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  1. Skin colonisation at the catheter exit site is strongly associated with catheter colonisation and catheter-related sepsis.

    Science.gov (United States)

    Ponnusamy, Vennila; Perperoglou, Aris; Venkatesh, Vidheya; Curley, Anna; Brown, Nicholas; Tremlett, Catherine; Clarke, Paul

    2014-12-01

    The commonest mode of catheter colonisation is via the extraluminal route with skin bacteria. Catheter-related sepsis causes significant mortality and morbidity in neonates. Our aim was to study the relationships between culture-positive catheter exit site skin swabs, percutaneous central venous catheter segments and blood to determine the magnitude of associations between exit site skin colonisation, catheter colonisation and catheter-related sepsis. In a prospective study, an exit site skin swab and three formerly in vivo catheter segments (proximal, middle and tip) were taken for culture at catheter removal. In those neonates who were clinically unwell at catheter removal, a peripheral blood culture was also collected. Univariate and multivariate analyses were used to study associations. Skin swabs were culture positive in 39 (21%) of 187 catheter removals. With a culture-positive skin swab, the risk of associated catheter colonisation was nearly eight times higher (OR: 7.84, 95% CI: 3.59-17.15) and the risk of definite catheter-related sepsis with the same organism was nearly 10 times higher (OR 9.86, 95% CI: 3.13-31.00). Culture-positive skin swabs from the catheter exit site were strongly associated with catheter colonisation and with definite catheter-related sepsis with the same organism. These data provide further evidence supporting catheter colonisation via the extraluminal route and highlight the importance of optimising skin disinfection before catheter insertion. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  2. Reprocessing single-use cardiac catheters for interventional cardiology. A cost-minimization model for estimating potential saving at departmental scale and national level

    Directory of Open Access Journals (Sweden)

    Francesco Tessarolo

    2009-06-01

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    Background: The utilization of single-use percutaneous catheters (SUDs is a common practice in interventional cardiology, but the increasing of cardiac interventions and the consequent economic load demand for assessing SUDs’ reuse. The study aimed at estimating the potential saving for Italian cardiology departments in the hypothesis that reprocessing and reuse of SUD is performed by guaranteeing safety and efficiency of the reconditioned device as high as the new marketed one.

    Methods: A cost-minimization model was applied from the perspective of the health national service. Input parameters for the model were settled by reviewing published data on technical, hygiene and functional properties of reprocessed electrophysiology (EP and percutaneous transluminal coronary angioplasty (PTCA catheters. Potential saving at department level was calculated as percentage of the actual expenditure for purchasing single-use devices. Two-ways sensitivity analysis was conducted on main cost drivers. Finally, saving at national level was estimated.

    Results: The revision of technical and safety data showed the feasibility of reprocessing and reuse of EP and PTCA catheters under determined constrains. Potential savings of 39%, and 12% were calculated at department level for EP and PTCA catheters, respectively. Sensitivity analysis showed saving was dependent primarily on departmental workload. Major variations in saving occurred in the range between one and 200 catheters per year. The cut-off between benefit and charges was also related to regeneration rate and maximum number of uses. The estimate of potential saving at national level ranged in the interval from €19.85M to €24.24M.

    Conclusions:When safety and efficiency is assured by certified reuse processing, substantial saving could be achieved both at departmental and national level contributing to optimize budget

  3. Clinical features of catheter-related candidemia at disease onset.

    Science.gov (United States)

    Yoshino, Yusuke; Wakabayashi, Yoshitaka; Suzuki, Satoshi; Seo, Kazunori; Koga, Ichiro; Kitazawa, Takatoshi; Okugawa, Shu; Ota, Yasuo

    2014-11-01

    Early detection of catheter-related candidemia is necessary to ensure that patients receive prompt and appropriate treatment. The aim of the present case-control study is to investigate the clinical features of catheter-related candidemia at disease onset, so as to determine the clinical indications for empiric antifungal therapy. All 41 cases of catheter-related candidemia from September 2009 to August 2011 at a teaching hospital were included in the present study. To determine the characteristics that were risk factors for developing catheter-related candidemia, we compared all cases of catheter-related candidemia with all 107 cases of catheter-related blood stream infection (CRBSI) caused by non-Candida spp. In comparison with CRBSI due to non-Candida spp., the duration of catheter use was significantly longer in cases of catheter-related candidemia (13.9 ± 9.0 days vs. 23.2 ± 25.2 days). There was also a significant difference in the frequency of pre-antibiotic treatment between catheter-related candidemia and CRBSI due to non-Candida spp. (97.6% [40/41 cases] vs. 44.9% [48/107 cases]). Patients with catheter-related candidemia also had significantly more severe clinical statuses (measured using the Sepsis-related Organ Failure Assessment score) than patients with CRBSI due to non-Candida spp. (7.63 ± 3.65 vs. 5.92 ± 2.81). When compared to patients with CRBSI caused by non-Candida spp., patients with catheter-related candidemia had significantly more severe clinical backgrounds, longer duration of catheter use and more frequent prior administration of antibiotic agents.

  4. Reprocessing single-use cardiac catheters for interventional cardiology. A cost-minimization model for estimating potential saving at departmental scale and national level

    OpenAIRE

    Francesco Tessarolo; Marcello Disertori; Giovanni M. Guarrera; Stefano Capri; Giandomenico Nollo

    2009-01-01

    Background: The utilization of single-use percutaneous catheters (SUDs) is a common practice in interventional cardiology, but the increasing of cardiac interventions and the consequent economic load demand for assessing SUDs’ reuse. The study aimed at estimating the potential saving for Italian cardiology departments in the hypothesis that reprocessing and reuse of SUD is performed by guaranteeing safety and efficiency of the reconditioned device as high...

  5. Theoretical modelling, experimental studies and clinical simulations of urethral cooling catheters for use during prostate thermal therapy

    International Nuclear Information System (INIS)

    Davidson, Sean R H; Sherar, Michael D

    2003-01-01

    Urethral cooling catheters are used to prevent thermal damage to the urethra during thermal therapy of the prostate. Quantification of a catheter's heat transfer characteristics is necessary for prediction of the catheter's influence on the temperature and thermal dose distribution in periurethral tissue. Two cooling catheters with different designs were examined: the Dornier Urowave catheter and a prototype device from BSD Medical Corp. A convection coefficient, h, was used to characterize the cooling ability of each catheter. The value of the convection coefficient (h = 330 W m -2 deg C -1 for the Dornier catheter, h = 160 W m -2 deg C -1 for the BSD device) was obtained by comparing temperatures measured in a tissue-equivalent phantom material to temperatures predicted by a finite element method simulation of the phantom experiments. The coefficient was found to be insensitive to the rate of coolant flow inside the catheter between 40 and 120 ml min -1 . The convection coefficient method for modelling urethral catheters was incorporated into simulations of microwave heating of the prostate. Results from these simulations indicate that the Dornier device is significantly more effective than the BSD catheter at cooling the tissue surrounding the urethra

  6. Tissue adhesion to bioactive glass-coated silicone tubing in a rat model of peritoneal dialysis catheters and catheter tunnels.

    Science.gov (United States)

    Ross, Edward A; Batich, Christopher D; Clapp, William L; Sallustio, Judith E; Lee, Nadeen C

    2003-02-01

    Silicone peritoneal dialysis catheters do not develop tissue ingrowth, lack a mechanical barrier to periluminal bacterial migration and need cuffs for anchorage. We hypothesized that a bioactive glass coating composed of silicon, calcium, sodium and phosphorous oxides would cause a beneficial tissue reaction causing catheter adhesion, and tested this in a rat model. A hexane solvent-based method of coating silicone tubes with Bioglass powder was used, which maintained flexibility, and then the ultrastructure was confirmed with scanning electron microscopy (EM). Segments 2.5 cm were implanted subcutaneously in 8 Sprague-Dawley rats, with uncoated tubes as a contralateral control, and histology was done at 2, 4 and 6 weeks, including special stains and EM. The uncoated segments grossly had no adherence to surrounding tissue, and were physically separate from a thin fibrous capsule of approximately 50 micro width. Trichrome stains demonstrated the capsule was rich in collagen. There was minimal adjacent tissue reaction. In contrast, the coated tubes were palpably fixed to the soft tissues, and sections demonstrated an adjacent prominent layer of macrophages and multinucleated giant cells. Small numbers of lymphocytes were noted. This cellular reaction increased over the 6-week implant duration, and was also associated with neovascularization of the tissue adjacent to the segments (33 vessels in coated vs. 20 in controls per x 200 field, P tubing by promoting adhesion by collagen and cell proliferation, and are promising for future studies of peritoneal dialysis catheters.

  7. Polyurethane versus silicone catheters for central venous port devices implanted at the forearm.

    Science.gov (United States)

    Wildgruber, Moritz; Lueg, Claudia; Borgmeyer, Sebastian; Karimov, Ilham; Braun, Ulrike; Kiechle, Marion; Meier, Reinhard; Koehler, Michael; Ettl, Johannes; Berger, Hermann

    2016-05-01

    We aimed to analyse short and long-term complications of polyurethane (PU) versus silicone catheters used in totally implantable venous-access ports (TIVAPs) implanted at the forearm. Retrospective analysis of 698 consecutively implanted TIVAPs was performed. Primary end-points were defined as rates of major complications associated with either type of central venous port catheter. Technical success rate, device service interval as well as minor complications not requiring port explantation were defined as secondary end-points. A total of 698 port devices were implanted in 681 patients, 396 equipped with a PU catheter, 302 with a silicone catheter. The technical success rate was 99.9% with no major periprocedural complications. During follow-up a total of 211 complications in 146 patients were observed (1.0/1000 catheter days), 183 occurred associated with PU catheters (1.8/100 catheter days), 28 (0.3/1000 catheter days) with silicone catheters (log rank test p < 0.0001). Catheter-related bloodstream infections as well as thrombotic complications occurred significantly more frequently with PU catheters, while silicone catheters exhibited a trend towards a higher rate of mechanical failure such as disconnection or catheter rupture. Major complications requiring explantation of the device occurred more frequently with PU-based catheters (10.6%) compared to silicone catheter carrying ports (4.6%, log rank test p < 0.001). PU catheters are more susceptible to catheter-related infections and exhibit a higher thrombogenicity, compared to silicone catheters. Silicone catheters instead exhibit a trend towards decreased mechanical stability. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. 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 ...

  9. 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 ...

  10. Convective Leakage Makes Heparin Locking of Central Venous Catheters Ineffective Within Seconds: Experimental Measurements in a Model Superior Vena Cava.

    Science.gov (United States)

    Barbour, Michael C; McGah, Patrick M; Ng, Chin H; Clark, Alicia M; Gow, Kenneth W; Aliseda, Alberto

    2015-01-01

    Central venous catheters (CVCs), placed in the superior vena cava (SVC) for hemodialysis or chemotherapy, are routinely filled while not in use with heparin, an anticoagulant, to maintain patency and prevent thrombus formation at the catheter tip. The heparin-locking procedure, however, places the patient at risk for systemic bleeding, as heparin is known to leak from the catheter into the blood stream. We provide evidence from detailed in vitro experiments that shows the driving mechanism behind heparin leakage to be convective-diffusive transport due to the pulsatile flow surrounding the catheter. This novel mechanism is supported by experimental planar laser-induced fluorescence (PLIF) and particle image velocimetry (PIV) measurements of flow velocity and heparin transport from a CVC placed inside a model SVC inside a pulsatile flow loop. The results predict an initial, fast (<10 s), convection-dominated phase that rapidly depletes the concentration of heparin in the near-tip region, the region of the catheter with side holes. This is followed by a slow, diffusion-limited phase inside the catheter lumen, where the concentration is still high, that is insufficient at replenishing the lost heparin concentration in the near-tip region. The results presented here, which are consistent with previous in vivo estimates of 24 hour leakage rates, predict that the concentration of heparin in the near-tip region is essentially zero for the majority of the interdialytic phase, rendering the heparin locking procedure ineffective.

  11. Pseudo-Rigid-Body Model and Kinematic Analysis of MRI-Actuated Catheters.

    Science.gov (United States)

    Greigarn, Tipakorn; Çavuşoğlu, M Cenk

    2015-05-01

    This paper presents a kinematic study of a pseudorigid-body model (PRBM) of MRI-compatible, magnetically actuated, steerable catheters. It includes a derivation of a mathematical model of the PRBM of the catheter, singularity studies of the model, and a new manipulability measure. While the forward kinematics of the model presented here is applicable to PRBMs for other applications, actuation method is unique to the particular design. Hence, a careful study of singularities and manipulability of the model is required. The singularities are studied from the underlying equations of motion with intuitive interpretations. The proposed manipulability measure is a generalization of the inverse condition number manipulability measure of robotic manipulators. While the PRBM is an approximation of the flexible catheter, kinematic studies of the PRBM still provide some insight into feasibility and limitations of the catheter, which is beneficial to the design and motion planning of the catheter.

  12. 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....

  13. 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 ...

  14. Accurate model-based segmentation of gynecologic brachytherapy catheter collections in MRI-images.

    Science.gov (United States)

    Mastmeyer, Andre; Pernelle, Guillaume; Ma, Ruibin; Barber, Lauren; Kapur, Tina

    2017-12-01

    The gynecological cancer mortality rate, including cervical, ovarian, vaginal and vulvar cancers, is more than 20,000 annually in the US alone. In many countries, including the US, external-beam radiotherapy followed by high dose rate brachytherapy is the standard-of-care. The superior ability of MR to visualize soft tissue has led to an increase in its usage in planning and delivering brachytherapy treatment. A technical challenge associated with the use of MRI imaging for brachytherapy, in contrast to that of CT imaging, is the visualization of catheters that are used to place radiation sources into cancerous tissue. We describe here a precise, accurate method for achieving catheter segmentation and visualization. The algorithm, with the assistance of manually provided tip locations, performs segmentation using image-features, and is guided by a catheter-specific, estimated mechanical model. A final quality control step removes outliers or conflicting catheter trajectories. The mean Hausdorff error on a 54 patient, 760 catheter reference database was 1.49  mm; 51 of the outliers deviated more than two catheter widths (3.4  mm) from the gold standard, corresponding to catheter identification accuracy of 93% in a Syed-Neblett template. In a multi-user simulation experiment for evaluating RMS precision by simulating varying manually-provided superior tip positions, 3σ maximum errors were 2.44  mm. The average segmentation time for a single catheter was 3 s on a standard PC. The segmentation time, accuracy and precision, are promising indicators of the value of this method for clinical translation of MR-guidance in gynecologic brachytherapy and other catheter-based interventional procedures. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Catheter Angiography

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    Full Text Available ... prick when the needle is inserted into your vein for the intravenous line (IV). Injecting a local anesthetic at the site where the catheter is inserted may sting briefly, but it will ...

  16. Intracardiac Echocardiography Guided Transeptal Catheter Injection of Microspheres for Assessment of Cerebral Microcirculation in Experimental Models

    Directory of Open Access Journals (Sweden)

    Judith Bellapart

    2013-01-01

    Full Text Available The use of microspheres for the determination of regional microvascular blood flow (RMBF has previously used different approaches. This study presents for the first time the intracardiac injection of microspheres using transeptal puncture under intracardiac echocardiography guidance. Five Merino sheep were instrumented and cardiovascularly supported according to local guidelines. Two catheter sheaths into the internal jugular vein facilitated the introduction of an intracardiac probe and transeptal catheter, respectively. Five million colour coded microspheres were injected into the left atrium via this catheter. After euthanasia the brain was used as proof of principle and the endpoint for determination of microcirculation at different time points. Homogeneous allocation of microspheres to different regions of the brain was found over time. Alternate slices from both hemispheres showed the following flow ranges: for slice 02; 0.57–1.02 mL/min/g, slice 04; 0.45–1.42 mL/min/g, slice 06; 0.35–1.87 mL/min/g, slice 08; 0.46–1.77 mL/min/g, slice 10; 0.34–1.28 mL/min/g. A mixed effect regression model demonstrated that the confidence interval did include zero suggesting that the apparent variability intra- and intersubject was not statistically significant, supporting the stability and reproducibility of the injection technique. This study demonstrates the feasibility of the transeptal injection of microspheres, showing a homogeneous distribution of blood flow through the brain unchanged over time and has established a new interventional model for the measurement of RMBF in ovine models.

