Thirteen lesions (42%) were type A, 17 (55%) type B and one (3%) type C. Balloon sizes varied between 2.0 and 3.5 mm. Twenty-nine lesions could be successfully dilated (93.5%); two cases were unsuccessful due to an acute occlusion in one and residual stenosis of more than 50% in the other. For only one case, another balloon catheter different from the "Monorail" system was necessary to complete a multi-vessel angioplasty. Coronary visualization and manipulation of the balloon through the tip of the diagnostic catheter were satisfactory in all cases, except with the 3.5 mm balloon catheter. Coronary angioplasty with "Monorail" system balloon catheters through 6 F "high-flow" diagnostic catheters is feasible and provides a high success rate in simple and moderately complex selected lesions, including multivessel angioplasty with advantages of smaller artery punction and the feasibility of performing coronary angioplasty with the same catheter used for diagnostic angiography.

Phlebitis risk varies by peripheral venous catheter site and increases after 96 hours: a large multi-centre prospective study.

Science.gov (United States)

Cicolini, Giancarlo; Manzoli, Lamberto; Simonetti, Valentina; Flacco, Maria Elena; Comparcini, Dania; Capasso, Lorenzo; Di Baldassarre, Angela; Eltaji Elfarouki, Ghaleb

2014-11-01

This multi-centre prospective field study evaluated whether peripheral venous catheter site of insertion influences the risk of catheter-related phlebitis. Potential predictors of phlebitis were also investigated. Millions of patients worldwide use peripheral venous catheters, which frequently cause local complications including phlebitis, infection and obstruction. Although phlebitis predictors have been broadly investigated, uncertainties remain on the potential effect of cannulation anatomical site, duration and the appropriate time for catheter removal. A prospective cohort design was carried out from January-June 2012. The clinical course of each patient who received a new peripheral venous catheter for any cause in five Italian hospitals was followed by trained nurses until catheter removal. The presence of phlebitis was assessed every 24 hours using the Visual Infusion Phlebitis score. Analyses were based upon multilevel mixed-effects regression. The final sample consisted of 1498 patients. The average time for catheters in situ was 65·6 hours and 23·6% of the catheters were in place beyond 96 hours. Overall phlebitis incidence was 15·4%, 94·4% of which were grade 1. The likelihood of phlebitis independently increased with increasing catheter duration, being highest after 96 hours. Compared with patients with catheter placed in the dorsum of the hand (22·8% of the sample), those with the catheter located in the antecubital fossa (34·1%) or forearm were less likely to have a phlebitis of any grade. Antecubital fossa and forearm veins may be preferential sites for peripheral venous cannulation. Our results support Centers for Disease Control and Prevention recommendations to replace catheters in adults no later than 96 hours. A relevant proportion of healthcare personnel did not adhere to such guidelines - more attention to this issue is required. © 2014 John Wiley & Sons Ltd.

Catheter-free Period Over 2 Days Is Associated with Better Outcome in Catheter-related Bloodstream Infection due to Candida

OpenAIRE

Matsuo, Takahiro; Mori, Nobuyoshi; Hoshino, Eri; Sakurai, Aki; Furukawa, Keiichi

2017-01-01

Abstract Background Regardless of active antifungal drugs, mortality of candidemia remains high. Although it is well-known that central venous catheter (CVC) is one of the most important risk factors of candidemia and should be removed immediately, little is known about optimal timing of CVC replacement after removal. Here, we analyzed contributing risk factors associated with 30-day mortality for catheter-related bloodstream infection (CRBSI) due to candida and optimal timing of CVC replacem...

Risk Factors for Catheter Associated Urinary Tract Infections in a Pediatric Institution.

Science.gov (United States)

Lee, Nora G; Marchalik, Daniel; Lipsky, Andrew; Rushton, H Gil; Pohl, Hans G; Song, Xiaoyan

2016-04-01

Catheter associated urinary tract infections are an essential measure for health care quality improvement that affects reimbursement through hospital acquired condition reduction programs in adult patients. With the mounting importance of preventing such infections we evaluated risk factors for acquiring catheter associated urinary tract infections in pediatric patients. All catheter associated urinary tract infections were identified at 1 pediatric institution from September 2010 to August 2014 from a prospective database maintained by the infection control office. To identify risk factors patients with a catheter associated urinary tract infection were individually matched to control patients with a urinary catheter but without infection by age, gender, date and the hospital location of the infection in 1:2 fashion. A total of 50 patients with catheter associated urinary tract infection were identified and matched to 100 control patients. Compared to controls the patients with infection were more likely to have a catheter in place for longer (2.9 days, OR 1.08, 95% CI 1.01, 1.15, p = 0.02). They were also more likely to be on contact precautions (OR 4.00, 95% CI 1.73, 9.26, p = 0.001), and have concurrent infections (OR 3.04, 95% CI 1.39, 6.28, p = 0.005) and a history of catheterization (OR 3.24, 95% CI 1.55, 6.77, p = 0.002). Using a conditional multivariate regression model the 3 most predictive variables were duration of catheter drainage, contact isolation status and history of catheterization. Longer duration of urinary catheter drainage, positive contact precautions status and a history of catheterization appear to be associated with a higher risk of catheter associated urinary tract infection in hospitalized pediatric patients. Physicians should attempt to decrease the duration of catheterization, especially in patients who meet these criteria, to minimize the risk of catheter associated urinary tract infection. Copyright © 2016 American Urological

Efficacy of Prophylactic Antibiotics at Peritoneal Catheter Insertion on Early Peritonitis: Data from the Catheter Section of the French Language Peritoneal Dialysis Registry.

Science.gov (United States)

Lanot, Antoine; Lobbedez, Thierry; Bechade, Clémence; Verger, Christian; Fabre, Emmanuel; Dratwa, Max; Vernier, Isabelle

2016-01-01

International guidelines recommend the use of a prophylactic antibiotic before the peritoneal dialysis (PD) catheter can be inserted. The main objective of this study was to assess whether this practice is associated with a lower risk of early peritonitis and to estimate the magnitude of the centre effect. A retrospective, multi-centric study was conducted, in which data from the French Language Peritoneal Dialysis Registry was analysed. Patients were separated into 2 groups based on whether or not prophylactic antibiotics were used prior to catheter placement. Out of the 2,014 patients who had a PD catheter placed between February 1, 2012 and December 31, 2014, 1,105 were given a prophylactic antibiotic. In a classical logit model, the use of prophylactic antibiotics was found to protect the individual against the risk of early peritonitis (OR 0.67, 95% CI 0.49-0.92). However, this association lost significance in a mixed logistic regression model with centre as a random effect: OR 0.73 (95% CI 0.48-1.09). Covariates associated with the risk of developing early peritonitis were age over 65: OR 0.73 (95% CI 0.39-0.85), body mass index over 35 kg/m2: OR 1.99 (95% CI 1.13-3.47), transfer to PD due to graft failure: OR 2.24 (95% CI 1.22-4.11), assisted PD: OR 1.96 (95% CI 1.31-2.93), and the use of the Moncrief technique: OR 3.07 (95% CI 1.85-5.11). There is a beneficial effect of prophylactic antibiotic used prior to peritoneal catheter placement, on the occurence of early peritonitis. However, the beneficial effect could be masked by a centre effect. © 2016 S. Karger AG, Basel.

Urinary catheter related nosocomial infections in paediatric intensive care unit.

Directory of Open Access Journals (Sweden)

Tullu M

1998-04-01

Full Text Available The present prospective study was carried out in the Paediatric Intensive Care Unit (PICU of a tertiary care teaching hospital in Mumbai. The objective was to determine the incidence, risk factors, mortality and organisms responsible for urinary catheter related infections (UCRI. Colonization and/or bacteriuria was labelled as urinary catheter related infection (UCRI. Forty-four patients with 51 urinary catheters were studied. Incidence of UCRI was 47.06%. Age, female sex and immunocompromised status did not increase the risk of UCRI. Duration of catheter in-situ and duration of stay in the PICU were associated with higher risk of UCRI. The mortality was not increased by UCRI. Commonest organism isolated in UCRI was E. coli, which had maximum susceptibility to nitrofurantoin and amikacin.

Pleural fluid drainage: Percutaneous catheter drainage versus surgical chest tube drainage

International Nuclear Information System (INIS)

Illescas, F.F.; Reinhold, C.; Atri, M.; Bret, P.M.

1987-01-01

Over the past 4 years, 55 cases (one transudate, 28 exudates, and 26 empymas) were drained. Surgical chest tubes alone were used in 35 drainages, percutaneous catheters alone in five drainages, and both types in 15 drainages. Percutaneous catheter drainage was successful in 12 of 20 drainages (60%). Surgical tube drainage was successful in 18 of 50 drainages (36%). The success rate for the nonempyema group was 45% with both types of drainage. For the empyema group, the success rate for percutaneous catheter drainage was 66% vs 23% for surgical tube drainage. Seven major complications occurred with surgical tube drainage, but only one major complication occurred with percutaneous catheter drainage. Radiologically guided percutaneous catheter drainage should be the procedure of choice for pleural fluid drainage. It has a higher success rate for empyemas and is associated with less complications

A simple method of using a Foley catheter to drain pleural effusion.

Science.gov (United States)

Ben-Nun, Alon; Best, Lael Anson

2008-01-01

Pleural effusion is a common problem, and various techniques of pleural fluid drainage have been described. We report our experience of using a Foley-type catheter to drain pleural effusion. After the injection of local anesthesia, the catheter is inserted, usually through the 7th intercostal space, with the patient sitting upright. The size of the catheter is selected according to the predicted fluid characteristics, and ranges from 18 to 24 F. Once the catheter is positioned in the pleural space, the balloon is inflated with diluted soluble contrast material and connected to a urine collection bag. During the last 10 years, we have used 3500 catheters for this purpose. The catheter site can be used as a port for various procedures, including needle biopsy of the parietal pleura, talc-slurry pleurodesis, and intra-pleural fibrinolysis. This method of pleural drainage is simple, reliable, and inexpensive.

Laparoscopic Placement of Peritoneal Dialysis Catheters in CAPD Patients: Complications and Survival

Directory of Open Access Journals (Sweden)

A Roueentan

2008-06-01

Full Text Available Background: Laparoscopic techniques for the placement of peritoneal dialysis catheters are becoming increasingly popular. Recently, with the improvements in laparoscopic surgery, various methods for the insertion of peritoneal dialysis catheters have been reported, indicating that the laparoscopic insertion is preferred over the open and percutaneous techniques. The aim of this study was to introduce and assess a simplified laparoscopic method for the insertion of peritoneal dialysis catheters in continuous ambulatory peritoneal dialysis (CAPD patients.Methods: We enrolled 79 consecutive end-stage renal patients (46 men and 33 women with a mean age of 50 years (range: 19-83 years in this study. During the surgery, a 5-mm trocar was placed in the left upper quadrant for the optics and another 5-mm trocar was placed to the left of the umbilicus. Using the second trocar, a tunnel was formed 2 cm left of the umbilical plane for the insertion of a Tenckhoff catheter. Under direct vision, the catheter was advanced into the abdomen. The catheter was tested for patency. Catheters of all subjects were capped for two weeks before dialysis initiation.Results: The mean duration of the operation was 15 minutes. Ten patients died during the follow-up period, all due to other medical problems, and six patients underwent renal transplantation; however, no deaths or complications were observed during surgery. Early onset complications were seen in 12 patients (15.1%. The most frequent late-onset medical and mechanical complications were peritonitis (6.3% and hernia (3.7%. During a follow-up period of four years, removal of the catheter was required in two patients as a result of peritonitis.Conclusion: We obtained a low complication rate and a high catheter survival rate with this laparoscopic insertion of the Tenckhoff catheter. We believe future experience will encourage the use of this safe, simple and quick procedure.