  17. 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.

  18. Catheter Angiography

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    Full Text Available ... Videos About Us News Physician Resources Professions Site Index A-Z Catheter Angiography Catheter angiography uses a ... few millimeters) in the skin where the catheter can be inserted into an artery. The catheter is ...

  19. Thulium fiber laser recanalization of occluded ventricular catheters in an ex vivo tissue model

    Science.gov (United States)

    Hutchens, Thomas C.; Gonzalez, David A.; Hardy, Luke A.; McLanahan, C. Scott; Fried, Nathaniel M.

    2017-04-01

    Hydrocephalus is a chronic medical condition that occurs in individuals who are unable to reabsorb cerebrospinal fluid (CSF) created within the ventricles of the brain. Treatment requires excess CSF to be diverted from the ventricles to another part of the body, where it can be returned to the vascular system via a shunt system beginning with a catheter within the ventricle. Catheter failures due to occlusion by brain tissues commonly occur and require surgical replacement of the catheter. In this preliminary study, minimally invasive clearance of occlusions is explored using an experimental thulium fiber laser (TFL), with comparison to a conventional holmium: yttrium aluminium garnet (YAG) laser. The TFL utilizes smaller optical fibers (450-μm OD), providing critical extra cross-sectional space within the 1.2-mm-inner-diameter ventricular catheter for simultaneous application of an endoscope for image guidance and a saline irrigation tube for visibility and safety. TFL ablation rates using 100-μm core fiber, 33-mJ pulse energy, 500-μs pulse duration, and 20- to 200-Hz pulse rates were compared to holmium laser using a 270-μm core fiber, 325-mJ, 300-μs, and 10 Hz. A tissue occluded catheter model was prepared using coagulated egg white within clear silicone tubing. An optimal TFL pulse rate of 50 Hz was determined, with an ablation rate of 150 μm/s and temperature rise outside the catheter of ˜10°C. High-speed camera images were used to explore the mechanism for removal of occlusions. Image guidance using a miniature, 0.7-mm outer diameter, 10,000 pixel endoscope was explored to improve procedure safety. With further development, simultaneous application of TFL with small fibers, miniature endoscope for image guidance, and irrigation tube for removal of tissue debris may provide a safe, efficient, and minimally invasive method of clearing occluded catheters in the treatment of hydrocephalus.

  20. Effectiveness of a Drill-assisted Intraosseous Catheter versus Manual Intraosseous Catheter by Resident Physicians in a Swine Model

    Directory of Open Access Journals (Sweden)

    Hafner, John William

    2013-11-01

    Full Text Available Introduction: Our objective was to compare the effectiveness, speed, and complication rate of the traditional manually placed intraosseous (IO catheter to a mechanical drill-assisted IO catheter by emergency medicine (EM resident physicians in a training environment. Methods: Twenty-one EM residents participated in a randomized prospective crossover experiment placing 2 intraosseous needles (Cook® Intraosseous Needle, Cook Medical, Bloomington, IN; and EZ-IO® Infusion System, Vidacare, San Antonio, TX. IO needles were placed in anesthetized mixed breed swine (mass range: 25 kg to 27.2 kg. The order of IO placement and puncture location (proximal tibia or distal femur were randomly assigned. IO placement time was recorded from skin puncture until the operator felt they had achieved successful placement. We used 3 verification criteria: aspiration of marrow blood, easy infusion of 10 mL saline mixed with methylene blue, and lack of stained soft tissue extravasation. Successful placement was defined as meeting 2 out of the 3 predetermined criteria. We surveyed participants regarding previous IO experience, device preferences, and comfort levels using multiple choice, Likert scale, and visual analog scale (VAS questions. IO completion times, VAS, and mean Likert scales were compared using Student’s t-test and success rates were compared using Fisher’s exact test with p<0.05 considered significant.Results: Drill-assisted IO needle placement was faster than manually placed IO needle placement (3.66 vs. 33.57 seconds; p=0.01. Success rates were 100% with the drill-assisted IO needle and 76.2% with the manual IO needle (p=0.04. The most common complication of the manual IO insertion was a bent needle (33.3% of attempts. Participants surveyed preferred the drill-assisted IO insertion more than the manual IO insertion (p<0.0001 and felt the drill-assisted IO was easier to place (p<0.0001.Conclusion: In an experimental swine model, drill-assisted IO

  1. Endovascular Catheter for Magnetic Navigation under MR Imaging Guidance: Evaluation of Safety in Vivo at 1.5T

    Science.gov (United States)

    Hetts, S.W.; Saeed, M.; Martin, A.J.; Evans, L.; Bernhardt, A.F.; Malba, V.; Settecase, F.; Do, L.; Yee, E.J.; Losey, A.; Sincic, R.; Roy, S.; Arenson, R.L.; Wilson, M.W.

    2013-01-01

    BACKGROUND AND PURPOSE: Endovascular navigation under MR imaging guidance can be facilitated by a catheter with steerable microcoils on the tip. Not only do microcoils create visible artifacts allowing catheter tracking, but also they create a small magnetic moment permitting remote-controlled catheter tip deflection. A side product of catheter tip electrical currents, however, is the heat that might damage blood vessels. We sought to determine the upper boundary of electrical currents safely usable at 1.5T in a coil-tipped microcatheter system. MATERIALS AND METHODS: Alumina tubes with solenoid copper coils were attached to neurovascular microcatheters with heat shrink-wrap. Catheters were tested in carotid arteries of 8 pigs. The catheters were advanced under x-ray fluoroscopy and MR imaging. Currents from 0 mA to 700 mA were applied to test heating and potential vascular damage. Postmortem histologic analysis was the primary endpoint. RESULTS: Several heat-mitigation strategies demonstrated negligible vascular damage compared with control arteries. Coil currents ≤300 mA resulted in no damage (0/58 samples) compared with 9 (25%) of 36 samples for > 300-mA activations (P = .0001). Tip coil activation ≤1 minute and a proximal carotid guide catheter saline drip > 2 mL/minute also had a nonsignificantly lower likelihood of vascular damage. For catheter tip coil activations ≤300 mA for ≤1 minute in normal carotid flow, 0 of 43 samples had tissue damage. CONCLUSIONS: Activations of copper coils at the tip of microcatheters at low currents in 1.5T MR scanners can be achieved without significant damage to blood vessel walls in a controlled experimental setting. Further optimization of catheter design and procedure protocols is necessary for safe remote control magnetic catheter guidance. PMID:23846795

  2. Catheter Angiography

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

  3. Catheter Angiography

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

  4. Catheter Angiography

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    Full Text Available ... risks? What are the limitations of Catheter Angiography? What is Catheter Angiography? Angiography is a minimally invasive ... of ionizing radiation ( x-rays ). top of page What are some common uses of the procedure? Catheter ...

  5. Catheter Angiography

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

  6. Catheter Angiography

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    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 ...

  7. Urinary catheters

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    ... indwelling catheter, clean the area where the catheter exits your body and the catheter itself with soap ... DO, urologist with the Michigan Institute of Urology, West Bloomfield, MI. Review provided by VeriMed Healthcare Network. ...

  8. Catheter Angiography

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    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 ...

  9. An In Vivo Rabbit Model for the Evaluation of Antimicrobial Peripherally Inserted Central Catheter to Reduce Microbial Migration and Colonization as Compared to an Uncoated PICC

    Directory of Open Access Journals (Sweden)

    Nicholas D. Allan

    2012-01-01

    Full Text Available Infection is the leading complication associated with intravascular devices, and these infections develop when a catheter becomes colonized by microorganisms. To combat this issue, medical device manufacturers seek to provide healthcare facilities with antimicrobial medical devices to prevent or reduce the colonization. In order to adequately evaluate these devices, an in vivo model is required to accurately assess the performance of the antimicrobial devices in a clinical setting. The model presented herein was designed to provide a simulation of the subcutaneous tunnel environment to evaluate the ability of an antimicrobial peripherally inserted central catheter (PICC, coated with chlorhexidine based technology, to reduce microbial migration and colonization compared to an uncoated PICC. Three samples of control, uncoated PICCs and three samples of coated PICCs were surgically tunneled into the backs of female New Zealand White rabbits. The insertion sites were then challenged with Staphylococcus aureus at the time of implantation. Animals were evaluated out to thirty days and sacrificed. Complete en bloc dissection and evaluation of the catheter and surrounding tissue demonstrated that the chlorhexidine coated catheter was able to significantly reduce microbial colonization and prevent microbial migration as compared to the standard, un-treated catheter.

  10. 3D Printed Modeling of the Mitral Valve for Catheter-Based Structural Interventions.

    Science.gov (United States)

    Vukicevic, Marija; Puperi, Daniel S; Jane Grande-Allen, K; Little, Stephen H

    2017-02-01

    As catheter-based structural heart interventions become increasingly complex, the ability to effectively model patient-specific valve geometry as well as the potential interaction of an implanted device within that geometry will become increasingly important. Our aim with this investigation was to combine the technologies of high-spatial resolution cardiac imaging, image processing software, and fused multi-material 3D printing, to demonstrate that patient-specific models of the mitral valve apparatus could be created to facilitate functional evaluation of novel trans-catheter mitral valve repair strategies. Clinical 3D transesophageal echocardiography and computed tomography images were acquired for three patients being evaluated for a catheter-based mitral valve repair. Target anatomies were identified, segmented and reconstructed into 3D patient-specific digital models. For each patient, the mitral valve apparatus was digitally reconstructed from a single or fused imaging data set. Using multi-material 3D printing methods, patient-specific anatomic replicas of the mitral valve were created. 3D print materials were selected based on the mechanical testing of elastomeric TangoPlus materials (Stratasys, Eden Prairie, Minnesota, USA) and were compared to freshly harvested porcine leaflet tissue. The effective bending modulus of healthy porcine MV tissue was significantly less than the bending modulus of TangoPlus (p  0.95). We have demonstrated that patient-specific mitral valve models can be reconstructed from multi-modality imaging datasets and fabricated using the multi-material 3D printing technology and we provide two examples to show how catheter-based repair devices could be evaluated within specific patient 3D printed valve geometry. However, we recognize that the use of 3D printed models for the development of new therapies, or for specific procedural training has yet to be defined.

  11. Exclusion of fluoroscopy use in catheter ablation procedures: six years of experience at a single center.

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    Fernández-Gómez, Juan M; Moriña-Vázquez, Pablo; Morales, Elena Del Rio; Venegas-Gamero, José; Barba-Pichardo, Rafael; Carranza, Manuel Herrera

    2014-06-01

    Nonfluoroscopic mapping systems have demonstrated significant reduction of radiation exposure in radiofrequency (RF) catheter ablation procedures. However, their use as only imaging guide is still limited. To evaluate the usefulness of a completely nonfluoroscopic approach to catheter ablation of supraventricular arrhythmias using the Ensite-NavX™ electroanatomical navigation system. During 6 years, all consecutive patients referred for RF catheter ablation of regular supraventricular tachycardia (SVT) were admitted for a "zero-fluoroscopy" approach and studied prospectively. The only exclusion criterion was the need to perform a transseptal puncture. A total of 340 procedures were performed on 328 patients (179 men, age 55.7 ± 18.6 years). One hundred fifty-three patients had typical atrial flutter (AFL), 146 had AV nodal reentrant tachycardia (AVNRT), 35 had AV reciprocating tachycardia (AVRT), 4 patients had incisional atrial flutter (IAF), and 2 had focal atrial tachycardia (AT). Procedural success was achieved in 337 of the cases (99.1%). In 322 (94.7%), the procedure was completed without any fluoroscopy use. Mean procedure time was 110.5 ± 51.8 minutes. Mean RF application time was 9.8 ± 12.8 minutes and the number of RF lesions was 16.43 ± 15.8. Only 1 major complication related to vascular access was recorded. During follow-up, there were 12 recurrences (3.5%) (8 patients from the AVNRT group, 4 patients from the AP group). RF catheter ablation of SVT with an approach completely guided by the NavX system and without use of fluoroscopy is feasible, safe, and effective. © 2014 Wiley Periodicals, Inc.

  12. 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 (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 bifurcation of the cruciate sulcal veins with the SSS was

  13. Catheter Angiography

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    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 ( ...

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

    Science.gov (United States)

    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).

  15. Chlorhexidine 2% and choice of transparent dressing increase skin reactions at central venous catheter insertion sites.

    Science.gov (United States)

    Loewenthal, Mark; Dobson, Pauline; Boyle, Michael

    2016-12-01

    Infection at central venous catheter (CVC) sites remains a common problem, particularly with long-term use. This report discusses the influence of choice of transparent dressing type and chlorhexidine concentration on skin reactions at CVC insertion sites. A concentration of 2% chlorhexidine is associated with a higher rate of skin reactions than either 0.5% or 1% chlorhexidine. Higher chlorhexidine concentrations may not decrease the number of central line-associated bloodstream infections. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  16. Automated Pointing of Cardiac Imaging Catheters.

    Science.gov (United States)

    Loschak, Paul M; Brattain, Laura J; Howe, Robert D

    2013-12-31

    Intracardiac echocardiography (ICE) catheters enable high-quality ultrasound imaging within the heart, but their use in guiding procedures is limited due to the difficulty of manually pointing them at structures of interest. This paper presents the design and testing of a catheter steering model for robotic control of commercial ICE catheters. The four actuated degrees of freedom (4-DOF) are two catheter handle knobs to produce bi-directional bending in combination with rotation and translation of the handle. An extra degree of freedom in the system allows the imaging plane (dependent on orientation) to be directed at an object of interest. A closed form solution for forward and inverse kinematics enables control of the catheter tip position and the imaging plane orientation. The proposed algorithms were validated with a robotic test bed using electromagnetic sensor tracking of the catheter tip. The ability to automatically acquire imaging targets in the heart may improve the efficiency and effectiveness of intracardiac catheter interventions by allowing visualization of soft tissue structures that are not visible using standard fluoroscopic guidance. Although the system has been developed and tested for manipulating ICE catheters, the methods described here are applicable to any long thin tendon-driven tool (with single or bi-directional bending) requiring accurate tip position and orientation control.

  17. Serratia marcescens bacteraemia outbreak in haemodialysis patients with tunnelled catheters due to colonisation of antiseptic solution. Experience at 4 hospitals.

    Science.gov (United States)

    Merino, José L; Bouarich, Hanane; Pita, Mª José; Martínez, Patricia; Bueno, Blanca; Caldés, Silvia; Corchete, Elena; Jaldo, Mª Teresa; Espejo, Beatriz; Paraíso, Vicente

    %) colonised by S. marcescens. Given the routine application of this antiseptic in handling catheters at these units, this was considered the source of contagion and new cases were not observed after the removal of the batches. The presence of bacteraemia due to unconventional germs should alert us to a potential outbreak. The application of a solution contaminated by S. marcescens in haemodialysis catheters was the source of bacteraemia. The intravenous antibiotic treatment and the catheter lock solution allowed an excellent survival of patients and catheters. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  18. Optimization of Catheter Ablation of Atrial Fibrillation: Insights Gained from Clinically-Derived Computer Models

    Directory of Open Access Journals (Sweden)

    Jichao Zhao

    2015-05-01

    Full Text Available Atrial fibrillation (AF is the most common heart rhythm disturbance, and its treatment is an increasing economic burden on the health care system. Despite recent intense clinical, experimental and basic research activity, the treatment of AF with current antiarrhythmic drugs and catheter/surgical therapies remains limited. Radiofrequency catheter ablation (RFCA is widely used to treat patients with AF. Current clinical ablation strategies are largely based on atrial anatomy and/or substrate detected using different approaches, and they vary from one clinical center to another. The nature of clinical ablation leads to ambiguity regarding the optimal patient personalization of the therapy partly due to the fact that each empirical configuration of ablation lines made in a patient is irreversible during one ablation procedure. To investigate optimized ablation lesion line sets, in silico experimentation is an ideal solution. 3D computer models give us a unique advantage to plan and assess the effectiveness of different ablation strategies before and during RFCA. Reliability of in silico assessment is ensured by inclusion of accurate 3D atrial geometry, realistic fiber orientation, accurate fibrosis distribution and cellular kinetics; however, most of this detailed information in the current computer models is extrapolated from animal models and not from the human heart. The predictive power of computer models will increase as they are validated with human experimental and clinical data. To make the most from a computer model, one needs to develop 3D computer models based on the same functionally and structurally mapped intact human atria with high spatial resolution. The purpose of this review paper is to summarize recent developments in clinically-derived computer models and the clinical insights they provide for catheter ablation.

  19. Catheter-based induction of renal ischemia/reperfusion in swine: description of an experimental model.

    Science.gov (United States)

    Malagrino, Pamella A; Venturini, Gabriela; Yogi, Patrícia S; Dariolli, Rafael; Padilha, Kallyandra; Kiers, Bianca; Gois, Tamiris C; da Motta-Leal-Filho, Joaquim M; Takimura, Celso K; Girardi, Adriana C C; Carnevale, Francisco C; Zeri, Ana C M; Malheiros, Denise M A C; Krieger, José E; Pereira, Alexandre C

    2014-09-01

    Several techniques to induce renal ischemia have been proposed: clamp, PVA particles, and catheter-balloon. We report the development of a controlled, single-insult model of unilateral renal ischemia/reperfusion (I/R) without contralateral nephrectomy, using a suitable model, the pig. This is a balloon-catheter-based model using a percutaneous, interventional radiology procedure. One angioplasty balloon-catheter was placed into the right renal artery and inflated for 120 min and reperfusion over 24 h. Serial serums were sampled from the inferior vena cava and urine was directly sampled from the bladder throughout the experiment, and both kidneys were excised after 24 h of reperfusion. Analyses of renal structure and function were performed by hematoxylin-eosin/periodic Acid-Schiff, serum creatinine (SCr), blood urea nitrogen (BUN), fractional excretion of ions, and glucose, SDS-PAGE analysis of urinary proteins, and serum neutrophil gelatinase-associated lipocalin (NGAL). Total nitrated protein was quantified to characterize oxidative stress. Acute tubular necrosis (ATN) was identified in every animal, but only two animals showed levels of SCr above 150% of baseline values. As expected, I/R increased SCr and BUN. Fractional sodium, potassium, chloride, and bicarbonate excretion were modulated during ischemia. Serum-nitrated proteins and NGAL had two profiles: decreased with ischemia and increased after reperfusion. This decline was associated with increased protein excretion during ischemia and early reperfusion. Altogether, these data show that the renal I/R model can be performed by percutaneous approach in the swine model. This is a suitable translational model to study new early renal ischemic biomarkers and pathophysiological mechanisms in renal ischemia. © 2014 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

  20. Catheter Angiography

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    Full Text Available ... the body for abnormalities such as aneurysms and disease such as atherosclerosis (plaque). The use of a catheter makes it possible to combine diagnosis and treatment in a single procedure. Catheter angiography ...

  1. Catheter Angiography

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    Full Text Available ... anxiety during the procedure. The area of the groin or arm where the catheter will be inserted ... it will make the rest of the procedure pain-free. You will not feel the catheter in ...

  2. Catheter Angiography

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    Full Text Available ... Angiography 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 ...

  3. 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 ...

  4. 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 ...

  5. Catheter Angiography

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

  6. Evaluation of the safety of latrogenic lntestinal perforation during placement of percutaneous drainage catheter in rabbit

    International Nuclear Information System (INIS)

    Lee, Choon Hyeong; Oh, Joo Hyung; Park, Ga Young; Shin, Hong Sub; Kim, In Sub; Yoon, Yup; Lee, Dong Ho; Ko, Young Tae; Choi, Woo Suk; Lim, Joo Won

    1996-01-01

    To evaluate the safety of transgression of the bowel during intraperitoneal percutaneous catheter placement in an animal model. Eight 8-F straight catheters were percutaneously inserted into the small and large bowel of eight rabbits. In four animals, the catheters were left in place until autopsy, whereas in the remaining four, the catheters were withdrawn five days after insertion. Autopsy was performed in all animals ten days after catheter placement, and gross and microscopic examination was carried out. Transgressing the bowel during intraperitoneal percutaneous catheter placement did not contribute to any clinically significant complications. At autopsy, there was no bowel leakage, peritonitis, or abscess, although peritoneal adhesions were found around the catheter tract. Although further study is warranted, our study with an animal model indicated that transgression of the intestine during percutaneous placement of an intraabdominal catheter did not produce significant complications

  7. Evaluation of the safety of latrogenic lntestinal perforation during placement of percutaneous drainage catheter in rabbit

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Choon Hyeong; Oh, Joo Hyung; Park, Ga Young; Shin, Hong Sub; Kim, In Sub; Yoon, Yup; Lee, Dong Ho; Ko, Young Tae; Choi, Woo Suk; Lim, Joo Won [Kyunghee Univ. Hospital, Seoul (Korea, Republic of)

    1996-10-01

    To evaluate the safety of transgression of the bowel during intraperitoneal percutaneous catheter placement in an animal model. Eight 8-F straight catheters were percutaneously inserted into the small and large bowel of eight rabbits. In four animals, the catheters were left in place until autopsy, whereas in the remaining four, the catheters were withdrawn five days after insertion. Autopsy was performed in all animals ten days after catheter placement, and gross and microscopic examination was carried out. Transgressing the bowel during intraperitoneal percutaneous catheter placement did not contribute to any clinically significant complications. At autopsy, there was no bowel leakage, peritonitis, or abscess, although peritoneal adhesions were found around the catheter tract. Although further study is warranted, our study with an animal model indicated that transgression of the intestine during percutaneous placement of an intraabdominal catheter did not produce significant complications.

  8. 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

  9. Role of short-term antibiotic therapy at the moment of catheter removal after laparoscopic radical prostatectomy.

    Science.gov (United States)

    Pinochet, Rodrigo; Nogueira, Lucas; Cronin, Angel M; Katz, Darren; Rabbani, Farhang; Guillonneau, Bertrand; Touijer, Karim

    2010-01-01

    To assess the role of short-term antibiotic therapy (ABT) in preventing urinary tract infection (UTI) after catheter removal following laparoscopic radical prostatectomy (LRP). 729 consecutive patients underwent LRP by one of two surgeons. One surgeon systematically prescribed a 3-day course of ABT (ciprofloxacin) starting the day before catheter removal; the other surgeon did not. The groups were compared for the incidence of symptomatic UTI occurring within 6 weeks after catheter removal. ABT was given to 261 of 713 patients (37%), while the remaining 452 patients (63%) did not receive ABT. After catheter removal, UTI was observed less frequently among patients receiving ABT: 3.1 vs. 7.3% in those not receiving ABT (p = 0.019). A number needed to treat to prevent 1 UTI is 24. Hospital readmission for febrile UTI was observed only in patients who did not receive ABT (n = 5, 1.1 vs. 0%, p = 0.16). One would need to prescribe ABT for 91 LRP patients to prevent 1 case of febrile UTI. ABT at the time of catheter removal reduced the risk of postoperative UTI after LRP. One would need to prescribe ABT to 24 patients to prevent 1 case of UTI. Copyright © 2010 S. Karger AG, Basel.

  10. Volume of the left ventricle at the end of a ventricular diastole in computerised tomography compared with cardiac catheter ventriculography

    Energy Technology Data Exchange (ETDEWEB)

    Rienmueller, R.; Lissner, J.; Kment, A.; Bohn, J.; Strauer, B.E.; Hellwig, D.; Erdmann, E.; Cyran, J.; Steinbeck, G.

    1981-06-01

    In 47 patients the authors calculated the volume at the end of a diastole according to both the cardiac catheter ventriculogram and the CT ventriculogram, comparing the results obtained with each of these methods. A linear regression was found. The correlation coefficient was approximately r = 0.96; n = 47. Cardiological examination revealed that of the examined patients (including the cardiac catheter finding) 18 patients had coronary heart disease, whereas 9 had cardiomyopathy, 6 artial hypertension, 9 had various cardiac abnormalities and 5 did not show any organically manifest heart disease. The article discusses CT determination of the volume at the end of the ventricular diastole, and discusses the results.

  11. A successful retrograde re-entry at aorta using the Outback LTD catheter for a bilateral common iliac artery occlusion.

    Science.gov (United States)

    Kim, Tae-Hoon; Ahn, Ji-Hun; Kim, Do-Hoi

    2013-05-01

    The Outback LTD re-entry catheter system has become a valuable tool for peripheral intervention and it has been widely used for variable peripheral chronic total occlusion (CTO). However, its use in the setting of the aorta was restricted because of concerns of bleeding risks resulting from re-entry puncture or ballooning. This report presents a case of successful re-entry using the Outback LTD Re-Entry Catheter (Cordis, Bridgewater, New Jersy) at the aorta in a patient with bilateral common iliac artery occlusion. Copyright © 2012 Wiley Periodicals, Inc.

  12. Effects of a catheter-associated urinary tract infection prevention campaign on infection rate, catheter utilization, and health care workers' perspective at a community safety net hospital.

    Science.gov (United States)

    Gray, Dorinne; Nussle, Richard; Cruz, Abner; Kane, Gail; Toomey, Michael; Bay, Curtis; Ostovar, Gholamabbas Amin

    2016-01-01

    Preventing catheter-associated urinary tract infections is in the forefront of health care quality. However, nurse and physician engagement is a common barrier in infection prevention efforts. After implementation of a multidisciplinary catheter-associated urinary tract infection (CAUTI) prevention campaign, we studied the impact of our campaign and showed its association with reducing the CAUTI rate and catheter utilization and the positive effect on health care workers' engagement and perspectives. CAUTI prevention campaigns can lead to lower infection rates and change health care workers' perspective. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  13. 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 ...

  14. Catheter Angiography

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    Full Text Available ... imaging technologies and, in most cases, a contrast material injection is needed to produce pictures of blood vessels in the body. Angiography is performed using: x-rays with catheters computed tomography (CT) magnetic resonance imaging (MRI) In catheter angiography, a thin ...

  15. Catheter Angiography

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    Full Text Available ... 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 ...

  16. Catheter Angiography

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    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 ...

  17. Navigation of guidewires and catheters in the body during intervention procedures : A review of computer-based models

    NARCIS (Netherlands)

    Sharei Amarghan, H.; Alderliesten, Tanja; van den Dobbelsteen, J.J.; Dankelman, J.

    2018-01-01

    Guidewires and catheters are used during minimally invasive interventional procedures to traverse in vascular system and access the desired position. Computer models are increasingly being used to predict the behavior of these instruments. This information can be used to choose the right

  18. 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 ...

  19. Endovascular brain intervention and mapping in a dog experimental model using magnetically-guided micro-catheter technology.

    Science.gov (United States)

    Kara, Tomas; Leinveber, Pavel; Vlasin, Michal; Jurak, Pavel; Novak, Miroslav; Novak, Zdenek; Chrastina, Jan; Czechowicz, Krzysztof; Belehrad, Milos; Asirvatham, Samuel J

    2014-06-01

    Despite the substantial progress that has been achieved in interventional cardiology and cardiac electrophysiology, endovascular intervention for the diagnosis and treatment of central nervous system (CNS) disorders such as stroke, epilepsy and CNS malignancy is still limited, particularly due to highly tortuous nature of the cerebral arterial and venous system. Existing interventional devices and techniques enable only limited and complicated access especially into intra-cerebral vessels. The aim of this study was to develop a micro-catheter magnetically-guided technology specifically designed for endovascular intervention and mapping in deep CNS vascular structures. Mapping of electrical brain activity was performed via the venous system on an animal dog model with the support of the NIOBE II system. A novel micro-catheter specially designed for endovascular interventions in the CNS, with the support of the NIOBE II technology, was able to reach safely deep intra-cerebral venous structures and map the electrical activity there. Such structures are not currently accessible using standard catheters. This is the first study demonstrating successful use of a new micro-catheter in combination with NIOBE II technology for endovascular intervention in the brain.

  20. Catheter Angiography

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    Full Text Available ... machine produces a small burst of radiation that passes through the body, recording an image on photographic ... By selecting the arteries through which the catheter passes, it is possible to assess vessels in several ...

  1. 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 ...

  2. 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 ...

  3. Catheter Angiography

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    Full Text Available ... story about radiology? Share your patient story here Images × Image Gallery Interventional radiologist performing an angiography exam View ... ray, Interventional Radiology and Nuclear Medicine Radiation Safety Images related to Catheter Angiography Sponsored by Please note ...

  4. Catheter Angiography

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    Full Text Available ... dose of ionizing radiation ( x-rays ). top of page What are some common uses of the procedure? Catheter ... live more than an hour away. top of page What does the equipment look like? The equipment typically ...

  5. Catheter Angiography

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    Full Text Available ... the body absorb the x-rays in varying degrees. Dense bone absorbs much of the radiation while ... by angioplasty and placement of a stent . The degree of detail displayed by catheter angiography may not ...

  6. 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 ... Society of Urogenital Radiology note that the available data suggest that it is safe to continue breastfeeding ...

  7. Catheter Angiography

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    Full Text Available ... will make the rest of the procedure pain-free. You will not feel the catheter in your ... of North America, Inc. (RSNA). To help ensure current and accurate information, we do not permit copying ...

  8. Catheter Angiography

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    Full Text Available ... tube, called a catheter , is inserted into an artery through a small incision in the skin. Once ... in the chest and abdomen, or in other arteries. detect atherosclerotic (plaque) disease in the carotid artery ...

  9. 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 ... material injection, you should immediately inform the technologist. Women should always inform their physician or x-ray ...

  10. Catheter Angiography

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    Full Text Available ... such as aneurysms and disease such as atherosclerosis (plaque). The use of a catheter makes it possible ... and abdomen, or in other arteries. detect atherosclerotic (plaque) disease in the carotid artery of the neck, ...

  11. Catheter Angiography

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    Full Text Available ... you are pregnant and discuss any recent illnesses, medical conditions, medications you're taking and allergies, especially ... is Catheter Angiography? Angiography is a minimally invasive medical test that helps physicians diagnose and treat medical ...

  12. 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 ...

  13. Catheter Angiography

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    Full Text Available ... disease). evaluate obstructions of vessels. top of page How should I prepare? You should inform your physician ... as a strand of spaghetti. top of page How does the procedure work? Catheter angiography works much ...

  14. Catheter Angiography

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    Full Text Available ... of page What are some common uses of the procedure? Catheter angiography is used to examine blood ... an hour away. top of page What does the equipment look like? The equipment typically used for ...