Asymptomatic Ventricular Pre-excitation: Between Sudden Cardiac Death and Catheter Ablation

Science.gov (United States)

Brugada, Josep

2018-01-01

Debate about the best clinical approach to the management of asymptomatic patients with ventricular pre-excitation and advice on whether or not to invasively stratify and ablate is on-going. Weak evidence about the real risk of sudden cardiac death and the potential benefit of catheter ablation has probably prevented the clarification of action in this not infrequent and sometimes conflicting clinical situation. After analysing all available data, real evidence-based medicine could be the alternative strategy for managing this group of patients. According to recent surveys, most electrophysiologists invasively stratify. Based on all accepted risk factors – younger age, male, associated structural heart disease, posteroseptal localisation, ability of the accessory pathway to conduct anterogradely at short intervals of ≤250 milliseconds and inducibility of sustained atrioventricular re-entrant tachycardia and/or atrial fibrillation – a shared decisionmaking process on catheter ablation is proposed. PMID:29636970

Coil embolization of internal mammary artery injured during central vein catheter and cardiac pacemaker lead insertion

Energy Technology Data Exchange (ETDEWEB)

Chemelli, A.P. [Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck (Austria)], E-mail: Andreas.Chemelli@i-med.ac.at; Chemelli-Steingruber, I.E. [Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck (Austria); Bonaros, N. [Department of Cardiovascular Surgery, Innsbruck Medical University (Austria); Luckner, G. [Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University (Austria); Millonig, G. [Department of Gastroenterology and Hepatology, Innsbruck Medical University (Austria); Seppi, K. [Department of Neurology, Innsbruck Medical University (Austria); Lottersberger, C.; Jaschke, W. [Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck (Austria)

2009-08-15

Purpose: This study describes several cases of endovascular coil embolization of the proximal internal mammary artery injured by blind approach to the subclavian vein for central venous catheter or pacemaker lead insertion. Materials and methods: We conducted a retrospective analysis of five patients with iatrogenic arterial lesions of the internal mammary artery (IMA). The lesions occurred in three patients from a puncture of the subclavian vein during insertion of a central venous catheter and in two patients from a puncture of the subclavian vein for insertion of a pacemaker lead. Four patients had acute symptoms of bleeding with mediastinal hematoma and hematothorax and one patient was investigated in a chronic stage. A pseudoaneurysm was detected in all five patients. All four acute and hemodynamic unstable patients required hemodynamic support. Results: In all patients, embolization was performed using a coaxial catheter technique, and a long segment of the IMA adjacent distally and proximally to the source of bleeding was occluded with pushable microcoils. In one patient, additional mechanically detachable microcoils were used at the very proximal part of the IMA. Microcoil embolization of the IMA was successful in all patients, and the source of bleeding was eliminated in all patients. Conclusion: Transarterial coil embolization is a feasible and efficient method in treating acute bleeding and pseudoaneurysm of the IMA and should be considered if mediastinal hematoma or hemathorax occurs after blind puncture of the subclavian vein.

Predicting Success of Catheter Drainage in Infected Necrotizing Pancreatitis

NARCIS (Netherlands)

Hollemans, Robbert A.; Bollen, Thomas L.; van Brunschot, Sandra; Bakker, Olaf J.; Ahmed Ali, Usama; van Goor, Harry; Boermeester, Marja A.; Gooszen, Hein G.; Besselink, Marc G.; van Santvoort, Hjalmar C.

2016-01-01

At least 30% of patients with infected necrotizing pancreatitis are successfully treated with catheter drainage alone. It is currently not possible to predict which patients also need necrosectomy. We evaluated predictive factors for successful catheter drainage. This was a post hoc analysis of 130

Frequency of puncture holes in peritoneal dialysis catheters related to the beta cap adapter.

Science.gov (United States)

Ohashi, Yasushi; Kansal, Sheru; Schreiber, Martin

2012-01-01

Between November 2009 and September 2011, 12 patients (6 women, 6 men) undergoing continuous peritoneal dialysis (PD) or automated PD developed puncture-like holes in the PD catheter near the interface of the adapter with the superior aspect of the Silastic PD catheter The adapter is used to connect the PD catheter to the PD transfer set. Over the course of 23 months, the 12 patients presented to the PD unit with 19 separate instances of catheter holes, for an event rate of 0.23 holes per patient-year Data including socio-demographic information, PD modality, need for antibiotic treatment, event recurrence, infectious complications, and time from catheter placement were collected from patients whose catheters did and did not develop holes. We observed no differences between patients whose catheters developed holes and those whose catheters did not. The location of the individual holes suggested a relationship between the adapter and the catheter holes. The holes, which led to increased patient morbidity and costs, may be related to structural changes made in 2006 to the adapter.

Catalog of 199 register-based definitions of chronic conditions

DEFF Research Database (Denmark)

Hvidberg, Michael F; Johnsen, Søren P; Glümer, Charlotte

2016-01-01

INTRODUCTION: The aim of the current study was to present and discuss a broad range of register-based definitions of chronic conditions for use in register research, as well as the challenges and pitfalls when defining chronic conditions by the use of registers. MATERIALS AND METHODS: The definit......INTRODUCTION: The aim of the current study was to present and discuss a broad range of register-based definitions of chronic conditions for use in register research, as well as the challenges and pitfalls when defining chronic conditions by the use of registers. MATERIALS AND METHODS......: The definitions were defined based on information from nationwide Danish public healthcare registers. Medical and epidemiological specialists identified and grouped relevant diagnosis codes that covered chronic conditions, using the International Classification System version 10 (ICD-10). Where relevant...... definitions were proposed based on record linkage between multiple registers, including registers of prescribed drugs and use of general practitioners' services. CONCLUSIONS THIS STUDY PROVIDED A CATALOG OF REGISTER-BASED DEFINITIONS FOR CHRONIC CONDITIONS FOR USE IN HEALTHCARE PLANNING AND RESEARCH, WHICH IS...

Scale-space for empty catheter segmentation in PCI fluoroscopic images.

Science.gov (United States)

Bacchuwar, Ketan; Cousty, Jean; Vaillant, Régis; Najman, Laurent

2017-07-01

In this article, we present a method for empty guiding catheter segmentation in fluoroscopic X-ray images. The guiding catheter, being a commonly visible landmark, its segmentation is an important and a difficult brick for Percutaneous Coronary Intervention (PCI) procedure modeling. In number of clinical situations, the catheter is empty and appears as a low contrasted structure with two parallel and partially disconnected edges. To segment it, we work on the level-set scale-space of image, the min tree, to extract curve blobs. We then propose a novel structural scale-space, a hierarchy built on these curve blobs. The deep connected component, i.e. the cluster of curve blobs on this hierarchy, that maximizes the likelihood to be an empty catheter is retained as final segmentation. We evaluate the performance of the algorithm on a database of 1250 fluoroscopic images from 6 patients. As a result, we obtain very good qualitative and quantitative segmentation performance, with mean precision and recall of 80.48 and 63.04% respectively. We develop a novel structural scale-space to segment a structured object, the empty catheter, in challenging situations where the information content is very sparse in the images. Fully-automatic empty catheter segmentation in X-ray fluoroscopic images is an important and preliminary step in PCI procedure modeling, as it aids in tagging the arrival and removal location of other interventional tools.

Risk factors for peritoneal dialysis catheter failure in children ...

African Journals Online (AJOL)

Background Peritoneal dialysis catheter (PDC) failure still remains a common clinical problem in pediatric patients despite advancements in catheter placement and dialysis techniques. Our aim was to determine the risk factors that may lead to PDC failure, especially those factors that could be potentially modified to ...

Encrusted and incarcerated urinary bladder catheter: what are the ...

African Journals Online (AJOL)

Urinary bladder catheter encrustations are known complications of long-term urinary catheterisation, which is commonly seen in clinical practice. These encrustations can impede deflation of the balloon and therefore cause problems in the removal of the catheter. The options in managing an encrusted and incarcerated ...

Encrusted and incarcerated urinary bladder catheter: what are the ...

African Journals Online (AJOL)

2010-11-25

Nov 25, 2010 ... cases of extraluminal encrusted urethral catheters. Extracorporeal shock wave lithotripsy (ESWL) has been utilised in the treatment of the bladder stones. Borrowing this principle, Kunzman et al. (12) has even used ESWL to fragment the stone-like encrustation over the retained Foley catheter balloon.

Surface-Treated versus Untreated Large-Bore Catheters as Vascular Access in Hemodialysis and Apheresis Treatments

Directory of Open Access Journals (Sweden)

Rolf Bambauer

2012-01-01

Full Text Available Background. Catheter-related infections, thrombosis, and stenosis are among the most frequent complications associated with catheters, which are inserted in vessels. Surface treatment processes of the outer surface, such as ion-beam-assisted deposition, can be used to mitigate such complications. Methods. This retrospective study (1992–2007 evaluated silver-coated (54 patients and noncoated (105 patients implanted large-bore catheters used for extracorporeal detoxification. The catheters were inserted into the internal jugular or subclavian veins. After removal, the catheters were cultured for bacterial colonization using standard microbiologic assays. They also were examined using scanning electron microscope. Results. The silver coated catheters showed a tendency towards longer in situ time. The microbiologic examinations of the catheter tips were in both catheter types high positive, but not significant. Conclusion. The silver-coated catheters showed no significantly reduction in infection rate by evaluation of all collected data in this retrospective study. There was no association between both catheters in significantly reducing savings in treatment costs and in reducing patient discomfort. Other new developed catheter materials such as the microdomain-structured inner and outer surface are considered more biocompatible because they mimic the structure of natural biological surface.