  15. Effect of External Pressure and Catheter Gauge on Flow Rate, Kinetic Energy, and Endothelial Injury During Intravenous Fluid Administration in a Rabbit Model.

    Science.gov (United States)

    Hu, Mei-Hua; Chan, Wei-Hung; Chen, Yao-Chang; Cherng, Chen-Hwan; Lin, Chih-Kung; Tsai, Chien-Sung; Chou, Yu-Ching; Huang, Go-Shine

    2016-01-01

    The effects of intravenous (IV) catheter gauge and pressurization of IV fluid (IVF) bags on fluid flow rate have been studied. However, the pressure needed to achieve a flow rate equivalent to that of a 16 gauge (G) catheter through smaller G catheters and the potential for endothelial damage from the increased kinetic energy produced by higher pressurization are unclear. Constant pressure on an IVF bag was maintained by an automatic adjustable pneumatic pressure regulator of our own design. Fluids running through 16 G, 18 G, 20 G, and 22 G catheters were assessed while using IV bag pressurization to achieve the flow rate equivalent to that of a 16 G catheter. We assessed flow rates, kinetic energy, and flow injury to rabbit inferior vena cava endothelium. By applying sufficient external constant pressure to an IVF bag, all fluids could be run through smaller (G) catheters at the flow rate in a 16 G catheter. However, the kinetic energy increased significantly as the catheter G increased. Damage to the venous endothelium was negligible or minimal/patchy cell loss. We designed a new rapid infusion system, which provides a constant pressure that compresses the fluid volume until it is free from visible residual fluid. When large-bore venous access cannot be obtained, multiple smaller catheters, external pressure, or both should be considered. However, caution should be exercised when fluid pressurized to reach a flow rate equivalent to that in a 16 G catheter is run through a smaller G catheter because of the profound increase in kinetic energy that can lead to venous endothelium injury.

  16. Hygroscopic dilators vs balloon catheter ripening of the cervix for induction of labor in nulliparous women at term: Retrospective study

    OpenAIRE

    Shindo, Ryosuke; Aoki, Shigeru; Yonemoto, Naohiro; Yamamoto, Yuriko; Kasai, Junko; Kasai, Michi; Miyagi, Etsuko

    2017-01-01

    Objective To compare the efficacy and safety of hygroscopic dilators and balloon catheters for ripening of the cervix in induction of labor. Study design This retrospective, observational study used data from the Successive Pregnancy Birth Registry System of the Japan Society of Obstetrics and Gynecology from 2012 to 2014. Nulliparous women in whom labor was induced by mechanical methods of cervical ripening at term were enrolled. The eligible women were divided into dilator, balloon

  17. [Foley catheter versus prostaglandin E2 gel for induction of labour at term: the PROBAAT study

    NARCIS (Netherlands)

    Jozwiak, M.; Oude Rengerink, K.; Leeuw, J.W. de; Mol, B.W.; Bloemenkamp, K.W.; Benthem, M.; Beek, E. van; Dijksterhuis, M.G.; Graaf, I.M. de; Huizen, M.E. van; Oudijk, M.A.; Papatsonis, D.N.; Perquin, D.A.; Porath, M.; Post, J.A. van der; Rijnders, R.J.; Scheepers, H.C.; Spaanderman, M.E.A.; Pampus, M.G. van

    2012-01-01

    Objective To study the effectiveness and safety of induction of labour with a Foley catheter compared with vaginal prostaglandin E2 gel in full term pregnant women. Design Multicentre, randomised, open-label trial in 12 hospitals in the Netherlands between February 2009 and May 2010. Methods Women

  18. 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

  19. Respiration and heartbeat signal detection from airflow at airway in rat by catheter flow sensor with temperature compensation function

    Science.gov (United States)

    Hasegawa, Y.; Kawaoka, H.; Yamada, T.; Matsushima, M.; Kawabe, T.; Shikida, M.

    2017-12-01

    We previously proposed an evaluation method for detecting both respiration and heartbeat signals from the airflow at the mouth (Kawaoka et al 201518th Int. Conf. on Solid-State Sensors, Actuators and Microsystems; Kawaoka et al 2015 IEEE Sensors; Kawaoka et al 2016 Technical Digest IEEE Micro Electro Mechanical Systems Conf.). In the current study, we developed a catheter flow sensor with temperature compensation that uses MEMS technologies and used it to directly detect the breathing airflow in the airway of a rat. The temperature sensors were integrated with the catheter flow sensor. Heaters working as airflow and temperature sensors were produced on polymer film by using the same fabrication process so that the temperature coefficients of their resistances would coincide. As a result, the variation in sensor outputs due to the airflow temperature changes ranging from 20 °C to 34 °C was suppressed to less than 2.5%. The developed catheter flow sensor was inserted into the airway of a rat to detect both respiration and heartbeat signals. The accuracy of the breathing airflow measurements was improved thanks to the temperature compensation. The tidal volume variations between the expired and inspired air were suppressed to within 5%. Heartbeat signal information was extracted from the measured breathing waveforms by applying a discrete Fourier transform.

  20. Feasibility of Endovascular Radiation Therapy Using Holmium-166 Filled Balloon Catheter in a Swine Hemodialysis Fistula Model: Preliminary Results

    Energy Technology Data Exchange (ETDEWEB)

    Won, Jong Yun; Lee, Kwang Hun; Lee, Do Yun [Dept. of Radiology, Research Institute of Radiological Science, Yensei University College of Medicine, Seoul (Korea, Republic of); Kim, Myoung Soo [Dept. of Radiology, Yensei University College of Medicine, Seoul (Korea, Republic of); Kang, Byung Chul [Dept. of Radiology, Internal Medicine, EwhaWoman' s University School of Medicine, Seoul (Korea, Republic of); Kim, Seung Jung [Dept. of Internal Medicine, EwhaWoman' s University School of Medicine, Seoul (Korea, Republic of)

    2011-08-15

    To describe how to make a swine hemodialysis fistula model and report our initial experience to test the feasibility of endovascular radiation therapy with Holmium-166 filled balloon catheters. The surgical formation of arterio-venous fistula (AVF) was performed by end-to-side anastomosis of the bilateral jugular vein and carotid artery of 6 pigs. After 4 weeks, angiograms were taken and endovascular radiation was delivered to the venous side of AVF with Holmium-166 filled balloon catheters. Pigs were sacrificed 4 weeks after the radiation and AVFs were harvested for histological examination. All animals survived without any morbidity during the experimental periods. The formation of fistula on the sides of necks was successful in 11 of the 12 pigs (92%). One AVF failed from the small jugular vein. On angiograms, 4 of the 11 AVFs showed total occlusion or significant stenosis and therefore, endovascular radiation could not be performed. Of 7 eligible AVFs, five underwent successful endovascular radiation and two AVFs did not undergo radiation for the control. Upon histologic analysis, one non-radiated AVF showed total occlusion and others showed intimal thickening from the neointimal hyperplasia. Formation of the swine carotid artery-jugular vein hemodialysis fistula model was successful. Endovascular radiation using a Holmium-166 filled balloon catheter was safe and feasible.

  1. Catheter Angiography

    Medline Plus

    Full Text Available ... or other procedures such as chemoembolization or selective internal radiation therapy. identify dissection or splitting in the aorta in the chest or abdomen or its major branches. show the extent and severity of ... the artery, causing internal bleeding. It also is possible that the catheter ...

  2. 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. ...

  3. Catheter Angiography

    Medline Plus

    Full Text Available ... the equipment look like? How does the procedure work? How is the procedure performed? What will I experience during and after the procedure? Who interprets the results and how do I get them? What are the benefits vs. risks? What are the limitations of Catheter Angiography? What ...

  4. Catheter Angiography

    Medline Plus

    Full Text Available ... spaghetti. top of page How does the procedure work? Catheter angiography works much the same as a regular x-ray ... any possibility that they are pregnant. See the Safety page for more information about pregnancy and x- ...

  5. Robotic positioning of standard electrophysiology catheters: a novel approach to catheter robotics.

    Science.gov (United States)

    Knight, Bradley; Ayers, Gregory M; Cohen, Todd J

    2008-05-01

    Robotic systems have been developed to manipulate and position electrophysiology (EP) catheters remotely. One limitation of existing systems is their requirement for specialized catheters or sheaths. We evaluated a system (Catheter Robotics Remote Catheter Manipulation System [RCMS], Catheter Robotics, Inc., Budd Lake, New Jersey) that manipulates conventional EP catheters placed through standard introducer sheaths. The remote controller functions much like the EP catheter handle, and the system permits repeated catheter disengagement for manual manipulation without requiring removal of the catheter from the body. This study tested the hypothesis that the RCMS would be able to safely and effectively position catheters at various intracardiac sites and obtain thresholds and electrograms similar to those obtained with manual catheter manipulation. Two identical 7 Fr catheters (Blazer II; Boston Scientific Corp., Natick, Massachusetts) were inserted into the right femoral veins of 6 mongrel dogs through separate, standard 7 Fr sheaths. The first catheter was manually placed at a right ventricular endocardial site. The second catheter handle was placed in the mating holder of the RCMS and moved to approximately the same site as the first catheter using the Catheter Robotics RCMS. The pacing threshold was determined for each catheter. This sequence was performed at 2 right atrial and 2 right ventricular sites. The distance between the manually and robotically placed catheters tips was measured, and pacing thresholds and His-bundle recordings were compared. The heart was inspected at necropsy for signs of cardiac perforation or injury. Compared to manual positioning, remote catheter placement produced the same pacing threshold at 7/24 sites, a lower threshold at 11/24 sites, and a higher threshold at only 6/24 sites (p > 0.05). The average distance between catheter tips was 0.46 +/- 0.32 cm (median 0.32, range 0.13-1.16 cm). There was no difference between right atrial

  6. Equivalent success and complication rates of tunneled common femoral venous catheter placed in the interventional suite vs. at patient bedside.

    Science.gov (United States)

    Chau, Alex; Hernandez, Jose Alberto; Pimpalwar, Sheena; Ashton, Daniel; Kukreja, Kamlesh

    2018-02-08

    Femoral tunneled central line placement in the pediatric population offers an alternative means for intravenous (IV) access, but there is concern for higher complication and infection rates when placed at bedside. To describe the complications and infection outcomes of primary femoral tunneled central venous catheter placement in the interventional radiology suite compared to the portable bedside location at a single tertiary pediatric institution. We conducted a retrospective review comparing interventional radiology suites vs. bedside primary tunneled common femoral vein central line placement (January 2014 to December 2015). We identified 244 primary femoral placements in pediatric patients, ages 1 day to 18 years, using our electronic medical record and collected into a Research Electronic Data Capture. We compared categorical variables using the Fisher exact test. We compared continuous variables using the Wilcoxon rank test. In total, 2,375 pediatric patients received peripherally inserted and central lines; 244 of these were primary femoral tunneled central venous catheters (in 140 boys and 104 girls). In 140 children (mean age: 206 days), lines were inserted in the interventional radiology (IR) suite (technical success of 100%), with 14 (10.0%) complications including infection (n=7), malposition (n=2), bleeding (n=0), thrombosis (n=1) and line occlusion (n=4). The infection rate was 2.1 per 1,000 line days. In 104 children (mean age: 231 days), lines were placed at bedside (technical success 100%) with 14 (13.3%) complications including infection (n=3), malposition (n=5), bleeding (n=0), thrombosis (n=2) and line occlusion (n=4). The infection rate was 0.78 per 1,000 line days. The total line days were 7,109, of which 3,258 were in the IR suite and 3,851 in the bedside group. There was no statistical significance for complication rate (P=0.55) or infection rate (P=0.57) between bedside and interventional suite placements. In a cohort of children

  7. 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

  8. Less leakage and dislodgement with a catheter-over-needle versus a catheter-through-needle approach for peripheral nerve block: an ex vivo study.

    Science.gov (United States)

    Tsui, Ban C H; Tsui, Jenkin

    2012-07-01

    The objective of this study was to compare the catheter-through-needle (CTN) and catheter-over-needle (CON) catheterization techniques ex vivo by measuring leak pressure around the catheter and the catheter's resistance to pulling force. Using an ex vivo porcine limb model, we compared the conventional CTN design with the CON design with respect to the ability to resist leakage at the catheter insertion site under high injection pressure and the force required to withdraw the catheter from tissue. One CON assembly (MultiSet, Pajunk) and three CTN assemblies (Contiplex, B.Braun; StimuCath, Arrow; Stimulong Sono, Pajunk) were studied. Ten porcine hind limbs were used to test leakage and another ten were used to measure withdrawal force. Catheters were placed at angles of 15° and 30° at depths of 3 cm and 5 cm. Leakage was assessed visually at the insertion site, and pressure was measured at the moment leakage occurred. Withdrawal force was measured by pulling the catheter from the tissue. No evidence of leakage was detected at the CON catheter insertion site at the highest pressure applied (1,000 mmHg) (n = 40). The CON assembly withstood significantly higher injection pressure than the CTN catheters without causing leaks at the catheter insertion site [CON, mean (standard deviation) > 1,000 (0) mmHg; B.Braun, 596 (92) mmHg; Pajunk Stimulong, 615 (107) mmHg; and Arrow, 422 (104) mmHg; P < 0.001 CON vs CTN]. The force required to withdraw the catheter from the porcine limb was greater with CON catheters [3.8 (0.8) N] than with any of the CTN catheters [range, 0.4 (0.2) - 0.8 (0.2) N], depending on depth, angle, and manufacturer (P < 0.001 CON vs CTN). In the porcine leg model, CON catheterization provides greater resistance to leakage under high injection pressure and greater holding force in tissue than traditional CTN catheters.

  9. Induction of labour at term with oral misoprostol versus a Foley catheter (PROBAAT-II): a multicentre randomised controlled non-inferiority trial.

    Science.gov (United States)

    Ten Eikelder, Mieke L G; Oude Rengerink, Katrien; Jozwiak, Marta; de Leeuw, Jan W; de Graaf, Irene M; van Pampus, Mariëlle G; Holswilder, Marloes; Oudijk, Martijn A; van Baaren, Gert-Jan; Pernet, Paula J M; Bax, Caroline; van Unnik, Gijs A; Martens, Gratia; Porath, Martina; van Vliet, Huib; Rijnders, Robbert J P; Feitsma, A Hanneke; Roumen, Frans J M E; van Loon, Aren J; Versendaal, Hans; Weinans, Martin J N; Woiski, Mallory; van Beek, Erik; Hermsen, Brenda; Mol, Ben Willem; Bloemenkamp, Kitty W M

    2016-04-16

    Labour is induced in 20-30% of all pregnancies. In women with an unfavourable cervix, both oral misoprostol and Foley catheter are equally effective compared with dinoprostone in establishing vaginal birth, but each has a better safety profile. We did a trial to directly compare oral misoprostol with Foley catheter alone. We did an open-label randomised non-inferiority trial in 29 hospitals in the Netherlands. Women with a term singleton pregnancy in cephalic presentation, an unfavourable cervix, intact membranes, and without a previous caesarean section who were scheduled for induction of labour were randomly allocated to cervical ripening with 50 μg oral misoprostol once every 4 h or to a 30 mL transcervical Foley catheter. The primary outcome was a composite of asphyxia (pH ≤7·05 or 5-min Apgar score misoprostol and 927 women to Foley catheter. The composite primary outcome occurred in 113 (12·2%) of 924 participants in the misoprostol group versus 106 (11·5%) of 921 in the Foley catheter group (adjusted relative risk 1·06, 90% CI 0·86-1·31). Caesarean section occurred in 155 (16·8%) women versus 185 (20·1%; relative risk 0·84, 95% CI 0·69-1·02, p=0·067). 27 adverse events were reported in the misoprostol group versus 25 in the Foley catheter group. None were directly related to the study procedure. In women with an unfavourable cervix at term, induction of labour with oral misoprostol and Foley catheter has similar safety and effectiveness. FondsNutsOhra. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Effect of Left Atrial Ablation Process and Strategy on Microemboli Formation During Irrigated Radiofrequency Catheter Ablation in an In Vivo Model.

    Science.gov (United States)

    Takami, Mitsuru; Lehmann, H Immo; Parker, Kay D; Welker, Kirk M; Johnson, Susan B; Packer, Douglas L

    2016-01-01

    Formation of microemboli during catheter ablation has been suggested as a cause for asymptomatic cerebral emboli. However, it is unknown which part of the process and ablation setting/strategy is most strongly related to this occurrence. A total of 27 pigs were used. Catheter/sheath manipulations in left atrium were performed in 25 of 27 pigs outfitted with microemboli monitoring systems. Ablations using open-irrigated radiofrequency catheters were performed in 18 of 25 pigs. Two of 27 pigs did not undergo left atrial procedures and were injected with microembolic materials in the carotid artery to serve as positive controls. In total, 334 sheath/catheter manipulations (transseptal puncture, sheath flushing, catheter insertion, pulmonary vein venography, and sheath exchange) and 333 radiofrequency applications (power setting, 30/50 W; point-by-point/drag ablations) were analyzed. High microbubble volume in the extracorporeal circulation loop and a high number of microembolic signals in carotid artery were observed during sheath/catheter manipulations especially in saline/contrast injections at fast speed and ablations with steam pop. Fast sheath flushing produced significantly higher microbubble volume than slow sheath flushing (median, 12 200 versus 121 nL; Pdrag ablations, and steam pop. Brain magnetic resonance imaging showed positive-embolic lesions in control pigs. Formation of microbubbles was the greatest during fast saline/contrast injections and steam pops, whereas high-power radiofrequency applications, drag ablations, and steam pops produced most of the microparticles. © 2016 American Heart Association, Inc.

  11. 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. ...

  12. 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

    OBJECTIVE Cerebrospinal fluid (CSF) shunts are the primary treatment for patients suffering from hydrocephalus. While proven effective in symptom relief, these shunt systems are plagued by high failure rates and often require repeated revision surgeries to replace malfunctioning components. One of the leading causes of CSF shunt failure is obstruction of the ventricular catheter by aggregations of cells, proteins, blood clots, or fronds of choroid plexus that occlude the catheter's small inlet holes or even the full internal catheter lumen. Such obstructions can disrupt CSF diversion out of the ventricular system or impede it entirely. Previous studies have suggested that altering the catheter's fluid dynamics may help to reduce the likelihood of complete ventricular catheter failure caused by obstruction. However, systematic correlation between a ventricular catheter's design parameters and its performance, specifically its likelihood to become occluded, still remains unknown. Therefore, an automated, open-source computational fluid dynamics (CFD) simulation framework was developed for use in the medical community to determine optimized ventricular catheter designs and to rapidly explore parameter influence for a given flow objective. METHODS The computational framework was developed by coupling a 3D CFD solver and an iterative optimization algorithm and was implemented in a high-performance computing environment. The capabilities of the framework were demonstrated by computing an optimized ventricular catheter design that provides uniform flow rates through the catheter's inlet holes, a common design objective in the literature. The baseline computational model was validated using 3D nuclear imaging to provide flow velocities at the inlet holes and through the catheter. RESULTS The optimized catheter design achieved through use of the automated simulation framework improved significantly on previous attempts to reach a uniform inlet flow rate distribution using

  13. Totally implantable catheter embolism: two related cases

    Directory of Open Access Journals (Sweden)

    Rodrigo Chaves Ribeiro

    Full Text Available CONTEXT AND OBJECTIVE: Long-term totally implantable catheters (e.g. Port-a-Cath® are frequently used for long-term venous access in children with cancer. The use of this type of catheter is associated with complications such as infection, extrusion, extravasation and thrombosis. Embolism of catheter fragments is a rare complication, but has potential for morbidity. The aim here was to report on two cases in which embolism of fragments of a long-term totally implantable catheter occurred. DESIGN AND SETTING: Case series study at Hospital do Servidor Público Estadual, São Paulo. METHODS: Retrospective review of catheter embolism in oncological pediatric patients with long-term totally implantable catheters. RESULTS: The first patient was a 3-year-old girl diagnosed with stage IV Wilms' tumor. Treatment was started with the introduction of a totally implantable catheter through the subclavian vein. At the time of removal, it was realized that the catheter had fractured inside the heart. An endovascular procedure was necessary to remove the fragment. The second case was a boy diagnosed with stage II Wilms' tumor at the age of two years. At the time of removal, it was noticed that the catheter had disconnected from the reservoir and an endovascular procedure was also necessary to remove the embolized catheter. CONCLUSION: Embolism of fragments of totally implantable catheters is a rare complication that needs to be recognized even in asymptomatic patients.

  14. 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

  15. [Cerebrovascular fiberoptic catheter oximetry in an intracranial pressure model in swine. New aspects of a clinical routine].

    Science.gov (United States)

    Menzel, M; Rieger, A; Roth, S; Sanchin, L; Soukup, J; Hennig, C; Furka, H; Burkert, W; Radke, J

    1997-02-01

    The reliability of continuous fibreoptic oximetry in cerebral venous blood and its correlation with intracranial and cerebral perfusion pressures (pressure-volume curve) were examined in an experimental porcine study. The pressure in the infratentorial compartment of 13 domestic pigs (18-24 kg) was gradually increased by inflating a Fogarty balloon catheter placed on the surface of the right cerebellar hemisphere and below the tentorium. Single volumes of 0.4 ml saline were injected into the inflatable balloon at 1-min intervals up to a total volume of 7 ml. Intracranial pressure (ICP), arterial blood pressure, cerebral perfusion pressure (CPP), and cerebral venous saturation measured continuously by fibreoptic oximetry and intermittent blood-gas analyses (SjO2 superior sagittal sinus) were monitored during balloon inflation. All data were down-loaded onto a PC and evaluated off-line by a commercial statistical software package. Over the whole pressure-volume curve, two phases of SjO2 behaviour were registered by continuous fibreoptic oximetry (Oximetrix 3, Abbott) (Fig. 1). CPP ranges of less than 50% reduction from the initial value showed a linear correlation (rmittl. = 0.712, P < 0.01) between both parameters (CPP-SjO2). In CPP ranges below a crucial point of about 50 mmHg no such correlation was found (rmittl = 0.176, P < 0.5). In contrast, in 3 pigs a very good correlation was found between CPP and SjO2 over the whole pressure-volume curve as measured by blood-gas analyses of samples from the cerebrovenous catheter (rmittl. = 0.84, P < 0.05). We conclude that in physiological CPP ranges down to 50 mmHg, SjO2 measurement is a reliable method of detecting oxygen desaturation in cerebrovenous blood. Below that CPP value, the fibreoptic catheter showed repeated false-high oxygen saturation values. The accuracy of SjO2 measurement seems to depend on sufficient cerebral blood flow (CBF): with decreasing CBF the amount of cerebral venous outflow is diminished. We

  16. Home Parenteral Nutrition in Adult Patients With Chronic Intestinal Failure: Catheter-Related Complications Over 4 Decades at the Main Danish Tertiary Referral Center.

    Science.gov (United States)

    Brandt, Christopher Filtenborg; Tribler, Siri; Hvistendahl, Mark; Naimi, Rahim M; Brøbech, Per; Staun, Michael; Jeppesen, Palle Bekker

    2018-01-01

    Catheter-related complications (CRCs) cause mortality and morbidity in patients dependent on parenteral support at home (HPN) due to intestinal failure (IF). This study describes the incidences of CRCs in an adult IF cohort over 40 years. It illustrates the evolution and consequences of CRCs, their association to demographic characteristics, and potential risk factors in an effort to provide the rationale for preventive precautions to the relevant patients with IF at risk. All patients with IF discharged with HPN from 1970-2010 were included. Patient and treatment characteristics were extracted from the Copenhagen IF database. The incidences were given per 1000 central venous catheter (CVC) days. The 1715 CRCs occurred in 70% of the 508 patients with IF (56% of the 2191 CVCs). The incidence of catheter-related bloodstream infections (CRBSIs) was 1.43. Higher age, HPN administration by community home nurses, and prior CRBSIs significantly raised the hazard for CRBSIs. In the 1970s, catheters were generally replaced following CRBSIs, whereas catheter salvage was the norm in the 2000s. The incidences of mechanical complications, tunnel infections, and catheter-related venous thromboses were 0.80, 0.25, and 0.11, respectively. The overall CRC incidence was 2.58, decreasing the first 3 decades but peaking in the last (2.84). The deaths related to CRCs were low (0.018). Even in an experienced IF center of excellence, the incidence of CRCs increased over the 4 decades. This increase could be explained by the expansion of the indication of HPN to a more elderly and frail patient population. © 2016 American Society for Parenteral and Enteral Nutrition.

  17. Hydronephrosis Predicts Successful Catheter Removal after Painful Urinary Retention - Preliminary Results of a Prospective Single Center Study.

    Science.gov (United States)

    Heidegger, Isabel; Fritz, Josef; Steiner, Hannes; Bektic, Jasmin; Pichler, Renate

    2016-01-01

    The study aims to identify candidates who can be managed conservatively after the first episode of spontaneous painful acute urinary retention (AUR). A total of 20 patients with primary spontaneous painful AUR were prospectively included in the study. Twenty-four hours after AUR, the catheter was removed. When residual urinary volume was <100 ml, patients were referred without catheter, when residual urinary volume was ≥100 ml, the catheter was replaced and removed again at day 4, 7 or 10 after AUR, respectively. Receiver operating characteristic curves, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated to assess predictors for successful catheter removal. Thirteen out of 20 (65%) patients had a successful catheter removal until day 10 after AUR. Among them 12 of 13 (93.2%) had a successful catheter removal until day 4 of AUR. Hydronephrosis urinary volume and Qmax at the time of AUR were significant numeric predictors for failure of successful catheter removal. In addition, we calculated a prediction model combing age + prostate volume + urinary volume + Qmax that highly predicts successful catheter removal (sensitivity 100%, specificity 69%, PPV 64%, NPV 100%). We found for the first time a significant association between hydronephrosis and successful catheter removal. Successful catheter removal until day 4 after AUR can safely be managed without immediate transurethral resection of the prostate. © 2015 S. Karger AG, Basel.

  18. Induction of labour with a Foley catheter or oral misoprostol at term: the PROBAAT-II study, a multicentre randomised controlled trial

    NARCIS (Netherlands)

    ten Eikelder, Mieke L. G.; Neervoort, Femke; Oude Rengerink, Katrien; Jozwiak, Marta; de Leeuw, Jan-Willem; de Graaf, Irene; van Pampus, Maria G.; Franssen, Maureen; Oudijk, Martijn; van der Salm, Paulien; Woiski, Mallory; Pernet, Paula Jm; Feitsma, A. Hanneke; van Vliet, Huib; Porath, Martina; Roumen, Frans; van Beek, Erik; Versendaal, Hans; Heres, Marion; Mol, Ben Willem J.; Bloemenkamp, Kitty W. M.

    2013-01-01

    Induction of labour is a common obstetric procedure. At present, different methods are used for induction of labour in women with an unfavourable cervix. Recently, we showed that in term women with an unfavorable cervix the use of a Foley catheter in comparison with vaginal Prostaglandin E2 gel,

  19. Induction of labour with a Foley catheter or oral misoprostol at term : the PROBAAT-II study, a multicentre randomised controlled trial

    NARCIS (Netherlands)

    ten Eikelder, Mieke L. G.; Neervoort, Femke; Rengerink, Katrien Oude; Jozwiak, Marta; de Leeuw, Jan-Willem; de Graaf, Irene; van Pampus, Maria G.; Franssen, Maureen; Oudijk, Martijn; van der Salm, Paulien; Woiski, Mallory; Pernet, Paula J. M.; Feitsma, A. Hanneke; van Vliet, Huib; Porath, Martina; Roumen, Frans; van Beek, Erik; Versendaal, Hans; Heres, Marion; Mol, Ben Willem J.; Bloemenkamp, Kitty W. M.

    2013-01-01

    Background: Induction of labour is a common obstetric procedure. At present, different methods are used for induction of labour in women with an unfavourable cervix. Recently, we showed that in term women with an unfavorable cervix the use of a Foley catheter in comparison with vaginal Prostaglandin

  20. A randomized controlled trial of coiled versus straight swan-neck Tenckhoff catheters in peritoneal dialysis patients.

    Science.gov (United States)

    Johnson, David W; Wong, Jennifer; Wiggins, Kathryn J; Kirwan, Robyn; Griffin, Anthony; Preston, John; Wall, Daryl; Campbell, Scott B; Isbel, Nicole M; Mudge, David W; Hawley, Carmel M; Nicol, David L

    2006-11-01

    Current clinical practice guidelines recommend that no particular type of peritoneal dialysis (PD) catheter has been proved superior to another. However, a recent Cochrane review recommended the need for a large, well-designed, randomized, controlled trial of straight versus coiled PD catheters because of the paucity and suboptimal quality of previously performed trials. A randomized controlled trial was undertaken at 2 metropolitan teaching hospitals comparing the effects of straight versus coiled PD catheters on time to catheter malposition (primary outcome), catheter-associated infection, technique failure, and all-cause mortality. One hundred thirty-two PD patients were enrolled and randomly assigned to insertion of a coiled (n = 62) or straight catheter (n = 70). There was no significant difference in time to laparoscopic reposition between the 2 cohorts (log-rank score, 0.41; P = 0.52). However, median technique survival was significantly worse for coiled catheters (1.5 years; 95% confidence interval [CI], 1.2 to 1.8) compared with straight catheters (2.1 years; 95% CI, 1.8 to 2.5; P < 0.05), primarily because of increased risk for inadequate dialytic clearance with the former. On univariate Cox proportional hazards model analysis, insertion of a coiled PD catheter was associated significantly with a greater risk for technique failure (unadjusted hazard ratio, 1.86; 95% CI, 1.03 to 3.36). No difference was observed between the 2 groups with respect to catheter-associated infections or overall patient survival. Coiled catheters do not influence the risk for drainage failure caused by catheter malposition compared with straight catheters, but are associated with significantly increased risk for PD technique failure, primarily because of inadequate dialytic clearance.

  1. 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 < .001). Catheter utilization was 4.5% at baseline and 4.9% at the end of the project. Catheter

  2. Double-balloon catheter and sequential oral misoprostol versus oral misoprostol alone for induction of labour at term: a retrospective cohort study.