Improving patient safety during insertion of peripheral venous catheters: an observational intervention study

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Kampf, Günter

2013-11-01

Full Text Available [english] Background: Peripheral venous catheters are frequently used in hospitalized patients but increase the risk of nosocomial bloodstream infection. Evidence-based guidelines describe specific steps that are known to reduce infection risk. However, the degree of guideline implementation in clinical practice is not known. The aim of this study was to determine the use of specific steps for insertion of peripheral venous catheters in clinical practice and to implement a multimodal intervention aimed at improving both compliance and the optimum order of the steps.Methods: The study was conducted at University Hospital Hamburg. An optimum procedure for inserting a peripheral venous catheter was defined based on three evidence-based guidelines (WHO, CDC, RKI including five steps with 1A or 1B level of evidence: hand disinfection before patient contact, skin antisepsis of the puncture site, no palpation of treated puncture site, hand disinfection before aseptic procedure, and sterile dressing on the puncture site. A research nurse observed and recorded procedures for peripheral venous catheter insertion for healthcare workers in four different departments (endoscopy, central emergency admissions, pediatrics, and dermatology. A multimodal intervention with 5 elements was established (teaching session, dummy training, e-learning tool, tablet and poster, and direct feedback, followed by a second observation period. During the last observation week, participants evaluated the intervention.Results: In the control period, 207 insertions were observed, and 202 in the intervention period. Compliance improved significantly for four of five steps (e.g., from 11.6% to 57.9% for hand disinfection before patient contact; p<0.001, chi-square test. Compliance with skin antisepsis of the puncture site was high before and after intervention (99.5% before and 99.0% after. Performance of specific steps in the correct order also improved (e.g., from 7.7% to 68

Percutaneous placement of peritoneal port-catheter in oncologic patients

International Nuclear Information System (INIS)

Orsi, Franco; Vigna, Paolo Della; Bonomo, Guido; Penco, Silvia; Lovati, Elena; Bellomi, Massimo

2004-01-01

The aim of this paper is to describe the technique of percutaneous ultrasound (US)-guided placement of a peritoneal port-catheter in an interventional radiological setting. Nineteen patients with peritoneal carcinomatosis were selected for intraperitoneal port-catheter placement in order to perform intracavitary receptor-immuno- or radio-immunotherapy with Ytrium-90. All the procedures were performed percutaneously under US and fluoro guidance; the insertion site for catheters was chosen according to abdominal conditions and US findings: all devices were implanted at the lower abdominal quadrants. All patients were followed up with CT and US according to the therapy protocol. The procedure was successfully completed in 15/19 patients, in 4 being contraindicated by peritoneal adhesions. No procedure-related complications and device occlusions during therapy were observed; one catheter displaced 7 months later the placement. In our experience, this procedure was feasible, reliable and easy to perform, allowing the correct administration of the planned intracavitary therapy. Peritoneal adhesions are the main limitation of peritoneal port placement. (orig.)

Effective flow performances and dialysis doses delivered with permanent catheters: a 24-month comparative study of permanent catheters versus arterio-venous vascular accesses.

Science.gov (United States)

Canaud, Bernard; Leray-Moragues, Hélène; Kerkeni, Nadia; Bosc, Jean-Yves; Martin, Katja

2002-07-01

Permanent venous catheters have emerged as a long-term vascular access option for renal replacement therapy in end-stage renal disease patients. The design and venous location of catheter devices bear intrinsic flow limitations that may negatively affect the adequacy of dialysis and the patient outcome. There is limited data comparing the long-term dialysis adequacy delivered with permanent catheters vs arterio-venous vascular accesses (AVA). To explore this problem, we conducted a prospective 24-month trial comparing the flow performances and dialysis dose (Kt/Vdp) deliveries of both access options in a group of 42 haemodialysis patients during two study phases. During the first 12 months the patients completed a treatment period by means of permanent dual silicone catheters (DualKT). Then they were transferred to an AVA (40 native arterio-venous fistulas and two PTFE grafts) and monitored for an additional 12-month period. Assessments of flow adequacy and dialysis quantification were performed monthly. Dialysis adequacy was achieved in all cases. No patient had to be transferred prematurely to the AVA because of catheter failure. Three catheters had to be replaced due to bacteraemia in three patients. The mean effective blood flow rates achieved were 316+/-3.5 ml/min and 340+/-3.3 ml/min with DualKT and AVA, respectively, for a pre-set machine blood flow of 348+/-2.2 ml/min. Recirculation rates evaluated with the 'slow blood flow' method were 8.6+/-0.6 and 12.1+/-0.8% for DualKT and AVA using mean values of the solute markers urea and creatinine. Due to the possibility of a comparison veno-venous vs arterio-venous blood circulation, a corrected arterio-venous access recirculation could be derived from the difference between the two, which was around 3%. The blood flow resistance of the DualKT was slightly higher than with AVA as indicated by venous pressure differences. Kt/Vdp delivered was 1.37+/-0.02 and 1.45+/-0.02 with DualKT and AVA access respectively. The

Closed-loop helium circulation system for actuation of a continuously operating heart catheter pump.

Science.gov (United States)

Karabegovic, Alen; Hinteregger, Markus; Janeczek, Christoph; Mohl, Werner; Gföhler, Margit

2017-06-09

Currently available, pneumatic-based medical devices are operated using closed-loop pulsatile or open continuous systems. Medical devices utilizing gases with a low atomic number in a continuous closed loop stream have not been documented to date. This work presents the construction of a portable helium circulation addressing the need for actuating a novel, pneumatically operated catheter pump. The design of its control system puts emphasis on the performance, safety and low running cost of the catheter pump. Static and dynamic characteristics of individual elements in the circulation are analyzed to ensure a proper operation of the system. The pneumatic circulation maximizes the working range of the drive unit inside the catheter pump while reducing the total size and noise production.Separate flow and pressure controllers position the turbine's working point into the stable region of the pressure creation element. A subsystem for rapid gas evacuation significantly decreases the duration of helium removal after a leak, reaching subatmospheric pressure in the intracorporeal catheter within several milliseconds. The system presented in the study offers an easy control of helium mass flow while ensuring stable behavior of its internal components.

[Catheter-associated bloodstream infections: implementation of a new consensus protocol].

Science.gov (United States)

Urrea Ayala, M; Rozas Quesada, L

2009-07-01

Catheter-associated bloodstream infection is highly prevalent and often associated with fatal complications. Some studies have shown that applying preventive interventions could help to reduce and control this type of infection. To determine whether a new consensus protocol for the manipulation and maintenance of central venous catheters would decrease catheter-associated bloodstream infections (CA-BSIs) in paediatric patients. To evaluate its compliance in intensive care units. Prospective study in the paediatric (PICU) and neonatal (NICU) intensive cares units, haematology, oncology and hospital wards in a Maternal and Paediatric reference Hospital in Barcelona. The study period is divided into two periods: before (first semester) and after the start of the new protocol (second semester) in 2007. The most important changes have been the insertion of the hermetic connection in the proximal and distal site (between the line and the syringe) of the central venous catheter (CVC), the labelling of the medication line and the CVC with the date of placement. A check-list to evaluate compliance was introduced in both intensive care units (paediatrics and neonatal) during the second study period. The rates of bloodstream infection per 1000 catheter-days were assessed. The rate of bloodstream infections per 1000 catheter-days before and after the start of the new protocol was 5.7 and 4.9 in PICU; 24.6 and 18.0 in NICU; 7.6 and 4.6 in haematology-oncology, and 11.9 and 10.3 in hospital wards. As regards compliance to the protocol, we found that proximal sealed connectors were used in more than 95% of the cases and up to 85% of the central venous catheter were labelled with the insertion date in both intensive care units. A consensus protocol for the use and maintenance of central venous catheters and healthcare worker training helped to control the rate of CA-BSIs. We reaffirm the importance of epidemiological surveillance as a measure for controlling nosocomial infections.

Vaginal extrusion of a ventriculo-peritoneal shunt catheter in an adult

Directory of Open Access Journals (Sweden)

Christopher M Bonfield

2015-01-01

Full Text Available Ventriculo-peritoneal shunts (VPS are commonly used in the treatment of various neurosurgical conditions, including hydrocephalus and pseudotumor cerebri. We report only the second case of vaginal extrusion of a VPS catheter in an adult, and the first case with a modern VPS silastic peritoneal catheter. A 45-year-old female with a history of VPS for pseudotumor cerebri, Behcet′s syndrome, and hysterectomy presented to our institution with the chief complaint of tubing protruding from her vagina after urination. On gynecologic examination, the patient was found to have approximately 15 cm of VPS catheter protruding from her vaginal apex. A computed tomography scan of the abdomen and shunt X-ray series demonstrated no breaks in the tubing, but also confirmed the finding of the VPS catheter extruding through the vaginal cuff into the vagina. The patient had the VPS removed and an external ventricular drain was placed for temporary cerebrospinal fluid diversion. Ventricular catheter cultures were positive for diphtheroids. After an appropriate course of antibiotics, a contralateral ventriculo-pleural shunt was placed one week later. Although vary rare, vaginal extrusion can occur in adults, even with modern VPS catheters.

Double balloon esophageal catheter for diagnosis of tracheo-esophageal fistula

International Nuclear Information System (INIS)

Kiyan, Guersu; Dagli, Tolga E.; Tugtepe, Halil; Kodalli, Nihat

2003-01-01

Congenital H-type and recurrent tracheo-esophageal fistulas (TEF) are always difficult to diagnose. For a more accurate diagnosis we designed a new double balloon catheter, which is a modification of esophageal dilatation balloon. The catheter has two balloons to occlude the esophagus proximal and distal to the fistula. The fistula can be identified by passing of the contrast material to the tracheal tree, which was injected into the esophageal segment between the inflated balloons. To prove the efficiency of this catheter, a TEF was created surgically in a New Zealand rabbit. On the postoperative fourteenth day the catheter was tried and the fistula could be visualized easily by injecting the contrast material. We think this technique may be of use in the diagnosis of TEF in children. (orig.)

Prolonged use of indwelling urinary catheter following acute urinary ...

African Journals Online (AJOL)

J.O. Bello

prolonged use of urinary catheters following acute urinary retention secondary to benign prostate enlarge- ment (BPE) and urethral ... indwelling urinary catheter for >3 months following acute urinary retention due to BPE or USD. The study .... the major health-care financing strategy in Nigeria and accounts for more than ...

Stabilization of a percutaneously implanted port catheter system for hepatic artery chemotherapy infusion

International Nuclear Information System (INIS)

Shindoh, Noboru; Ozaki, Yutaka; Kyogoku, Shinsuke; Yamana, Daigo; Sumi, Yukiharu; Katayama, Hitoshi

1999-01-01

A port catheter system for hepatic artery infusion chemotherapy was implanted percutaneously via the left subclavian artery in 41 patients for treatment of unresectable liver metastases. The catheter tip was inserted into the gastroduodenal artery (GDA), the end hole was occluded with a guidewire fragment, and a side-hole for infusion was positioned at the bifurcation of the proper hepatic artery and the GDA. The GDA was embolized with steel coils around the infusion catheter tip via a transfemoral catheter. This procedure is designed to reduce the incidence of hepatic artery occlusion and infusion catheter dislocation.

In Vitro Urethra Model to Characterize The Frictional Properties of Urinary Catheters

DEFF Research Database (Denmark)

Røn, Troels; Lee, Seunghwan

2016-01-01

conformal sliding contacts with the catheter and high relevance to clinical catherization. With the proposed urethra model assembled in texture analyzer, the lubricity of catheters lubricated in different modes was tested. In comparison with conventional pin-on-disk tribometry, the coefficients of friction......, frictional properties of tubular devices such as catheters, endoscopes, and angioplasty balloons are particularly challenging to characterize because of non-standard shape and contact configuration. In this study, we propose that fabrication of in vitro urethra model with castable elastomers can provide...... of sliding contacts with the urethra model with unlubricated and lubricated catheters were determined. Impact of the improved bio-relevance of friction testing methods on the evaluation of various catheter materials and surface modification methods is discussed in detail....

Lights, camera and action in the implementation of central venous catheter dressing.

Science.gov (United States)

Ferreira, Maria Verônica Ferrareze; de Godoy, Simone; de Góes, Fernanda dos Santos Nogueira; Rossini, Fernanda de Paula; de Andrade, Denise

2015-01-01

To develop and validate an educational digital video on changing the dressing of short-term, non-cuffed, non-tunneled central venous catheters in hospitalized adult patients. This is a descriptive, methodological study based on Paulo Freire's assumptions. The development of the script and video storyboard were based on scientific evidence, on the researchers' experience, and that of nurse experts, as well as on a virtual learning environment. The items related to the script were approved by 97.2% of the nurses and the video was approved by 96.1%. The educational instrument was considered to be appropriate and we believe it will contribute to professional training in the nursing field, the updating of human resources, focusing on the educational process, including distance education. We believe it will consequently improve the quality of care provided to patients with central venous catheters.