    Science.gov (United States)

    Kehl, Sven; Weiss, Christel; Dammer, Ulf; Heimrich, Jutta; Beckmann, Matthias W; Faschingbauer, Florian; Sütterlin, Marc

    2016-09-01

    To evaluate the efficacy of induction of labour using a double-balloon catheter and, if necessary, sequential oral misoprostol without delay after removal of the catheter, in comparison with oral misoprostol alone. This retrospective cohort study included women undergoing induction of labour with oral misoprostol or double-balloon catheter with sequential oral misoprostol in singleton pregnancies at term. The catheter was placed in the evening and removed when there was no onset of labour within 12h. Then oral misoprostol was started within 3h. Primary outcome measure was the caesarean section rate. There were 13,082 deliveries during the study period with 3466 labour inductions out of which 1032 were eligible and analysed. The caesarean section rate was significantly lower in the double-balloon catheter group (26.1% vs. 17.3, p=0.021). Furthermore, in the combination group, the induction-to-delivery interval was shorter (median values 1144 vs. 1365min, p=0.001) and there were more deliveries within 24h (51.9 vs. 64.7%, p=0.003) and 48h (87.4 vs. 95.8%, p=0.002). When stratifying for parity, there were less caesarean sections in the combination group (37.2% vs. 24.2%, p=0.015) in nulliparous women, too. In both, nulliparous and parous women, the induction-to-delivery interval was shorter (1742 vs. 1400min, 0.005; 1020 vs. 912min, p=0.018). Especially in parous women, the rates of delivery within 24h (62.6% vs. 79.0%, p=0.007) and 48h (88.6% vs. 99.0%, p=0.007) were higher in the combination group. Double-balloon catheter and sequential oral misoprostol without long delay in absent onset of labour after removal of the catheter resulted in less caesarean section and shorter induction-to-delivery interval in comparison with oral misoprostol alone. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. Hygroscopic dilators vs balloon catheter ripening of the cervix for induction of labor in nulliparous women at term: Retrospective study.

    Directory of Open Access Journals (Sweden)

    Ryosuke Shindo

    Full Text Available To compare the efficacy and safety of hygroscopic dilators and balloon catheters for ripening of the cervix in induction of labor.This retrospective, observational study used data from the Successive Pregnancy Birth Registry System of the Japan Society of Obstetrics and Gynecology from 2012 to 2014. Nulliparous women in whom labor was induced by mechanical methods of cervical ripening at term were enrolled. The eligible women were divided into dilator, balloon 0.05. The vaginal instrumental delivery rate was higher in the two-balloon groups than in the dilator group. The volume of intrapartum hemorrhage was lowest in the dilator group. No significant difference in the frequencies of uterine rupture and intrauterine infection were observed among the dilator and two-balloon groups. With regard to neonatal outcomes, the frequency of a low Apgar score was statistically significantly lower in the dilator group than in the two-balloon groups. Moreover, the frequency of neonatal death tended to be lower in the dilator group than in the two-balloon groups.With regard to cervical ripening for labor induction in nulliparous women at term, the vaginal delivery rate on using a dilator and on using a balloon seems to be equivalent. Concerning maternal complications and neonatal outcomes, cervical ripening with hygroscopic dilators in labor induction might be safer.

  4. Hygroscopic dilators vs balloon catheter ripening of the cervix for induction of labor in nulliparous women at term: Retrospective study.

    Science.gov (United States)

    Shindo, Ryosuke; Aoki, Shigeru; Yonemoto, Naohiro; Yamamoto, Yuriko; Kasai, Junko; Kasai, Michi; Miyagi, Etsuko

    2017-01-01

    To compare the efficacy and safety of hygroscopic dilators and balloon catheters for ripening of the cervix in induction of labor. This retrospective, observational study used data from the Successive Pregnancy Birth Registry System of the Japan Society of Obstetrics and Gynecology from 2012 to 2014. Nulliparous women in whom labor was induced by mechanical methods of cervical ripening at term were enrolled. The eligible women were divided into dilator, balloon 0.05). The vaginal instrumental delivery rate was higher in the two-balloon groups than in the dilator group. The volume of intrapartum hemorrhage was lowest in the dilator group. No significant difference in the frequencies of uterine rupture and intrauterine infection were observed among the dilator and two-balloon groups. With regard to neonatal outcomes, the frequency of a low Apgar score was statistically significantly lower in the dilator group than in the two-balloon groups. Moreover, the frequency of neonatal death tended to be lower in the dilator group than in the two-balloon groups. With regard to cervical ripening for labor induction in nulliparous women at term, the vaginal delivery rate on using a dilator and on using a balloon seems to be equivalent. Concerning maternal complications and neonatal outcomes, cervical ripening with hygroscopic dilators in labor induction might be safer.

  5. Central venous catheters and catheter locks in children with cancer

    DEFF Research Database (Denmark)

    Handrup, Mette Møller; Møller, Jens Kjølseth; Schrøder, Henrik

    2013-01-01

    To determine if the catheter lock taurolidine can reduce the number of catheter-related bloodstream infections (CRBSI) in pediatric cancer patients with tunneled central venous catheters (CVC).......To determine if the catheter lock taurolidine can reduce the number of catheter-related bloodstream infections (CRBSI) in pediatric cancer patients with tunneled central venous catheters (CVC)....

  6. Reconstruction of Intima and Adventitia Models into a State Undeformed by a Catheter by Using CT, IVUS, and Biplane X-Ray Angiogram Images

    Directory of Open Access Journals (Sweden)

    Jinwon Son

    2017-01-01

    Full Text Available The number of studies on blood flow analysis using fluid-structure interaction (FSI analysis is increasing. Though a 3D blood vessel model that includes intima and adventitia is required for FSI analysis, there are difficulties in generating it using only one type of medical imaging. In this paper, we propose a 3D modeling method for accurate FSI analysis. An intravascular ultrasound (IVUS image is used with biplane X-ray angiogram images to calculate the position and orientation of the blood vessel. However, these images show that the blood vessel is deformed by the catheter inserted into the blood vessel for IVUS imaging. To eliminate such deformation, a CT image was added and the two models were registered. First, a 3D model of the undeformed intima was generated using a CT image. In the second stage, a model of intima and adventitia deformed by the catheter was generated by combining the IVUS image and the X-ray angiogram images. A 3D model of intima and adventitia with the deformation caused by insertion of the catheter eliminated was generated by matching these 3D blood vessel models in different states. In addition, a 3D blood vessel model including bifurcation was generated using the proposed method.

  7. Impact of a program aimed at reducing catheter-related infections implemented in nine pediatric intensive care units in Argentina.

    Science.gov (United States)

    Lenz, Ana M; Andion, Elena; Ruvinsky, Silvina; Aguirre, Clarisa; Alvarez Parma, Julieta; Jorro, Facundo; López Cruz, Gabriela; Pascutto, Martín; Penazzi, Matías; Santos, Silvia; Zuázaga, Marcela; Aquino, Norma; Vassallo, Juan C; Moreno, Guillermo; Magliola, Ricardo; Haimovich, Aldo; Landry, Luis; Bologna, Rosa

    2018-04-01

    Catheter-related infections (CRIs) cause a high level of morbidity and mortality with the increasing use of hospital resources. To describe the outcomes of a program implemented to reduce the rate of CRIs in pediatric intensive care units in Argentina. Collaborative, multi center, clinical-epidemiological, quasiexperimental, before-and-after intervention study. Children who had a central venous catheter during hospitalization in 9 pediatric intensive care units in the Autonomous City of Buenos Aires, Greater Buenos Aires, and other provinces between June 2011 and April 2012 were included. A bundle of measures based on health care staff training on catheter insertion, hand hygiene, and checklists was put into practice and implemented measures were monitored. The number and annual rate of CRIs and the rate of central venous catheter use before and after the program implementation were compared (Stata 8.0). The total number of CRIs was 117 and 74 before and after the intervention, respectively. The rate of CRIs was 8.6/1000 days of central venous catheter use and 5.8/1000 days before and after the intervention, respectively; RR: 0.82 (95% confidence interval: 0.68-0.98), p= 0.015. The rate of central venous catheter use decreased from 54% to 49%, a non-significant difference. The program achieved a significant reduction in CRI rates. Based on the program, CRI surveillance was implemented in all participating pediatric intensive care units. Training and continuous surveillance are necessary to maintain and improve the outcomes accomplished with the program. Sociedad Argentina de Pediatría.

  8. Experimental study of a closed-chest pulmonary embolism-reperfusion injury canine model by means of Swan-Ganz catheter

    International Nuclear Information System (INIS)

    Bao Na; Zhai Renyou Jiang Tao; Wang Yajie; Zheng Juan; Wang Chen

    2007-01-01

    Objective: To establish a closed-chest pulmonary embolism-reperfusion animal model by Swan-Ganz catheter and to explore the mechanisms of pulmonary embolism (PE)-reperfusion injury (RI). Methods: Experiments were made on 14 mongrel dogs, ranging in weight from 15 to 18 kg, anesthetized with 3% pentobarbital sodium. The dogs were intubated with I. D. 7 endotracheal tubes. Under sterile conditions, a 7 F Swan-Ganz catheter via the external jugular vein was positioned in the unilateral pulmonary diaphragmatic lobe (DL) artery. Occlusion/reperfusion of the DL artery was controlled with 1.2 ml diluted contrast agent filled into/drawn from the balloon. After the 24 h PE, the balloon was deflated to result in 4 h reperfusion of the DL. Measurements of blood gases and tumor necrosis factor-α (TNF-α)were made at normal condition, at 24 h PE and at 4 h reperfusion. Thin-section CT scans were performed at normal condition, 24 h PE, 30 rain, 1, 2, 3 and 4 h reperfusion, respectively. At the end of each experiment, tissue specimens of bilateral diaphragmatic lobes were obtained for both wet/dry (W/D) weight ratio and for pathological study. Results: Reperfusion pulmonary edema (RPE) was an acute, mixed, noncardiogenic edema that was observed in all 14 dogs who had been successfully established as PE/RI animal models. RPE demonstrated heterogeneous ground-glass opacifications that predominated in the areas distal to the recanalized vessels. It manifested pathologically as an edematous lung infihrated by inflammatory cells. The mean of PaO 2 and TNF-α of 4 h reperfusion was (81 ± 4) mm Hg( 1 mm Hg =0.133 kPa) and (16.0 ± 2.5)pg/ml, which were significantly different (P<0.05) from normal value [(96 ± 6)mm Hg and (13.9 ± 2.0) pg/ml]. The W/D of the injured lung (6.3 ± 1.2) was significantly greater (P<0.01) than that of the contralateral lung (4.5 ± 1.2), suggesting that the increase in the lung water was due to reperfusion injury. Conclusion: The closed-chest canine model

  9. Malposition of catheters during voiding cystourethrography

    Energy Technology Data Exchange (ETDEWEB)

    Rathaus, V.; Konen, O.; Shapiro, M. [Dept. of Diagnostic Imaging Sapir Medical Center, Kfar-Saba and Sackler Medical School, Tel Aviv University (Israel); Grunebaum, M. [Veteran Pediatric Radiologist, Kfar Saba (Israel)

    2001-04-01

    The aim of this study was to report catheter malposition during voiding cystourethrography. Eight hundred forty-three voiding cystourethrography (265 males and 578 females, aged 1 week to 12 years, mean age 2 years) were performed during a period of 4 years. The conventional standard procedure was applied. In 3 cases with passed history of urinary tract infection the catheter entered directly into the ureter. In all these cases the uretero-vesical reflux was present on the same side where the catheter entered. It appears that insertion of a catheter into the ureter is possible only in the presence of an anomaly or pathology at the vesicoureteric junction. (orig.)

  10. Antibiotics at the time of removal of central venous catheter to reduce morbidity and mortality in newborn infants.

    Science.gov (United States)

    McMullan, Rowena L; Gordon, Adrienne

    2018-03-07

    Late-onset sepsis is associated with increased rates of mortality and morbidity in newborn infants, in addition to poorer long-term developmental outcomes and increased length of stay and hospital costs. Central line-associated blood stream infection (CLABSI) is the most common cause of late-onset sepsis in hospitalised infants, and prevention of CLABSI is a key objective in neonatal care. Increased frequency of CLABSI around the time of removal of central venous catheters (CVCs) has been reported, and use of antibiotics at the time of removal may reduce the incidence and impact of late-onset sepsis in vulnerable newborn infants. To determine the efficacy and safety of giving antibiotics at the time of removal of a central venous catheter (CVC) for reduction of morbidity and mortality in newborn infants, in particular effects on late-onset sepsis. We used the standard search strategy of the Cochrane Neonatal Review Group without language restriction to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 3), MEDLINE via PubMed (1966 to 6 April 2017), Embase (1980 to 6 April 2017), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 6 April 2017). We also searched clinical trials databases, conference proceedings, and reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. Randomised, quasi-randomised, and cluster-randomised trials considering use of any antibiotic or combination of antibiotics at the time of CVC removal in newborn infants compared with placebo, no antibiotics, or another antibiotic or combination of antibiotics. We extracted data using standard methods of the Cochrane Neonatal Review Group. Two review authors independently selected, assessed the quality of, and extracted data from the included study. Only one randomised controlled trial was eligible for inclusion in this analysis. Forty-four of a total of 88 infants received two doses of cephazolin

  11. Comparison of the Effectiveness of a Virtual Simulator With a Plastic Arm Model in Teaching Intravenous Catheter Insertion Skills.

    Science.gov (United States)

    Günay İsmailoğlu, Elif; Zaybak, Ayten

    2018-02-01

    The objective of this study was to compare the effectiveness of a virtual intravenous simulator with a plastic arm model in teaching intravenous catheter insertion skills to nursing students. We used a randomized controlled quasi-experimental trial design and recruited 65 students who were assigned to the experimental (n = 33) and control (n = 32) groups using the simple random sampling method. The experimental group received intravenous catheterization skills training on the virtual intravenous simulator, and the control group received the same training on a plastic model of a human arm. Data were collected using the personal information form, intravenous catheterization knowledge assessment form, Intravenous Catheterization Skill Test, Self-Confidence and Satisfaction Scale, and Fear Symptoms Scale. In the study, the mean scores in the control group were 20.44 for psychomotor skills, 15.62 for clinical psychomotor skills, 31.78 for self-confidence, and 21.77 for satisfaction. The mean scores in the experimental group were 45.18 for psychomotor skills, 16.28 for clinical psychomotor skills, 34.18 for self-confidence, and 43.89 for satisfaction. The results indicated that psychomotor skills and satisfaction scores were higher in the experimental group, while the clinical psychomotor skills and self-confidence scores were similar in both groups. More students in the control group reported experiencing symptoms such as cold and sweaty hands, significant restlessness, and tense muscles than those in the experimental group.

  12. Comparison of hospital length of stay, costs, and readmissions of alteplase versus catheter replacement among patients with occluded central venous catheters.

    Science.gov (United States)

    Ernst, Frank R; Chen, Er; Lipkin, Craig; Tayama, Darren; Amin, Alpesh N

    2014-08-01

    Central venous catheter (CVC) occlusion is common, affecting 30% of all CVCs. To compare length of stay (LOS), costs, and readmissions associated with the use of alteplase to clear catheter blockage to outcomes associated with catheter replacement. Retrospective observational study utilizing a large hospital database. Hospitalized patients treated for catheter occlusion from January 2006 to December 2011. Univariate analyses of patient characteristics and treatment patterns and multivariable regression analyses of postocclusion hospital costs, LOS, and 30- and 90-day readmissions were conducted. We included 34,579 patients treated for a CVC occlusion by replacement (N=1028) or by alteplase (2 mg) administration (N=33,551). Patients receiving alteplase were somewhat younger than those having catheter replacement (60 ± 19 vs 62 ± 20 years old, P=0.0002). After adjusting for patient and hospital factors via regression modeling, average daily postocclusion costs were $317 lower for alteplase recipients than for catheter replacement patients (95% confidence interval [CI]: 238.22-392.24; P0.05). Odds of readmission were not significantly different at 30 or 90 days. Among patients treated for an occluded CVC, alteplase-treated patients had lower daily and total postocclusion costs than patients receiving catheter replacement. Cost differences were mainly driven by lower operating room/surgery, radiology, and supplier costs. Published 2014. The Authors Journal of Hospital Medicine published by Wiley Periodicals, Inc. on behalf of Society of Hospital Medicine.

  13. The Effect of Model Fidelity on Learning Outcomes of a Simulation-Based Education Program for Central Venous Catheter Insertion.

    Science.gov (United States)

    Diederich, Emily; Mahnken, Jonathan D; Rigler, Sally K; Williamson, Timothy L; Tarver, Stephen; Sharpe, Matthew R

    2015-12-01

    Simulation-based education for central venous catheter (CVC) insertion has been repeatedly documented to improve performance, but the impact of simulation model fidelity has not been described. The aim of this study was to examine the impact of the physical fidelity of the simulation model on learning outcomes for a simulation-based education program for CVC insertion. Forty consecutive residents rotating through the medical intensive care unit of an academic medical center completed a simulation-based education program for CVC insertion. The curriculum was designed in accordance with the principles of deliberate practice and mastery learning. Each resident underwent baseline skills testing and was then randomized to training on a commercially available CVC model with high physical fidelity (High-Fi group) or a simply constructed model with low physical fidelity (Low-Fi group) in a noninferiority trial. Upon completion of their medical intensive care unit rotation 4 weeks later, residents returned for repeat skills testing on the high-fidelity model using a 26-item checklist. The mean (SD) posttraining score on the 26-item checklist for the Low-Fi group was 23.8 (2.2) (91.5%) and was not inferior to the mean (SD) score for the High-Fi group of 22.5 (2.6) (86.5%) (P Simulation-based education using equipment with low physical fidelity can achieve learning outcomes comparable with those with high-fidelity equipment, as long as other aspects of fidelity are maintained and robust educational principles are applied during the design of the curriculum.

  14. The Polar Fluid Model for Blood Flow through a Tapered Artery with Overlapping Stenosis: Effects of Catheter and Velocity Slip

    Directory of Open Access Journals (Sweden)

    J. V. Ramana Reddy

    2015-01-01

    Full Text Available The blood flow through an overlapping clogged tapered artery in the presence of catheter is discussed. Since cholesterol deposition is resulting in the stenosis formation, velocity slip at the arterial wall is considered. The equations governing the fluid flow have been solved analytically under the assumption of the mild stenosis. The analysis with respect to various parameters arising out of fluid and geometry considered, on physiological parameters such as impedance and wall shear stress at the maximum height of the stenosis as well as across the entire length of the stenosis has been reported. A table summarizing the locations of extreme heights and the corresponding annular radii is provided. It is observed that the wall shear stress is the same at both the locations corresponding to the maximum height of the stenosis in case of nontapered artery while it varies in case of tapered artery. It is also observed that slip velocity and diverging tapered artery facilitate the fluid flow. Shear stress at the wall is increasing as micropolar parameter is decreasing and the trend is reversed in case of coupling number. The results obtained are validated by comparing them with the experimental and theoretical results.

  15. Unintended Thermal Injuries from Radiofrequency Ablation: Organ Protection with an Angioplasty Balloon Catheter in an Animal Model

    Directory of Open Access Journals (Sweden)

    Martha-Grace Knuttinen

    2014-01-01

    Full Text Available Objectives: The aim of this study was to investigate a novel approach of using a balloon catheter as a protective device to separate liver from the diaphragm or nearby bowel during radiofrequency ablation (RFA of hepatic dome tumors in an animal model. Materials and Methods: All experimental procedures were approved by animal Institutional Review Board. Using a 3 cm RF needle electrode, 70 hepatic ablation zones were created using ultrasound in 7 pigs. 50 lesions were created using balloon interposition between liver and diaphragm; 20 lesions were created using the balloon device interposed posteriorly between liver and bowel. Additional 21 control lesions were performed. Animals were sacrificed immediately; diaphragm and bowel were then visually inspected and sectioned. Diaphragmatic and bowel injury was then classified according to the depth of thickness. Results: Control lesions caused full thickness injury, either to diaphragm or bowel. During ablation of lesions with balloon interposition, there was significantly less diaphragmatic injury, P < 0.001 and less bowel injury, P < 0.01. Conclusion: Using balloon interposition as a protective device has advantages over previous saline infusion or CO 2 insufflation, providing a safe way to expand percutaneous RFA of liver tumors located on the undersurface of the diaphragm. In addition, this method may be used in protection of other organs adjacent to areas being ablated.

  16. Progress of Labor in Women Induced with Misoprostol versus the Foley Catheter

    Science.gov (United States)

    TUULI, Methodius G.; KEEGAN, Mary B.; ODIBO, Anthony O.; ROEHL, Kimberly; MACONES, George A.; CAHILL, Alison G.

    2014-01-01

    Objective To estimate and compare the duration and progress of labor in women induced with misoprostol versus Foley catheter plus oxytocin. Study Design We performed a retrospective cohort study of labor progress among 617 consecutive term pregnancies induced with misoprostol (n=503) or Foley catheter plus oxytocin (n=114) who completed the first stage of labor. Labor duration and progress in the entire cohort, and stratified by parity, were compared in multivariable interval-censored regression models adjusting for maternal obesity and birth weight. Repeated-measures analysis with 9th degree polynomial modeling was used to construct average labor curves. Results Total duration of labor was not significantly different in women induced with misoprostol compared to the Foley catheter median (median duration from 1 to 10 cm: 12 versus 14.2 hours, p=0.19). Progress from 1 to 4 cm was more rapid with the Foley catheter (median: 3.4 versus 5.6 hours, pmisoprostol and at 6cm for the Foley catheter. Similar general patterns were noted for nulliparous and multiparous women, except for a shorter duration of labor with the Foley catheter among multiparous women. Conclusion Induction of labor with the Foley catheter is associated with more rapid initial cervical dilation, but transition to active labor occurs later compared to misoprostol. These differences should be considered in the management of induced labor. PMID:23659988

  17. Women's Experiences with and Preference for Induction of Labor with Oral Misoprostol or Foley Catheter at Term

    OpenAIRE

    Ten Eikelder, Mieke L G; van de Meent, Marieke M; Mast, Kelly; Rengerink, Katrien Oude; Jozwiak, Marta; de Graaf, Irene M; Scholtenhuis, Marloes A G Holswilder-Olde; Roumen, Frans J M E; Porath, Martina M; van Loon, Aren J; van den Akker, Eline S; Rijnders, Robbert J P; Feitsma, A Hanneke; Adriaanse, Albert H; Muller, Moira A

    2017-01-01

    Objective We assessed experience and preferences among term women undergoing induction of labor with oral misoprostol or Foley catheter.  Study Design In 18 of the 29 participating hospitals in the PROBAAT-II trial, women were asked to complete a questionnaire within 24 hours after delivery. We adapted a validated questionnaire about expectancy and experience of labor and asked women whether they would prefer the same method again in a future pregnancy. Results The questionnaire was completed...

  18. Catheter-directed Intraportal Delivery of Endothelial Cell Therapy for Liver Regeneration: A Feasibility Study in a Large-Animal Model of Cirrhosis.

    Science.gov (United States)

    Lee, Kyungmouk Steve; Santagostino, Sara F; Li, David; Ramjit, Amit; Serrano, Kenneth; Ginsberg, Michael D; Ding, Bi-Sen; Rafii, Shahin; Madoff, David C

    2017-10-01

    Purpose To demonstrate the feasibility of imaging-guided catheter-directed delivery of endothelial cell therapy in a porcine model of cirrhosis for liver regeneration. Materials and Methods After approval from the institutional animal care and use committee, autologous liver endothelial cells were grown from core hepatic specimens from swine. Cirrhosis was induced in swine by means of transcatheter infusion of ethanol and iodized oil into the hepatic artery. Three weeks after induction of cirrhosis, the swine were randomly assigned to receive autologous cell therapy (endothelial cells, n = 4) or control treatment (phosphate-buffered saline, n = 4) by means of imaging-guided transhepatic intraportal catheterization. Fluorescence-activated cell sorting analysis was performed on biopsy samples 1 hour after therapy. Three weeks after intraportal delivery of endothelial cells, the swine were euthanized and the explanted liver underwent quantitative pathologic examination. Statistical analysis was performed with an unpaired t test by using unequal variance. Results Liver endothelial cells were successfully isolated, cultured, and expanded from eight 20-mm, 18-gauge hepatic core samples to 50 × 10 6 autologous cells per pig. Intraportal delivery of endothelial cell therapy or saline was technically successful in all eight swine, with no complications. Endothelial cells were present in the liver for a minimum of 1 hour after intraportal infusion. Swine treated with endothelial cell therapy showed mean levels of surrogate markers of hepatobiliary injury that were consistent with decreases in hepatic fibrosis and biliary ductal damage relative to the control animals, although statistical significance was not met in this pilot study: The mean percentage of positive pixels at Masson trichrome staining was 7.28% vs 5.57%, respectively (P = .20), the mean proliferation index with cytokeratin wide-spectrum was 2.55 vs 1.13 (P = .06), and the mean proliferation index with Ki67

  19. Microbial contamination of haemodialysis catheter connections.

    Science.gov (United States)

    Gorke, A

    2005-01-01

    Bacterial contamination and colonisation of the haemodialysis catheter is a reason for infection in dialysis patients. One reason for contamination may be frequent routine connections at the beginning, during and end of dialysis. Higher infection rates observed with double lumen catheters may be due to the absence of the sterile, disposable device that is fitted between the blood tubing and the catheter hubs with single lumen catheters. A sterile, disposable extension was implemented at the author's unit for use in dialysis with double lumen catheters. The proximal and distal ends of the extension were assessed for microbial contamination after standard dialysis. Results show microbial contamination in almost 30% of the samples retrieved from the extensions. Experiences in PD and the behaviour of skin bacteria on polymers, suggest that disposable extensions might have the potential to serve as a barrier or absorber for bacterial contamination.

  20. 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 ...

  1. Dislodgment of Port-A-Cath Catheters in Children

    Directory of Open Access Journals (Sweden)

    Chi-Lin Ho

    2008-10-01

    Conclusion: The dislodgment rate of port-a-cath catheters in children in our series was 4.1%. Most (83% catheters were broken at the site of anastomosis to the port. All dislodged catheters could be successfully retrieved by transcatheter retrieval using a gooseneck snare.

  2. Hemodynamic support with the pulsatile catheter pump in a sheep model of acute heart failure

    NARCIS (Netherlands)

    Li, Zhicheng; Gu, Y. John; Ye, Qing; Cheng, Shaofei; Wang, Weijun; Tang, Min; Zhao, Xiaogang; Rakhorst, Gerhard; Chen, Changzhi

    2006-01-01

    This study was aimed to mimic clinical heart failure (HF) conditions and to assess the effect of pulsatilecatheter (PUCA) pump support on hemodynamics and tissue perfusion in a sheep model of acute HF. In 14 sheep, HF was induced by partial occluding the middle left circumflex coronary artery

  3. Standardizing umbilical catheter usage in preterm infants.

    Science.gov (United States)

    Shahid, Shaneela; Dutta, Sourabh; Symington, Amanda; Shivananda, Sandesh

    2014-06-01

    Absence of guidelines on umbilical arterial catheter (UAC) and umbilical venous catheter (UVC) use and inability to predict the hospital course may sway the frontline staff to overuse umbilical catheters in preterm infants. Our objective was to evaluate the feasibility of implementing guidelines standardizing the use of umbilical catheters and its impact on the incidence of sepsis and resource use. All inborn infants delivered at <33 weeks' gestation and admitted to the NICU were included in this quality improvement study. The primary outcome was proportion of infants receiving umbilical catheters. Secondary outcomes were central venous catheter (CVC) use and central line-associated bloodstream infection (CLABSI). The proportion of infants receiving UACs and UVCs was significantly lower in postintervention (sustainment) phase than in the preintervention phase (93 [42.3%] vs 52 [23.6%], P = .0001) and (137 [62.6%] vs 93 [42.3%], P = .0001), respectively. There was no corresponding increase in the proportion of infants receiving peripherally inserted central catheters (PICCs) or surgical CVCs (SCVCs) during the sustainment phase. There was a significant reduction in the proportion of infants receiving CVCs (UVC, PICC, and SCVC) in the sustainment phase. The incidence of CLABSI was similar in the preintervention and sustainment phases. Implementation of guidelines standardizing the use of umbilical catheters in the NICU is feasible. Fewer infants were exposed to the risk of UVC or UAC, and fewer resources were used. Copyright © 2014 by the American Academy of Pediatrics.

  4. Catheter Angiography

    Medline Plus

    Full Text Available ... blood flow to the brain and cause a stroke. identify a small aneurysm or arteriovenous malformation (abnormal ... about pregnancy and x-rays. If you are breastfeeding at the time of the exam, you should ...

  5. Catheter Angiography

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  6. Catheter Angiography

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    Full Text Available ... pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to ... See the Safety page for more information about pregnancy and x-rays. If you are breastfeeding at ...

  8. Catheter Angiography

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  10. Catheter Angiography

    Science.gov (United States)

    ... leg veins) or pulmonary arteriovenous malformations. look at congenital abnormalities in blood vessels, especially arteries in children (e.g., malformations in the heart or other blood vessels due to congenital heart disease). evaluate obstructions of vessels. top of ...

  11. Catheter Angiography

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    Full Text Available ... especially to iodinated contrast materials. If you're breastfeeding, ask your doctor how to proceed. If you ... about pregnancy and x-rays. If you are breastfeeding at the time of the exam, you should ...

  12. Catheter Angiography

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    Full Text Available ... you will be admitted to the hospital overnight. Leave jewelry at home and wear loose, comfortable clothing. ... procedures such as chemoembolization or selective internal radiation therapy. identify dissection or splitting in the aorta in ...

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    Full Text Available ... doctor if you will be admitted to the hospital overnight. Leave jewelry at home and wear loose, ... the exam, you may be admitted to the hospital for an overnight stay if you live more ...

  14. CFD modeling of catheter-based Chemofilter device for filtering chemotherapy drugs from venous flow

    Science.gov (United States)

    Maani, Nazanin; Yee, Daryl; Nosonovsky, Michael; Greer, Julia; Hetts, Steven; Rayz, Vitaliy

    2017-11-01

    Purpose: Intra-arterial chemotherapy, a procedure where drugs are injected into arteries supplying a tumor, may cause systemic toxicity. The Chemofilter device, deployed in a vein downstream of the tumor, can chemically filter the excessive drugs from the circulation. In our study, CFD modeling of blood flow through the Chemofilter is used to optimize its hemodynamic performance. Methods:The Chemofilter consists of a porous membrane attached to a stent-like frame of the RX Accunet distal protection filters used for capturing blood clots. The membrane is formed by a lattice of symmetric micro-cells. This design provides a large surface area for the drug binding, and allows blood cells to pass through the lattice. A two-scale modeling approach is used, where the flow through individual micro-cells is simulated to determine the lattice permeability and then the entire device is modeled as a porous membrane. Results: The simulations detected regions of flow stagnation and recirculation caused by the membrane and its supporting frame. The effect of the membrane's leading angle on the velocity and pressure fields was determined. The device optimization will help the efficacy of drug absorption, while the risk of blood clotting reduces. NIH NCI R01CA194533.

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  17. Catheter Angiography

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    Full Text Available ... X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small ...

  18. Catheter Angiography

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    Full Text Available ... leg veins) or pulmonary arteriovenous malformations. look at congenital abnormalities in blood vessels, especially arteries in children (e.g., malformations in the heart or other blood vessels due to congenital heart disease). evaluate obstructions of vessels. top of ...

  19. Catheter Angiography

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    Full Text Available ... body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special detector. Different parts of the body absorb the x-rays in ...

  20. Catheter Angiography

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    Full Text Available ... you will be admitted to the hospital overnight. Leave jewelry at home and wear loose, comfortable clothing. ... may also be asked to remove jewelry, removable dental appliances, eye glasses ... to combine diagnosis and treatment in a single procedure. An example is finding ...