Hydrophilic-coated catheter appreciation study in a pediatric population

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Boucher, Andréanne; Cloutier, Jonathan; Lebel, Sylvie; Hamel, Micheline; Lamontagne, Pascale; Bolduc, Stéphane

2010-01-01

Objective: The objective of the paper was to compare the satisfaction of hydrophilic-coated catheters (HC) (SpeediCath, Coloplast Canada, Mississauga, ON) versus uncoated catheters in a pediatric neurogenic bladder population, in order to identify a target group for HC. The main hypothesis was that our patients, with regard to their limitations, might have difficulties using the HC. Material and methods: A comparative prospective study was initiated in one pediatric rehabilitation centre. Out of the 39 patients who tried the HC during a routine clinic visit, 31 patients/parents accepted to participate in a 1-week trial and to answer a satisfaction questionnaire. Their medical records were reviewed for age, neurological disease, intellectual deficit, impaired dexterity and method of catheterization (Mitrofanoff/urethra). Results: Thirty of the 31 patients answered the satisfaction questionnaire. The median age for the 30 patients was 13.5 years (range 6–20 years). Of these patients, 19 were females (63%), 26 performed self-catheterization (87%), and 6 had Mitrofanoff (20%). Ten children (33%) would be ready to proceed with HC and all 10 children would receive catheterization by the urethra. Of these, 9 were females (90%), 8 used compact-HC (80%) and all were self-sufficient. Patients using compact-HC would continue with this catheter. In the patient comments, males catheterizing per-urethra and patients using a continent stoma requiring long catheters had problems with the excess of lubricant. Conclusion: Most children preferred their usual uncoated catheter and would not change for HC. Female patients catheterizing per-urethra with a compact-HC seem to benefit most from this catheter. PMID:21749816

A comparison between two types of central venous catheters in the prevention of catheter-related infections: the importance of performing all the relevant cultures

NARCIS (Netherlands)

van Vliet, J.; Leusink, J.A.; de Jongh, B.M.; de Boer, A.

2001-01-01

Objective: to determine the efficacy of double-lumen central venous catheters coated with chlorhexidine and silver-sulfadiazine in reducing the incidence of catheter-related infections. Design: a randomized controlled trial. Setting: medical-surgical intensive care unit of a 600-bed teaching

Intraperitoneally placed Foley catheter via verumontanum initially presenting as a bladder rupture.

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Raheem, Omer A; Jeong, Young Beom

2011-09-01

Since urethral Foley catheterization is usually easy and safe, serious complications related to this procedure have been rarely reported. Herein, we describe a case of intraperitoneally placed urethral catheter via verumontanum presenting as intraperitoneal bladder perforation in a chronically debilitated elderly patient. A 82-yr-old male patient was admitted with symptoms of hematuria, lower abdominal pain after traumatic Foley catheterization. The retrograde cystography showed findings of intraperitoneal bladder perforation, but emergency laparotomy with intraoperative urethrocystoscopy revealed a tunnel-like false passage extending from the verumontanum into the rectovesical pouch between the posterior wall of the bladder and the anterior wall of the rectum with no bladder injury. The patient was treated with simple closure of the perforated rectovesical pouch and a placement of suprapubic cystostomy tube.

Role of Catheter-directed Thrombolysis in Management of Iliofemoral Deep Venous Thrombosis.

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Chen, James X; Sudheendra, Deepak; Stavropoulos, S William; Nadolski, Gregory J

2016-01-01

The treatment for iliofemoral deep venous thrombosis (DVT) is challenging, as the use of anticoagulation alone can be insufficient for restoring venous patency and thus lead to prolongation of acute symptoms and an increased risk of chronic complications, including venous insufficiency and postthrombotic syndrome (PTS). In these cases, earlier and more complete thrombus removal can ameliorate acute symptoms and reduce long-term sequelae. Endovascular therapies involving the use of pharmacologic, mechanical, and combined pharmacomechanical modalities have been developed to achieve these goals. The most frequently used of these techniques, catheter-directed thrombolysis (CDT), involves the infusion of a thrombolytic agent through a multiple-side-hole catheter placed within the thrombosed vein to achieve high local doses and thereby break down the clot while minimizing systemic thrombolytic agent exposure. Randomized controlled trial results have indicated decreased PTS rates and improved venous patency rates in patients treated with CDT compared with these rates in patients treated with anticoagulation. The use of newer pharmacomechanical techniques, as compared with conventional CDT, reduces procedural times and thrombolytic agent doses and is the subject of ongoing investigations. Endovascular thrombus removal techniques offer a means to improve venous valvular function and decrease the risk of debilitating long-term complications such as PTS and are a promising option for treating patients with iliofemoral DVT. (©)RSNA, 2016.

Detection of an embolized central venous catheter fragment with endobronchial ultrasound.

Science.gov (United States)

Dhillon, Samjot Singh; Harris, Kassem; Alraiyes, Abdul H; Picone, Anthony L

2018-01-01

An 84-year-old woman underwent Convex-probe Endobronchial Ultrasound (CP-EBUS) for 18 F-fluorodeoxyglucose avid subcarinal lymphadenopathy on Positron Emission Tomogram (PET) scan. Endobronchial ultrasound-guided transbronchial needle aspiration of the subcarinal lymph node revealed squamous cell lung carcinoma. A small hyperechoic rounded density was noted inside the lumen of the azygous vein. Based on chest computed tomography findings and her clinical history, this was felt to be a broken fragment of a peripherally inserted central catheter, which was placed for intravenous antibiotics, a few months prior to this presentation. To the best of our knowledge, this is the first ever CP-EBUS description of a broken fragment of central venous catheter. © 2016 John Wiley & Sons Ltd.

Complications of Peripherally Inserted Central Venous Catheters: A Retrospective Cohort Study.

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Paula Parás-Bravo

Full Text Available The use of venous catheters is a widespread practice, especially in oncological and oncohematological units. The objective of this study was to evaluate the complications associated with peripherally inserted central catheters (PICCs in a cohort of patients.In this retrospective cohort study, we included all patient carrying PICCs (n = 603 inserted at our institute between October 2010 and December 2013. The main variables collected were medical diagnosis, catheter care, location, duration of catheterization, reasons for catheter removal, complications, and nursing care. Complications were classified as infection, thrombosis, phlebitis, migration, edema, and/or ecchymosis.All patients were treated according to the same "nursing care" protocol. The incidence rate of complications was two cases per 1000 days of catheter duration. The most relevant complications were infection and thrombosis, both with an incidence of 0.17 cases per 1000 days of the total catheterization period. The total average duration of catheterization was 170 days [SD 6.06]. Additionally to "end of treatment" (48.42% and "exitus", (22.53% the most frequent cause of removal was migration (displacement towards the exterior of the catheter (5.80%.PICCs are safe devices that allow the administration of long-term treatment and preserve the integrity of the venous system of the patient. Proper care of the catheter is very important to improve the quality life of patients with oncologic and hematologic conditions. Therefore, correct training of professionals and patients as well as following the latest scientific recommendations are particularly relevant.

Evaluation of two different epidural catheters in clinical practice. narrowing down the incidence of paresthesia!

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Bouman, E A C; Gramke, H F; Wetzel, N; Vanderbroeck, T H T; Bruinsma, R; Theunissen, M; Kerkkamp, H E M; Marcus, M A E

2007-01-01

Although epidural anesthesia is considered safe, several complications may occur during puncture and insertion of a catheter. Incidences of paresthesia vary between 0.2 and 56%. A prospective, open, cohort-controlled pilot study was conducted in 188 patients, ASA I-III, age 19-87 years, scheduled for elective surgery and epidural anesthesia. We evaluated a 20 G polyamide (standard) catheter and a 20 G combined polyurethane-polyamide (new) catheter. Spontaneous reactions upon catheter-insertion, paresthesia on questioning, inadvertent dural or intravascular puncture, and reasons for early catheter removal were recorded. The incidence of paresthesia reported spontaneously was 21.3% with the standard catheter and 16.7% with the new catheter. Systematically asking for paresthesia almost doubled the paraesthesia rate. Intravascular cannulation occurred in 5%. No accidental dural punctures occurred. An overall incidence of 13.3% of technical problems led to early catheter removal. The new catheter was at least equivalent to the standard regarding epidural success rate and safety : rate of paresthesia, intravascular and dural cannulation.

Discriminating Tissue Stiffness with a Haptic Catheter: Feeling the Inside of the Beating Heart.

Science.gov (United States)

Kesner, Samuel B; Howe, Robert D

2011-01-01

Catheter devices allow physicians to access the inside of the human body easily and painlessly through natural orifices and vessels. Although catheters allow for the delivery of fluids and drugs, the deployment of devices, and the acquisition of the measurements, they do not allow clinicians to assess the physical properties of tissue inside the body due to the tissue motion and transmission limitations of the catheter devices, including compliance, friction, and backlash. The goal of this research is to increase the tactile information available to physicians during catheter procedures by providing haptic feedback during palpation procedures. To accomplish this goal, we have developed the first motion compensated actuated catheter system that enables haptic perception of fast moving tissue structures. The actuated catheter is instrumented with a distal tip force sensor and a force feedback interface that allows users to adjust the position of the catheter while experiencing the forces on the catheter tip. The efficacy of this device and interface is evaluated through a psychophyisical study comparing how accurately users can differentiate various materials attached to a cardiac motion simulator using the haptic device and a conventional manual catheter. The results demonstrate that haptics improves a user's ability to differentiate material properties and decreases the total number of errors by 50% over the manual catheter system.

Design, construction, and validation of a rotary multifunctional intravascular diagnostic catheter combining multispectral fluorescence lifetime imaging and intravascular ultrasound.

Science.gov (United States)

Bec, Julien; Xie, Hongtao; Yankelevich, Diego R; Zhou, Feifei; Sun, Yang; Ghata, Narugopal; Aldredge, Ralph; Marcu, Laura

2012-10-01

We report the development and validation of an intravascular rotary catheter for bimodal interrogation of arterial pathologies. This is based on a point-spectroscopy scanning time-resolved fluorescence spectroscopy technique enabling reconstruction of fluorescence lifetime images (FLIm) and providing information on arterial intima composition and intravascular ultrasound (IVUS) providing information on arterial wall morphology. The catheter design allows for independent rotation of the ultrasonic and optical channels within an 8 Fr outer diameter catheter sheath and integrates a low volume flushing channel for blood removal in the optical pathways. In the current configuration, the two channels consist of (a) a standard 3 Fr IVUS catheter with single element transducer (40 MHz) and (b) a side-viewing fiber optic (400 μm core). Experiments conducted in tissue phantoms showed the ability of the catheter to operate in an intraluminal setting and to generate coregistered FLIm and IVUS in one pull-back scan. Current results demonstrate the feasibility of the catheter for simultaneous bimodal interrogation of arterial lumen and for generation of robust fluorescence lifetime data under IVUS guidance. These results facilitate further development of a FLIm-IVUS technique for intravascular diagnosis of atherosclerotic cardiovascular diseases including vulnerable plaques.

The Variable Flow Characteristics for Different Brands of 3-Way Urinary Catheters: Proposing an Alternate and Accurate Standardised Labelling System.

Science.gov (United States)

Davis, Niall F; Abdelrahman, Mamoun; Cunnane, Conor V; Cunnane, Eoghan M; Walsh, Michael T; Thornhill, John A

2016-03-01

To evaluate an alternative catheter labelling approach for 3-way catheters based on the drainage channel and irrigation channel cross-sectional area (CSA), which impacts catheter flow rate characteristics. Three-way 22Fr catheters from Bard (Bard Limited), Rusch Simplastic (Teleflex Medical), Dover (COVIDIEN), and Rusch Golden were included in the study. Irrigation channel, drainage channel, and overall CSAs were digitally measured with an image-processing program. Irrigation channel and drainage channel flow rates were measured and correlated with their corresponding catheter CSA values. Catheter CSA and French value did not predict flow-rate characteristics, but irrigation channel CSA and drainage channel CSA were predictive. The 22Fr Rusch Simplastic catheter had the largest irrigation channel CSA (2.87 mm(2)) and drainage channel CSA (12.6 mm(2)), and had the greatest irrigation (5.27 ± 0.02 ml/s) and drainage flow rates (14.42 ± 0.22 ml/s). Twenty-two French gauge Rusch Golden catheters had the smallest irrigation channel CSA (1.34 mm(2)) and drainage channel CSA (7.82 mm(2)) and the lowest irrigation (1.83 ± 0.03 ml/s) and drainage flow rates (1.83 ± 0.03 ml/s). An alternative catheter labelling system to include overall CSA, irrigation channel CSA, and drainage channel CSA values would provide more accurate and transparent data relevant to anticipated drainage and irrigation flow rates. The proposed labelling method will assist urologists in selecting 3-way catheters for bladder irrigation. Copyright © 2016 Elsevier Inc. All rights reserved.

Account for Clinical Heterogeneity in Assessment of Catheter-based Renal Denervation among Resistant Hypertension Patients: Subgroup Meta-analysis.

Science.gov (United States)

Chen, Xiao-Han; Kim, Sehee; Zeng, Xiao-Xi; Chen, Zhi-Bing; Cui, Tian-Lei; Hu, Zhang-Xue; Li, Yi; Fu, Ping

2017-07-05

Catheter-based renal denervation (RDN) is a novel treatment for resistant hypertension (RH). A recent meta-analysis reported that RDN did not significantly reduce blood pressure (BP) based on the pooled effects with mild to severe heterogeneity. The aim of the present study was to identify and reduce clinical sources of heterogeneity and reassess the safety and efficacy of RDN within the identified homogeneous subpopulations. This was a meta-analysis of 9 randomized clinical trials (RCTs) among patients with RH up to June 2016. Sensitivity analyses and subgroup analyses were extensively conducted by baseline systolic blood pressure (SBP) level, antihypertensive medication change rates, and coronary heart disease (CHD). In all patients with RH, no statistical differences were found in mortality, severe cardiovascular events rate, and changes in 24-h SBP and office SBP at 6 and 12 months. However, subgroup analyses showed significant differences between the RDN and control groups. In the subpopulations with baseline 24-h SBP ≥155 mmHg (1 mmHg = 0.133 kPa) and the infrequently changed medication, the use of RDN resulted in a significant reduction in 24-h SBP level at 6 months (P = 0.100 and P= 0.009, respectively). Subgrouping RCTs with a higher prevalent CHD in control showed that the control treatment was significantly better than RDN in office SBP reduction at 6 months (P < 0.001). In all patients with RH, the catheter-based RDN is not more effective in lowering ambulatory or office BP than an optimized antihypertensive drug treatment at 6 and 12 months. However, among RH patients with higher baseline SBP, RDN might be more effective in reducing SBP.

Fantoni’s Tracheostomy using Catheter High Frequency Jet Ventilation

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P. Török

2012-01-01

Full Text Available Background: It has been shown previously that conventional ventilation delivered through a long cuffed endotracheal tube is associated with a high flow-resistance and frequent perioperative complications. Aim: We attempted to supersede the conventional ventilation by high-frequency jet ventilation through a catheter (HFJV-C and assess safety of the procedure. Material and methods: Using a translaryngeal tracheostomy kit, we performed a translaryngeal (Fantoni tracheostomy (TLT. Subsequently, we introduced a special 2-way prototype ventilatory catheter into the trachea via the TLT under bronchoscopic control. Satisfactory HFJV-C ventilation through the catheter was achieved in 218 patients. Results: There were no significant adverse effects on vital signs observed in the cohort during the study. The pH, SpO2, PaO2, and PaCO2 did not change significantly following the HFJV-C. The intrinsic PEEPi measured in trachea did not exceed 4—5 cm H2O during its application, which was significantly less than during the classical ventilation via the endotracheal tube fluctuating between 12 and 17 cm H2O. No serious medical complications occurred. Conclusion: The HFJV during Fantoni’s tracheostomy using the catheter HFJV-C proved to be a safe and effective method of lung ventilation at the intensive care unit. Key words: Translaryngeal tracheostomy, HFJV via catheter.

A comparative analysis of radiological and surgical placement of central venous catheters

International Nuclear Information System (INIS)

McBride, Kieran D.; Fisher, Ross; Warnock, Neil; Winfield, David A.; Reed, Malcolm W.; Gaines, Peter A.

1997-01-01

Purpose. To compare the differences in practice and outcome of all radiologically and surgically placed central venous catheters retrospectively over a 2-year period simultaneously, at a single institution. Methods.A total of 253 Hickman catheters were inserted in 209 patients; 120 were placed radiologically in 102 patients and 133 were placed surgically in 107 patients. The indication was chemotherapy in 76% of radiological and in 47% of surgical cases; the remainder were for total parenteral nutrition and venous access. Results. There were 6 (4.5%) primary surgical failures and a further 17 (13%) surgical cases requiring multiple placement attempts. Pneumothorax occurred once (0.8%) surgically and four times (3.3%) radiologically. There were no radiological primary misplacements but there were five (3.7%) surgical ones. Catheter or central vein thrombosis occurred in four (3.3%) radiological and five (3.7%) surgical cases. The rate of infection per 1000 catheter-days was 1.9 in radiologically placed catheters and 4.0 in surgically placed ones (p<0.001). Average catheter life-span was similar for the two placement methods (100±23 days). Conclusion. Radiological placement is consistently more reliable than surgical placement. There are fewer placement complications and fewer catheter infections overall

Catheter Displacement into Inferior Epigastric Vein Causing Local Phlebitis and Cellulitis

Directory of Open Access Journals (Sweden)

Noriko Hattori

2012-01-01

Full Text Available Catheter insertion for intravenous hyperalimentation is a commonly and widely used clinical technique. When compared with the incidence of complications associated with insertions into the internal jugular vein or the subclavian vein, complications associated with insertions into the femoral vein are less frequent. In this paper, we describe a very rare complication of femoral vein catheter insertion—namely, catheter displacement into the inferior epigastric vein.

Evaluation of electrical nerve stimulation for epidural catheter positioning in the dog.

Science.gov (United States)

Garcia-Pereira, Fernando L; Sanders, Robert; Shih, Andre C; Sonea, Ioana M; Hauptman, Joseph G

2013-09-01

To evaluate the accuracy of epidural catheter placement at different levels of the spinal cord guided solely by electrical nerve stimulation and resultant segmental muscle contraction. Prospective, experiment. Six male and two female Beagles, age (1 ± 0.17 years) and weight (12.9 ± 1.1 kg). Animals were anesthetized with propofol and maintained with isoflurane. An insulated epidural needle was used to reach the lumbosacral epidural space. A Tsui epidural catheter was inserted and connected to a nerve stimulator (1.0 mA, 0.1 ms, 2 Hz) to assess positioning of the tip at specific spinal cord segments. The catheter was advanced to three different levels of the spinal cord: lumbar (L2-L5), thoracic (T5-T10) and cervical (C4-C6). Subcutaneous needles were previously placed at these spinal levels and the catheter was advanced to match the needle location, guided only by corresponding muscle contractions. Catheter position was verified by fluoroscopy. If catheter tip and needle were at the same vertebral body a score of zero was assigned. When catheter tip was cranial or caudal to the needle, positive or negative numbers, respectively, corresponding to the number of vertebrae between them, were assigned. The mean and standard deviation of the number of vertebrae between catheter tip and needle were calculated to assess accuracy. Results are given as mean ± SD. The catheter position in relation to the needle was within 0.3 ± 2.0 vertebral bodies. Positive predictive values (PPV) were 57%, 83% and 71% for lumbar, thoracic and cervical regions respectively. Overall PPV was 70%. No significant difference in PPV among regions was found. Placement of an epidural catheter at specific spinal levels using electrical nerve stimulation was feasible without radiographic assistance in dogs. Two vertebral bodies difference from the target site may be clinically acceptable when performing segmental epidural regional anesthesia. © 2013 Association of Veterinary

Atrial fibrillation ablation using a closed irrigation radiofrequency ablation catheter.

Science.gov (United States)

Golden, Keith; Mounsey, John Paul; Chung, Eugene; Roomiani, Pahresah; Morse, Michael Andew; Patel, Ankit; Gehi, Anil

2012-05-01

Catheter ablation is an effective therapy for symptomatic, medically refractory atrial fibrillation (AF). Open-irrigated radiofrequency (RF) ablation catheters produce transmural lesions at the cost of increased fluid delivery. In vivo models suggest closed-irrigated RF catheters create equivalent lesions, but clinical outcomes are limited. A cohort of 195 sequential patients with symptomatic AF underwent stepwise AF ablation (AFA) using a closed-irrigation ablation catheter. Recurrence of AF was monitored and outcomes were evaluated using Kaplan-Meier survival analysis and Cox proportional hazards models. Mean age was 59.0 years, 74.9% were male, 56.4% of patients were paroxysmal and mean duration of AF was 5.4 years. Patients had multiple comorbidities including hypertension (76.4%), tobacco abuse (42.1%), diabetes (17.4%), and obesity (mean body mass index 30.8). The median follow-up was 55.8 weeks. Overall event-free survival was 73.6% with one ablation and 77.4% after reablation (reablation rate was 8.7%). Median time to recurrence was 26.9 weeks. AF was more likely to recur in patients being treated with antiarrhythmic therapy at the time of last follow-up (recurrence rate 30.3% with antiarrhythmic drugs, 13.2% without antiarrhythmic drugs; hazard ratio [HR] 2.2, 95% confidence interval [CI] 1.1-4.4, P = 0.024) and in those with a history of AF greater than 2 years duration (HR 2.7, 95% CI 1.1-6.9, P = 0.038). Our study represents the largest cohort of patients receiving AFA with closed-irrigation ablation catheters. We demonstrate comparable outcomes to those previously reported in studies of open-irrigation ablation catheters. Given the theoretical benefits of a closed-irrigation system, a large head-to-head comparison using this catheter is warranted. ©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.

Catheter-assisted retrieval of adhesive Geunther Tulip filter: preliminary experience

International Nuclear Information System (INIS)

Xiao Liang; Tong Jiajie; Xie Shiyang; Shen Jing

2011-01-01

Objective: To retrospectively summarize the technical experience in performing catheter-assisted retrieval of adhesive Geunther Tulip filter. Methods: During the period from November 2007 to October 2009, 95 patients with pulmonary embolism and acute deep vein thrombosis of lower limbs were admitted to authors' hospital. As simple snare technique failed to catch the adhesive Geunther Tulip filter previously implanted in inferior vena cava (IVC) in 6 patients (four males and two females with a mean age of 43.7 years), catheter-assisted retrieval of adhesive Geunther Tulip filter had to be carried out. The specific procedure was as follows. After phlebography of IVC confirmed that the filter's retrieval hook had adhered to IVC wall, the adhesion was separated with the help of catheter as well as goose-neck capturing device, then, the Geunther Tulip filter was retrieved. After the procedure, both anticoagulation and antibiotic medication were employed for 3-5 days. All the patients were followed up for 4-12 months. Vascular ultrasonography and pulmonary 3D CTA were re-examined in 6 months after primary operation. Results: All 6 adhesive Geunther Tulip filters were successfully removed with a success rate of 100%. The manipulation used in the procedure included catheter-twisting technique (n=1), catheter-looping technique (n=1) and catheter-snare looping technique (n=4). The mean operation time was 40.5 minutes (in the range of 17-78 minutes). The average filter-dwelling time was 46.7 days (ranging from 14 to 80 days). No thrombus formation in deep veins of lower extremity or pulmonary embolism occurred during the follow-up period. Conclusion: The catheter-assisted retrieval technique carries high retrieval rate for adhesive Geunther Tulip filter in IVC, it can markedly improve the retrieval success rate of Tulip IVC filter. (authors)

Unusual migration of ventriculo peritoneal distal catheter into vagina

Directory of Open Access Journals (Sweden)

Sghavamedin Tavallaee

2015-04-01

Full Text Available VP shunt is one of the most popular methods for ICP reduction and treatment of hydrocephalus. Various complications of this method are not uncommon such as shunt malfunction, infection and unusual migration of distal catheter. I present a case of migration of the peritoneal catheter out of the vagina.

Catheter-Related Bloodstream Infections in Adults Receiving Home Parenteral Nutrition

DEFF Research Database (Denmark)

Tribler, Siri; Brandt, Christopher F; Hvistendahl, Mark

2018-01-01

BACKGROUND: A common complication in patients receiving home parenteral nutrition (HPN) is catheter-related bloodstream infections (CRBSIs). The CRBSI incidence has been advocated as an outcome parameter assessing the quality of care. This study aimed to illustrate how the use of different CRBSI......) and European Society for Clinical Nutrition (ESPEN) CRBSI criteria. Employing a catheter-salvaging strategy, 40% of the CRBSI diagnoses were supported by the paired blood culture positivity criteria and only 6% by a positive catheter tip. In 53%, CRBSIs were categorized as a clinical or "probable CRBSI...

Preprocedural ultrasound examination versus manual palpation for thoracic epidural catheter insertion

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Ahmed M Hasanin

2017-01-01

Conclusion: Preprocedural ultrasound imaging increased the incidence of first pass success in thoracic epidural catheter insertion and reduced the catheter insertion time compared to manual palpation method.

Treatment of lung abscess: effectiveness of percutaneous catheter drainage in 14 patients

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Jeong, Su Hyun; Han, Young Min; Kim, Chong Soo; Chung, Gyung Ho; Ryu, Chun Su; Sohn, Myung Hee; Choi, Ki Chul [Chonbuk National University Medical School, Cheonju (Korea, Republic of)

1995-01-15

To evaluate the effectiveness of percutaneous catheter drainage in treatment of the lung abscess. We treated the lung abscesses in 14 patients (12 mean, 2 women), who did not respond to medical therapy, by percutaneous catheter drainage under fluoroscopic or ultrasound guidance. One abscess due to infacted bulla was managed by combination treatment with alcohol sclerosing therapy. Patients were followed by serial chest radiographs every three days and the amount of drained or aspirated pus evaluated. The treatment effect and recurrence were followed by chest PA and lateral chest at one week after removal of drainage catheter. Thirteen patients (93%) recovered clinically and radiologically within 3 days. In 10 patients, drainage catheter could be removed within 2 weeks, and three patients, the catheter was kept longer. Most complications were mild; vague to moderate chest pain (n = 14), mild hemoptysis (n = 2), and pneumothorax (n = 1). One man who suffered from far advanced pulmonary tuberculosis died of asphyxia caused by massive hemoptysis 16 days after percutaneous drainage. Percutaneous catheter drainage is a safe and effective method for treating lung abscess.

Improved electromagnetic tracking for catheter path reconstruction with application in high-dose-rate brachytherapy.

Science.gov (United States)

Lugez, Elodie; Sadjadi, Hossein; Joshi, Chandra P; Akl, Selim G; Fichtinger, Gabor

2017-04-01

Electromagnetic (EM) catheter tracking has recently been introduced in order to enable prompt and uncomplicated reconstruction of catheter paths in various clinical interventions. However, EM tracking is prone to measurement errors which can compromise the outcome of the procedure. Minimizing catheter tracking errors is therefore paramount to improve the path reconstruction accuracy. An extended Kalman filter (EKF) was employed to combine the nonlinear kinematic model of an EM sensor inside the catheter, with both its position and orientation measurements. The formulation of the kinematic model was based on the nonholonomic motion constraints of the EM sensor inside the catheter. Experimental verification was carried out in a clinical HDR suite. Ten catheters were inserted with mean curvatures varying from 0 to [Formula: see text] in a phantom. A miniaturized Ascension (Burlington, Vermont, USA) trakSTAR EM sensor (model 55) was threaded within each catheter at various speeds ranging from 7.4 to [Formula: see text]. The nonholonomic EKF was applied on the tracking data in order to statistically improve the EM tracking accuracy. A sample reconstruction error was defined at each point as the Euclidean distance between the estimated EM measurement and its corresponding ground truth. A path reconstruction accuracy was defined as the root mean square of the sample reconstruction errors, while the path reconstruction precision was defined as the standard deviation of these sample reconstruction errors. The impacts of sensor velocity and path curvature on the nonholonomic EKF method were determined. Finally, the nonholonomic EKF catheter path reconstructions were compared with the reconstructions provided by the manufacturer's filters under default settings, namely the AC wide notch and the DC adaptive filter. With a path reconstruction accuracy of 1.9 mm, the nonholonomic EKF surpassed the performance of the manufacturer's filters (2.4 mm) by 21% and the raw EM

Role of coexisting contralateral primary venous disease in development of post-thrombotic syndrome following catheter-based treatment of iliofemoral deep venous thrombosis.

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Lee, John J; Al-Jubouri, Mustafa; Acino, Robin; Comerota, Anthony J; Lurie, Fedor

2015-10-01

It has been reported that early clot removal benefits patients with iliofemoral deep venous thrombosis (DVT) by removing obstruction and preserving valve function. However, a substantial number of patients who had successful clot removal develop post-thrombotic syndrome (PTS). Residual thrombus and rethrombosis play a part in this phenomenon, but the role of coexisting primary chronic venous disease (PCVD) in these patients has not been studied. All patients who underwent catheter-based techniques of thrombus removal for symptomatic acute iliofemoral DVT during a 5-year period compose the study group. These patients were assessed for PTS by the Villalta scale, the Venous Clinical Severity Score (VCSS), and the Venous Insufficiency Epidemiological and Economic Study on Quality of Life (VEINES-QOL) questionnaire. The presence of coexisting PCVD was determined by clinical and duplex ultrasound findings in the contralateral leg at the time of the initial DVT diagnosis. Patients who had coexisting PCVD were compared with those without PCVD. Forty patients (40 limbs) were included in the study group. At initial diagnosis, 15 patients (38%) had coexisting symptomatic primary valve reflux in the unaffected limb. After thrombolysis, 9 of 40 limbs (22%) had complete lysis, 29 (73%) had ≥ 50% to 99% lysis, and 2 (5%) had thrombus removal techniques. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Catheter Migration After Implantationan Intrathecal Baclofen Infusion Pump for Severe Spasticity: A Case Report

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Tung-Chou Li

2008-09-01

Full Text Available We report a case of intrathecal baclofen infusion pump implantation complicated by migration of the catheter tip. A 55-year-old man required an intrathecal baclofen infusion for severe spasticity 4 years after a cervical spinal cord injury with incomplete tetraparesis. Twelve months after initial implantation of the device, the patient began to experience a recurrence of trunk tightness and spasticity. Subsequent X-ray and computed tomography evaluations of the catheter system revealed pooling of contrast medium outside of the intrathecal distribution in the lumbar subcutaneous region of the back and therefore migration of the pump catheter tip. At surgical revision, emphasis was placed on minimizing the length of catheter outside of the spine and securing the catheter in the supraspinous fascia with a right-angled anchor. The distance between the anchors and the entry point of the catheter into the supraspinous fascia was also reduced to prevent slipping when the patient bends forward. After surgery, the patient's spasticity improved and, 1 year later, he has experienced no further complications during follow-up, requiring an average baclofen dose of 150 mg/day. Here, we describe several surgical methods intended to secure the intrathecal catheter and prevent catheter migration. Other complications related to catheter failure are also highlighted.

Evaluation of percutaneous radiologic placement of peritoneal dialysis catheters: technical aspects, results, and complications

International Nuclear Information System (INIS)

Hong, Hyun Pyo; Oh, Joo Hyeong; Yoon, Yub; Lee, Tae Won; Ihm, Chun Gyoo

2001-01-01

To evaluate the technical aspects, results and complications of the percutaneous radiologic placement of peritoneal dialysis catheters. Between December 1999 and April 2001, 26 peritoneal dialysis catheters were placed percutaneously in 26 consecutive patients by interventional radiologists. The patient group consisted of 16 men and ten women with a mean age of 55 (range, 30-77) years. The results and complications arising were reviewed, and the expected patency of the catheters was determined by means of Kaplan-Meier survival analysis. The technical success rate for catheter placement was 100% (26/26 patients). Severe local bleeding occurred in one patient due to by inferior epigastric artery puncture, and was treated by compression and electronic cautery. The duration of catheter implantation ranged from 1 to 510 days and the patency rate was 416±45 days. Catheter malfunction occurred in four patients. In two, this was restored by manipulation in the intervention room, and in one, through the use of urokinase. In three patients, peritonitis occurred. Catheters were removed from four patients due to malfunction (n=2), peritonitis (n=1), and death (n=1). Percutaneous radiologic placement of a peritoneal dialysis catheter is a relatively simple procedure that reduces the complication rate and improves catheter patency

Evaluation of percutaneous radiologic placement of peritoneal dialysis catheters: technical aspects, results, and complications

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Hong, Hyun Pyo; Oh, Joo Hyeong; Yoon, Yub; Lee, Tae Won; Ihm, Chun Gyoo [Kyunghee University Hospital, seoul (Korea, Republic of)

2001-01-01

To evaluate the technical aspects, results and complications of the percutaneous radiologic placement of peritoneal dialysis catheters. Between December 1999 and April 2001, 26 peritoneal dialysis catheters were placed percutaneously in 26 consecutive patients by interventional radiologists. The patient group consisted of 16 men and ten women with a mean age of 55 (range, 30-77) years. The results and complications arising were reviewed, and the expected patency of the catheters was determined by means of Kaplan-Meier survival analysis. The technical success rate for catheter placement was 100% (26/26 patients). Severe local bleeding occurred in one patient due to by inferior epigastric artery puncture, and was treated by compression and electronic cautery. The duration of catheter implantation ranged from 1 to 510 days and the patency rate was 416{+-}45 days. Catheter malfunction occurred in four patients. In two, this was restored by manipulation in the intervention room, and in one, through the use of urokinase. In three patients, peritonitis occurred. Catheters were removed from four patients due to malfunction (n=2), peritonitis (n=1), and death (n=1). Percutaneous radiologic placement of a peritoneal dialysis catheter is a relatively simple procedure that reduces the complication rate and improves catheter patency.

Management of retained encrusted urethral catheter with extracorporeal shockwave lithotripsy

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Sameh Anwar Kunzman

2002-01-01

Full Text Available We report a case of non-deflating heavily encrusted Foley catheter successfully removed by extracorporeal shockwave lithotripsy (ESWL. To our knowledge this is the first case of using ESWL to remove encrusted foley catheter retained in the bladder.

Effects of catheter-based renal denervation on heart failure with reduced ejection fraction: a systematic review and meta-analysis.

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Fukuta, Hidekatsu; Goto, Toshihiko; Wakami, Kazuaki; Ohte, Nobuyuki

2017-11-01

Despite the recent advances in the management of heart failure, the mortality of heart failure patients remains high. It is of urgent need to develop new therapy for heart failure. Heart failure is characterized by increased sympathetic activity, and chronic sympathetic activation is involved in the maintenance of the pathological state. Catheter-based renal denervation (RDN) has emerged as an invasive but safe approach that can reduce sympathetic activation. Studies have reported inconsistent results regarding the effect of RDN in heart failure patients due to limited power with small sample sizes. We aimed to conduct a meta-analysis of the effect of RDN on heart failure patients with reduced left ventricular (LV) ejection fraction (EF). An electronic search for studies examining the effect of RDN on LV function in heart failure patients with reduced EF was conducted. Two controlled (80 patients) and 2 uncontrolled studies (21 patients) were included in this meta-analysis. In the pooled analysis, 6 months after RDN, there was a greater increase in EF (weighted mean difference [95% CI] = 8.63 [6.02, 11.24] %) and a greater decrease in LV end-diastolic diameter (-0.58 [-0.83, -0.34] cm) in RDN group than in control group. No serious adverse events such as acute renal artery stenosis and dissection occurred. Our meta-analysis of feasibility studies suggests that RDN may improve LV function in heart failure patients with reduced EF, providing the rationale to conduct next phase trials to confirm the observed potential benefits of RDN.

Swan-neck versus straight peritoneal dialysis catheter: Long-term effect on patient and method survival.

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Filiopoulos, V; Biblaki, D; Takouli, L; Dounavis, A; Hadjiyannakos, D; Vlassopoulos, D

2016-09-01

Peritoneal dialysis (PD) is limited mainly by a higher technique failure rate as compared to hemodialysis (HD), catheter malfunction being an important reason. Intra- and extra-peritoneal catheter configuration may be associated with mechanical and infectious complications affecting method survival. We report our experience with two extra-peritoneal catheter configurations: the straight and the swan-neck (SN) catheters. A total of 85 consecutive patients, 58 males and 27 females were included in the study. Among them, 26 were diabetics; 52 were treated with automated PD (APD) and 33 with continuous ambulatory PD (CAPD). Straight catheters were used in 38 patients (straight group) and SN catheters in 47 patients (SN group). Straight catheters were mostly used in the first 6-year period while SN catheters in the last 6-year period. The baseline demographics were similar between the two groups. A significantly higher frequency of APD use was observed in SN group. Technique survival was better with SN versus straight (log-rank test, P = 0.01) while patient and catheter survival were similar. A better technique survival is noted in our group of patients with SN catheters. An additional factor could be the significantly higher frequency of APD use in this group. Changes in PD solutions' composition could also contribute to improvement in technique survival. The outcome for patients and catheter types used was similar.

Interventional radiologic placement of tunneled central venous catheters : results and complications in 557 cases

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Kim, Chan Kyo; Do, Young Soo; Paik, Chul H. [Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of)] (and others)

1999-05-01

To evaluate prospectively the results of interventional radiologic placement of tunneled central venous catheters, and subsequent complications. Between April 1997 and April 1998, a total of 557 tunneled central venous catheters were percutaneously placed in 517 consecutive patients in an interventional radiology suite. The indications were chemotherapy in 533 cases, total parenteral nutrition in 23 and transfusion in one. Complications were evaluated prospectively by means of a chart review, chest radiography, central vein angiography and blood/catheter culture. The technical success rate for tunneled central venous catheter placement was 100% (557/557 cases). The duration of catheter placement ranged from 4 to 356 (mean, 112{+-}4.6) days; Hickman catheters were removed in 252 cases during follow-up. Early complications included 3 cases of pneumothorax(0.5%), 4 cases of local bleeding/hematoma(0.7%), 2 cases of primary malposition(0.4%), and 1 case of catheter leakage(0.2%). Late complications included 42 cases of catheter-related infection(7.5%), 40 cases of venous thrombosis (7.2%), 18 cases of migration (3.2%), 5 cases of catheter / pericatheter of occlusion(0.8%), and 1 case of pseudoaneurysm(0.2%). The infection rate and thrombosis rate per 1000 days were 1.57 and 1.50, respectively. The technical success rate of interventional radiologic placement of tunneled central venous catheters was high. In comparison to conventional surgical placement, it is a more reliable method and leads to fewer complications.

Catheter-Associated Urinary Tract Infections

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... Duodenoscope Sampling Method Interim Duodenoscope Culture Method Multiplex Real-Time PCR Detection of KPC & NDM-1 genes Quinolones ... The most commonly used external catheter is a soft flexible sheath that fits over the penis (“condom” ...

Acceptance criteria for reprocessed AcuNav catheters: comparison between functionality testing and clinical image assessment.

Science.gov (United States)

Bank, Alan J; Berry, James M; Wilson, Robert F; Lester, Bruce R

2009-03-01

The AcuNav-catheter is a vector-phased array ultrasound catheter that has shown great utility for both diagnosis and electrophysiological interventions. To test the feasibility of limited catheter reuse and to ensure that reprocessed catheters would produce acceptable clinical images, the present study compared the 2-D and Doppler image quality, as determined by clinical assessment, with the catheter's functional status as determined by the FirstCall 2000 transducer tester. Reprocessed catheters from four functional categories, two acceptable and two unacceptable, were used to collect images, 2-D and Doppler, from a porcine heart. The images were blinded and then rated by clinical evaluation. The study found that catheter images from all functional categories were found to be clinically acceptable except for those from the lowest unacceptable category. In addition, examination of tip deflection characteristics showed no significant difference between new and reprocessed catheters. We conclude that reprocessed AcuNav catheters that pass functional tests are able to produce clinical images, 2-D and Doppler, which are equivalent to their new counterparts.

The technical development of steerable catheter robot in performing interventional vascular surgery

International Nuclear Information System (INIS)

He Zhixiu; Qian Wei; Song Chengli

2011-01-01

Minimally invasive surgery is one of the primary means for the treatment of vascular diseases. The catheter is one of the main operating tools. As the vascular system is quite complicated and tiny, it is usually very difficult for the operator to accurately and bare-handily accomplish the whole intravascular procedure. Therefore, with the rapid development of minimally invasive surgeries the practical study related to the clinical employment of steerable catheter robot has attracted the researchers' attention. This paper aims to describe the emergence and development history of steerable catheter robot and also to introduce the main achievements as well as the up-to-date progress in the researches relevant to steerable catheter robot that the have been obtained by research workers all over the world so far. The prospects for the future development of steerable catheter robot are briefly discussed. (authors)

Nursing care for patients carrying indwelling catheter in target vessel for continuous chemotherapy

International Nuclear Information System (INIS)

Wen Lihong

2009-01-01

Objective: To reduce the occurrence of undesirable catheter-related events in patients with indwelling catheter during the course of continuous chemotherapy. Methods: (1)To enhance the propaganda,education and guidance to patients. (2) To standardize the nursing care operations. (3) To establish the reasonable care rules and procedures. (4) The nurses should take the daily nursing care,observations and recording work seriously. Results: Through the analysis of a variety of problems occurred in patients with indwelling catheter during the course of continuous chemotherapy the nursing care experience was summed up. Conclusion: Proper and effective care can reduce the occurrence of undesirable catheter-related events in patients with indwelling catheter during the course of continuous chemotherapy. (authors)

Lights, camera and action in the implementation of central venous catheter dressing

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Maria Verônica Ferrareze Ferreira

2015-12-01

Full Text Available Objective: to develop and validate an educational digital video on changing the dressing of short-term, non-cuffed, non-tunneled central venous catheters in hospitalized adult patients. Method: this is a descriptive, methodological study based on Paulo Freire's assumptions. The development of the script and video storyboard were based on scientific evidence, on the researchers' experience, and that of nurse experts, as well as on a virtual learning environment. Results: the items related to the script were approved by 97.2% of the nurses and the video was approved by 96.1%. Conclusion: the educational instrument was considered to be appropriate and we believe it will contribute to professional training in the nursing field, the updating of human resources, focusing on the educational process, including distance education. We believe it will consequently improve the quality of care provided to patients with central venous catheters.

Laparoscopic versus open peritoneal dialysis catheter insertion, the LOCI-trial: a study protocol

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Hagen Sander M

2011-12-01

Full Text Available Abstract Background Peritoneal dialysis (PD is an effective treatment for end-stage renal disease. It allows patients more freedom to perform daily activities compared to haemodialysis. Key to successful PD is the presence of a well-functioning dialysis catheter. Several complications, such as in- and outflow obstruction, peritonitis, exit-site infections, leakage and migration, can lead to catheter removal and loss of peritoneal access. Currently, different surgical techniques are in practice for PD-catheter placement. The type of insertion technique used may greatly influence the occurrence of complications. In the literature, up to 35% catheter failure has been described when using the open technique and only 13% for the laparoscopic technique. However, a well-designed randomized controlled trial is lacking. Methods/Design The LOCI-trial is a multi-center randomized controlled, single-blind trial (pilot. The study compares the laparoscopic with the open technique for PD catheter insertion. The primary objective is to determine the optimum placement technique in order to minimize the incidence of catheter malfunction at 6 weeks postoperatively. Secondary objectives are to determine the best approach to optimize catheter function and to study the quality of life at 6 months postoperatively comparing the two operative techniques. Discussion This study will generate evidence on any benefits of laparoscopic versus open PD catheter insertion. Trial registration Dutch Trial Register NTR2878

Cerebral microdialysis methodology--evaluation of 20 kDa and 100 kDa catheters.

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Hutchinson, P J; O'Connell, M T; Nortje, J; Smith, P; Al-Rawi, P G; Gupta, A K; Menon, D K; Pickard, J D

2005-08-01

Microdialysis monitoring of cerebral metabolism is now performed in several neuro-intensive care units. Conventional microdialysis utilizes CMA70 catheters with 20 kDa molecular weight cut-off membranes enabling the measurement of small molecules such as glucose, lactate, pyruvate and glutamate. The CMA71 100 kDa molecular weight cut-off microdialysis catheter has recently been introduced to allow detection of larger molecules such as cytokines. The objective of this study was to perform in vitro and in vivo testing of the CMA71 microdialysis catheter, comparing its performance with the CMA70. In vitro comparison studies of three of each catheter using reference analyte solutions, demonstrated equivalent recovery for glucose, lactate, pyruvate and glutamate (range 94-97% for CMA70 and 88-103% for CMA71). In vivo comparison involved intracranial placement of paired CMA70 and CMA71 catheters (through the same cranial access device) in six patients with severe traumatic brain injury. Both catheters were perfused with CNS Perfusion Fluid without dextran at 0.3 microl min-1 with hourly sampling and bedside analysis on a CMA600 microdialysis analyser. The two catheters yielded equivalent results for glucose, lactate, pyruvate, glutamate and lactate/pyruvate ratio. CMA71 microdialysis catheters can, therefore, be used for routine clinical monitoring of extracellular substances, as well as for their intended research role of larger molecular weight protein sampling.

The potential of photo-deposited silver coatings on Foley catheters to prevent urinary tract infections

International Nuclear Information System (INIS)

Cooper, Ian Richard; Pollini, Mauro; Paladini, Federica

2016-01-01

Catheter-associated urinary tract infection (CAUTI) represents one of the most common causes of morbidity and mortality. The resistance demonstrated by many microorganisms to conventional antibiotic therapies and the increasing health-care costs have recently encouraged the definition of alternative preventive strategies, which can have a positive effect in the management of infections. Antimicrobial urinary catheters have been developed through the photo-chemical deposition of silver coatings on the external and luminal surfaces. The substrates are exposed to ultraviolet radiation after impregnation into a silver-based solution, thus inducing the in situ synthesis of silver particles. The effect of the surface treatment on the material was investigated through scanning electron microscopy (SEM) and silver ion release measurements. The ability of microorganisms commonly associated with urinary tract infections was investigated in terms of bacterial viability, proliferation and biofilm development, using Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis as target organisms. The silver coatings demonstrated good distribution of silver particles to the substrate, and proved an effective antibacterial capability in simulated biological conditions. The low values of silver ion release demonstrated the optimum adhesion of the coating. The results indicated a good potential of silver-based antimicrobial materials for prevention of catheter-associated urinary tract infection. - Highlights: • Silver nanocoatings were deposited on urinary catheters. • Both luminal and outer surface were successfully treated. • The treated devices demonstrated were effective against different microorganisms. • The antibacterial potential of the devices was assessed.

The potential of photo-deposited silver coatings on Foley catheters to prevent urinary tract infections

Energy Technology Data Exchange (ETDEWEB)

Cooper, Ian Richard [School of Pharmacy & Biomolecular Sciences, University of Brighton, Lewes Road, Brighton BN2 4GJ (United Kingdom); Pollini, Mauro, E-mail: mauro.pollini@unisalento.it [Department of Engineering for Innovation, University of Salento, Via Monteroni, 73100 Lecce (Italy); Silvertech Ltd, Via Monteroni, 73100 Lecce (Italy); Paladini, Federica [Department of Engineering for Innovation, University of Salento, Via Monteroni, 73100 Lecce (Italy)

2016-12-01

Catheter-associated urinary tract infection (CAUTI) represents one of the most common causes of morbidity and mortality. The resistance demonstrated by many microorganisms to conventional antibiotic therapies and the increasing health-care costs have recently encouraged the definition of alternative preventive strategies, which can have a positive effect in the management of infections. Antimicrobial urinary catheters have been developed through the photo-chemical deposition of silver coatings on the external and luminal surfaces. The substrates are exposed to ultraviolet radiation after impregnation into a silver-based solution, thus inducing the in situ synthesis of silver particles. The effect of the surface treatment on the material was investigated through scanning electron microscopy (SEM) and silver ion release measurements. The ability of microorganisms commonly associated with urinary tract infections was investigated in terms of bacterial viability, proliferation and biofilm development, using Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis as target organisms. The silver coatings demonstrated good distribution of silver particles to the substrate, and proved an effective antibacterial capability in simulated biological conditions. The low values of silver ion release demonstrated the optimum adhesion of the coating. The results indicated a good potential of silver-based antimicrobial materials for prevention of catheter-associated urinary tract infection. - Highlights: • Silver nanocoatings were deposited on urinary catheters. • Both luminal and outer surface were successfully treated. • The treated devices demonstrated were effective against different microorganisms. • The antibacterial potential of the devices was assessed.

Peripheral intravenous catheter-related phlebitis and related risk factors.

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Nassaji-Zavareh, M; Ghorbani, R

2007-08-01

Peripheral intravenous catheter-related phlebitis is a common and significant problem in clinical practice. This study aims to investigate the incidence of phlebitis and to evaluate some important related factors. 300 patients admitted to medical and surgical wards of hospitals in Semnan, Iran from April 2003 to February 2004 were prospectively studied. Variables evaluated were age, gender, site and size of catheter, type of insertion and underlying conditions (diabetes mellitus, trauma, infectious disease and burns). Phlebitis was defined when at least four criteria were fulfilled (erythema, pain, tenderness, warmth, induration, palpable cord and swelling). Any patient who was discharged or their catheter removed before three days were excluded. Phlebitis occurred in 26 percent (95 percent confidence interval [CI] 21- 31 percent) of patients. There was no significant relationship between age, catheter bore size, trauma and phlebitis. Related risk factors were gender (odds-ratio [OR] 1.50, 95 percent CI 1.01-2.22), site (OR 3.25, 95 percent CI 2.26-4.67) and type of insertion (OR 2.04, 95 percent CI 1.36-3.05) of catheter, diabetes mellitus (OR 7.78, 95 percent CI 4.59-13.21), infectious disease (OR 6.21, 95 percent CI 4.27-9.03) and burns (OR 3.96, 95 percent CI 3.26-4.82). Phlebitis is still an important and ongoing problem in medical practice. In patients with diabetes mellitus and infectious diseases, more attention is needed.

Fluoroscopy guided percutaneous catheter drainage of pneumothorax in good mid-term patency with tube drainage

International Nuclear Information System (INIS)

Park, Ga Young; Oh, Joo Hyung; Yoon, Yup; Sung, Dong Wook

1995-01-01

To evaluate efficacy and the safety of percutaneous catheter drainage in patients with pneumothorax that is difficult to treat with closed thoracotomy. We retrospectively reviewed effectiveness of percutaneous catheter drainage (PCD) in 10 patients with pneumothorax. The catheter was inserted under fluoroscopic guidance. Seven patients had spontaneous pneumothorax caused by tuberculosis (n =4), reptured bullae (n = 2), and histiocytosis-X (n = 1). Three patients had iatrogenic pneumothorax caused by trauma (n = 1) and surgery (n = 2). All procedures were performed by modified Seldinger's method by using 8F-20F catheter. All catheter were inserted successfully. In 9 of 10 patients, the procedure was curative without further therapy. Duration of catheter insertion ranged from 1 day to 26 days. In the remaining 1 patient in whom multiple pneumothorax occurred after operation, catheter insertion was performed twice. Percutaneous catheter drainage under fluoroscopic guidance is effective and safe procedure for treatment of pneumothorax in patients with failed closed thoracotomy

Fluoroscopy guided percutaneous catheter drainage of pneumothorax in good mid-term patency with tube drainage

Energy Technology Data Exchange (ETDEWEB)

Park, Ga Young; Oh, Joo Hyung; Yoon, Yup; Sung, Dong Wook [Kyung Hee University Hospital, Seoul (Korea, Republic of)

1995-10-15

To evaluate efficacy and the safety of percutaneous catheter drainage in patients with pneumothorax that is difficult to treat with closed thoracotomy. We retrospectively reviewed effectiveness of percutaneous catheter drainage (PCD) in 10 patients with pneumothorax. The catheter was inserted under fluoroscopic guidance. Seven patients had spontaneous pneumothorax caused by tuberculosis (n =4), reptured bullae (n = 2), and histiocytosis-X (n = 1). Three patients had iatrogenic pneumothorax caused by trauma (n = 1) and surgery (n = 2). All procedures were performed by modified Seldinger's method by using 8F-20F catheter. All catheter were inserted successfully. In 9 of 10 patients, the procedure was curative without further therapy. Duration of catheter insertion ranged from 1 day to 26 days. In the remaining 1 patient in whom multiple pneumothorax occurred after operation, catheter insertion was performed twice. Percutaneous catheter drainage under fluoroscopic guidance is effective and safe procedure for treatment of pneumothorax in patients with failed closed thoracotomy.

Virulence factors in Proteus bacteria from biofilm communities of catheter-associated urinary tract infections.

Science.gov (United States)

Hola, Veronika; Peroutkova, Tereza; Ruzicka, Filip

2012-07-01

More than 40% of nosocomial infections are those of the urinary tract, most of these occurring in catheterized patients. Bacterial colonization of the urinary tract and catheters results not only in infection, but also various complications, such as blockage of catheters with crystalline deposits of bacterial origin, generation of gravels and pyelonephritis. The diversity of the biofilm microbial community increases with duration of catheter emplacement. One of the most important pathogens in this regard is Proteus mirabilis. The aims of this study were to identify and assess particular virulence factors present in catheter-associated urinary tract infection (CAUTI) isolates, their correlation and linkages: three types of motility (swarming, swimming and twitching), the ability to swarm over urinary catheters, biofilm production in two types of media, urease production and adherence of bacterial cells to various types of urinary tract catheters. We examined 102 CAUTI isolates and 50 isolates taken from stool samples of healthy people. Among the microorganisms isolated from urinary catheters, significant differences were found in biofilm-forming ability and the swarming motility. In comparison with the control group, the microorganisms isolated from urinary catheters showed a wider spectrum of virulence factors. The virulence factors (twitching motility, swimming motility, swarming over various types of catheters and biofilm formation) were also more intensively expressed. © 2012 Federation of European Microbiological Societies. Published by Blackwell Publishing Ltd. All rights reserved.

Policies for replacing long-term indwelling urinary catheters in adults.

Science.gov (United States)

Cooper, Fergus P M; Alexander, Cameron Edwin; Sinha, Sanjay; Omar, Muhammad Imran

2016-07-26

Long-term indwelling catheters are used commonly in people with lower urinary tract problems in home, hospital and specialised health-care settings. There are many potential complications and adverse effects associated with long-term catheter use. The effect of health-care policies related to the replacement of long-term urinary catheters on patient outcomes is unclear. To determine the effectiveness of different policies for replacing long-term indwelling urinary catheters in adults. We searched the Cochrane Incontinence Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 19 May 2016), and the reference lists of relevant articles. All randomised controlled trials investigating policies for replacing long-term indwelling urinary catheters in adults were included. At least two review authors independently performed data extraction and assessed risk of bias of all the included trials. Quality of evidence was assessed by adopting the GRADE approach. Any discrepancies were resolved by discussion between the review authors or an independent arbitrator. We contacted the authors of included trials to seek clarification where required. Three trials met the inclusion criteria, with a total of 107 participants in three different health-care settings: A USA veterans administration nursing home; a geriatric centre in Israel; and a community nursing service in Hong Kong. Data were available for three of the pre-stated comparisons. Priefer and colleagues evaluated different time intervals between catheter replacement (n = 17); Firestein and colleagues evaluated the use of antibiotic prophylaxis at the time of replacement (n = 70); and Cheung and colleagues compared two different types of cleaning solutions (n = 20).All the included trials were