  1. 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.

  2. Black-box modeling to estimate tissue temperature during radiofrequency catheter cardiac ablation: feasibility study on an agar phantom model

    International Nuclear Information System (INIS)

    Blasco-Gimenez, Ramón; Lequerica, Juan L; Herrero, Maria; Hornero, Fernando; Berjano, Enrique J

    2010-01-01

    The aim of this work was to study linear deterministic models to predict tissue temperature during radiofrequency cardiac ablation (RFCA) by measuring magnitudes such as electrode temperature, power and impedance between active and dispersive electrodes. The concept involves autoregressive models with exogenous input (ARX), which is a particular case of the autoregressive moving average model with exogenous input (ARMAX). The values of the mode parameters were determined from a least-squares fit of experimental data. The data were obtained from radiofrequency ablations conducted on agar models with different contact pressure conditions between electrode and agar (0 and 20 g) and different flow rates around the electrode (1, 1.5 and 2 L min −1 ). Half of all the ablations were chosen randomly to be used for identification (i.e. determination of model parameters) and the other half were used for model validation. The results suggest that (1) a linear model can be developed to predict tissue temperature at a depth of 4.5 mm during RF cardiac ablation by using the variables applied power, impedance and electrode temperature; (2) the best model provides a reasonably accurate estimate of tissue temperature with a 60% probability of achieving average errors better than 5 °C; (3) substantial errors (larger than 15 °C) were found only in 6.6% of cases and were associated with abnormal experiments (e.g. those involving the displacement of the ablation electrode) and (4) the impact of measuring impedance on the overall estimate is negligible (around 1 °C)

  3. Prospective pilot study on the incidence of infections caused by peripheral venous catheters at a general surgical ward

    Directory of Open Access Journals (Sweden)

    Heinrich, Ines

    2013-04-01

    Full Text Available [english] Device-associated infections comprise a significant proportion of all nosocomial infections. In this prospective, observational pilot study the incidence of infections in 89 peripheral venous catheters (PVCs was documented on a general surgical ward employing an infection data sheet developed by the Institute of Hygiene and Environmental Medicine, Greifswald in adherence to CDC standards for infections. 16 of 20 infections were documented during a four-week time period when medical students in the first four months of their practical year performed their compulsory rotation on the general surgical ward. Insufficient knowledge of adequate hygienic measures as well as non-compliance to aseptical procedural measures prior to and following insertion of a peripheral venous catheter are the assumed instigators of these infections. In order to ensure a uniform hygienic standard in the performance of applied procedures, it is essential that medical students during this practical year receive not only theoretical, but also hands-on schooling prior to initiation of their subsequent official residency.

  4. 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.

  5. Catheter-associated urinary tract infection (CAUTI) after term cesarean delivery: incidence and risk factors at a multi-center academic institution.

    Science.gov (United States)

    Moulton, Laura; Lachiewicz, Mark; Liu, Xiaobo; Goje, Oluwatosin

    2018-02-01

    The purpose of this study is to identify the rate of catheter-associated urinary tract infection (CAUTI) after Cesarean delivery (CD) and to determine if any factors increase risk of infection. A retrospective cohort study was performed at a multi-center institution for patients who underwent CD in 2013. All patients had urinary catheters inserted before surgery. Diagnosis followed IDSA guidelines with culture growing greater than 10 3 CFU of bacteria per mL with symptoms or symptomatic urinary tract infections treated at provider discretion. Statistical analysis was assessed with Chi-square and Student's t-test followed by logistic regression. Of 2419 patients, 36 patients developed CAUTI (1.5%). In the 24 (66.7%) cases diagnosed by IDSA guidelines, Escherichia coli was the most common causative organism (54.1%); followed by Enterococcus faecalis (16.7%), Streptococccus agalactiae (8.3%), and Group A Streptococcus (8.3%). Longer operative time (OR 1.013; 95% 1.002-1.023; p = .02) and pregnancies complicated by STI (OR 4.15; 95% CI 1.11-15.0; p < .05) were associated with higher rates of CAUTI. The overall rate of CAUTI after CD was low at 1.5%. Escherichia coli was the most common causative pathogen. Identification of the patients at high risk for CAUTI allows for risk reduction measures.

  6. Outcome of Radiologically Placed Tunneled Haemodialysis Catheters

    International Nuclear Information System (INIS)

    Sayani, R.; Anwar, M.; Haq, T.U.; Qamari, N.A.; Bilal, M.A.

    2013-01-01

    Objective: To study the outcome of radiologically placed double lumen tunneled haemodialysis catheters for the management of renal failure. Study Design: Case series. Place and Duration of Study: Interventional Suite of Radiology Department at the Aga Khan University Hospital, Karachi, from April 2010 to June 2011. Methodology: All consecutive patients who were referred to the department of radiology by the nephrologists for double lumen tunneled haemodialysis catheter (Permacath) placement during the study period were included. Patients with septicemia, those for whom follow-up was not available, those coming for catheter exchange or who died due to a noncatheter related condition were excluded. A radio-opaque, soft silicone double lumen catheter was inserted through a subcutaneous tunnel created over the anterior chest wall. The catheter tip was placed in the right atrium via the internal jugular vein. Ultrasound guidance was used for initial venous puncture. The rest of the procedure was carried out under fluoroscopic guidance. Technical success, catheter related bacteremia rates, adequacy of dialysis, patency, and adverse events were analyzed. Results: Overall 88 tunneled haemodialysis catheters were placed in 87 patients. Patients were followed-up for duration of 1 - 307 days with mean follow-up period of 4 months. Immediate technical success was 100%. The procedural complication rate was 5.6% (5 catheters). Eight patients died during the study period, seven from causes unrelated to the procedure. One patient died due to septicemia secondary to catheter related infection. Of the remaining 69 patients, 50 (72.4%) predominantly had uneventful course during the study period. Twelve patients developed infection (17.3%); two were successfully treated conservatively while in 10 patients catheter had to be removed. Seven catheters (10.1%) failed due to mechanical problems. In 3 patients the internal jugular veins got partially thrombosed. One catheter was

  7. Indwelling Urinary Catheter-Related Problems After Laparoscopic Radical Prostatectomy.

    Science.gov (United States)

    Reuvers, Sarah; Zonneveld, Willemijn; Meiland-van Bakel, Marja; Putter, Hein; Nicolai, Melianthe; Pelger, Rob; Elzevier, Henk

    2016-01-01

    The purpose of this study was to determine occurrence rates of catheter-related problems and their association to pertinent clinical characteristics in men with indwelling urinary catheters following laparoscopic radical prostatectomy. Descriptive, correlational study. One hundred twelve men who underwent laparoscopic radical prostatectomy between December 2010 and December 2012 at the Leiden University Medical Centre in the Netherlands were included in this study. After surgery, a Charriere 20 (20F) silicone catheter was left indwelling for 1 week. Data were gathered from 2 sources; we reviewed participants' medical records, and participants completed a questionnaire designed for this study. Pearson χ tests were used to analyze associations between dichotomous and ordinal variables and catheter-related problems. Univariate logistic regression analyses were used to analyze the relationships between continuous factors and catheter-related problems. Seventy-five percent of participants reported at least 1 catheter-related problem. Univariate regression analyses revealed correlations between body weight and experiencing catheter-related problems (odds ratio [OR] = 1.050; P = .028) and between body mass index and experiencing catheter-related problems (OR = 1.159; P = .049). Indwelling catheter-related problems after laparoscopic radical prostatectomy are prevalent, and they may occur at any time during the entire period of catheter use. High body mass index and high body weight were associated with an increased likelihood of catheter-related problems following radical prostatectomy.

  8. Perforation of the Right Ventricle Induced by Pulmonary Artery Catheter at Induction of Anesthesia for the Surgery for Liver Transplantation: A Case Report and Reviewed of Literature

    Directory of Open Access Journals (Sweden)

    Maria Auxiliadora-Martins

    2009-01-01

    Full Text Available We report a case of a 45-year-old male patient diagnosed with liver cirrhosis by hepatitis C and alcohol, with a Child-Pugh score C and a model for end-stage liver disease (MELD score of 27, and submitted to liver transplantation. The subject underwent insertion of the pulmonary artery catheter (PAC in the right internal jugular vein, with technical difficulty concerning catheter advance. There was sudden hypotension, increase in central venous pressure (CVP, and decrease in SvO2 15 minutes after the PAC had been inserted, followed by cardiorespiratory arrest in pulseless electrical activity (PEA, which was promptly assisted with resuscitation. Pericardiocentesis was performed without success, so the individual was subjected to a subxiphoid pericardial window, which led to output of large amounts of blood as well as PEA reversal to sinus rhythm. Sternotomy was performed; rupture of the apex of the right ventricle (RV was detected, and suture of the site was accomplished. After hemodynamic stabilization, the patient was transferred to the ICU, where he developed septic shock and, despite adequate therapy, died on the eighteenth day after ICU admission.

  9. Comparative Efficacies of Tedizolid Phosphate, Linezolid, and Vancomycin in a Murine Model of Subcutaneous Catheter-Related Biofilm Infection Due to Methicillin-Susceptible and -Resistant Staphylococcus aureus.

    Science.gov (United States)

    Bayer, Arnold S; Abdelhady, Wessam; Li, Liang; Gonzales, Rachelle; Xiong, Yan Q

    2016-08-01

    Tedizolid, a novel oxazolidinone, exhibits bacteriostatic activity through inhibition of protein synthesis. The efficacies of tedizolid, linezolid, and vancomycin were compared in a murine catheter-related biofilm infection caused by methicillin-susceptible and -resistant Staphylococcus aureus (MSSA and MRSA, respectively) strains engineered for bioluminescence. We observed significantly improved efficacy in terms of decreased S. aureus densities and bioluminescent signals in the tedizolid-treated group versus the linezolid- and vancomycin-treated groups in the model of infection caused by the MSSA and MRSA strains. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

  10. Management of cancer-associated upper extremity deep vein thrombosis with and without venous catheters at a tertiary care center.

    Science.gov (United States)

    ALKindi, Said Y; Chai-Adisaksopha, Chatree; Cheah, Matthew; Linkins, Lori-Ann

    2018-04-03

    Data on management of upper extremity deep vein thrombosis (UEDVT) in patients with cancer is limited. The objective of this study was to determine risk factors for UEDVT and the rates of recurrence and bleeding in a real-world setting. Retrospective review of consecutive patients assessed for cancer-associated UEDVT. Outcome measures were recurrent venous thromboembolism (VTE), and major and clinically relevant non-major bleeding (CRNMB). Risk factors for recurrent VTE and bleeding were assessed. Mean duration of follow-up was 7.2 months. Two hundred cases were identified; 69% were associated with a central line. Non-line associated UEDVT occurred more frequently in the setting of breast cancer, lung cancer and documented local mass effect. The incidence of recurrent VTE was 18.5%, of which 14 (37.8%) were ipsilateral UEDVT. The risk of recurrence is higher with male gender (HR 2.0, 95% CI; 1.0-4.0). Major and CRNMB occurred in 1% and 11.5%, respectively. Concurrent use of an antiplatelet agent was associated with a higher risk of CRNMB compared to anticoagulant therapy alone (HR 3.9, 95% CI; 1.4-10.7). Presence of a venous catheter was the primary risk factor for UEDVT, however, extrinsic compression by local tumour may be just as important for some cancer types. Furthermore, the majority of recurrent events did not occur in the same upper limb suggesting that UEDVT may be predictive of increased thrombotic risk rather than just a local effect of catheters. Copyright © 2018. Published by Elsevier Ltd.

  11. 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

  12. Electrical and thermal effects of esophageal temperature probes on radiofrequency catheter ablation of atrial fibrillation: results from a computational modeling study.

    Science.gov (United States)

    Pérez, Juan J; D'Avila, Andre; Aryana, Arash; Berjano, Enrique

    2015-05-01

    Luminal esophageal temperature (LET) monitoring is commonly employed during catheter ablation of atrial fibrillation (AF) to detect high esophageal temperatures during radiofrequency (RF) delivery along the posterior wall of the left atrium. However, it has been recently suggested that in some cases the esophageal probe itself may serve as an RF "antenna" and promote esophageal thermal injury. The aim of this study was to assess the electrical and thermal interferences induced by different types of commercially available esophageal temperature probes (ETPs) on RF ablation. In this study, we developed a computational model to assess the electrical and thermal effects of 3 different types of ETPs: a standard single-sensor and 2 multisensor probes (1 with and 1 without metallic surfaces). LET monitoring invariably underestimated the maximum temperature reached in the esophageal wall. RF energy cessation guided by LET monitoring using an ETP yielded lower esophageal wall temperatures. Also, the phenomenon of thermal latency was observed, particularly in the setting of LET monitoring. Most importantly, while only the ETP with a metallic surface produced minimal electrical alterations, the magnitude of this interference did not appear to be clinically significant. Temperature rises in both the esophageal wall and the ETP seem to be primarily produced by thermal conduction, and not caused by electrical and/or thermal interactions between the ablation catheter and the ETP, itself. As such, the proposed notion of the "antenna effect" producing satellite esophageal lesions during AF ablation was not evident in this study. © 2015 Wiley Periodicals, Inc.

  13. Innovation in catheter design for intra-arterial liver cancer treatments results in favorable particle-fluid dynamics.

    Science.gov (United States)

    van den Hoven, Andor F; Lam, Marnix G E H; Jernigan, Shaphan; van den Bosch, Maurice A A J; Buckner, Gregory D

    2015-08-01

    Liver tumors are increasingly treated with radioembolization. Here, we present first evidence of catheter design effect on particle-fluid dynamics and downstream branch targeting during microsphere administrations. A total of 7 experiments were performed in a bench-top model of the hepatic arterial vasculature with recreated hemodynamics. Fluorescent microspheres and clinically used holmium microspheres were administered with a standard microcatheter (SMC) and an anti-reflux catheter (ARC) positioned at the same level along the longitudinal vessel axis. Catheter-related particle flow dynamics were analyzed by reviewing video recordings of UV-light illuminated fluorescent microsphere administrations. Downstream branch distribution was analyzed by quantification of collected microspheres in separate filters for two first-order branches. Mean deviation from a perfectly homogenous distribution (DHD) was used to compare the distribution homogeneity between catheter types. The SMC administrations demonstrated a random off-centered catheter position (in 71 % of experiments), and a laminar particle flow pattern with an inhomogeneous downstream branch distribution, dependent on catheter position and injection force. The ARC administrations demonstrated a fixed centro-luminal catheter position, and a turbulent particle flow pattern with a more consistent and homogenous downstream branch distribution. Quantitative analyses confirmed a significantly more homogeneous distribution with the ARC; the mean DHD was 40.85 % (IQR 22.76 %) for the SMC and 15.54 % (IQR 6.46 %) for the ARC (p = 0.047). Catheter type has a significant impact on microsphere administrations in an in-vitro hepatic arterial model. A within-patient randomized controlled trial has been initiated to investigate clinical catheter-related effects during radioembolization treatment.

  14. 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.

  15. Inappropriate urinary catheter reinsertion in hospitalized older patients.

    Science.gov (United States)

    Hu, Fang-Wen; Tsai, Chuan-Hsiu; Lin, Huey-Shyan; Chen, Ching-Huey; Chang, Chia-Ming

    2017-01-01

    We investigated the incidence and rationale for inappropriate reinsertion of urinary catheters and elucidated whether reinsertion is an independent predictor of adverse outcomes. A longitudinal study was adopted. Patients aged ≥65 years with urinary catheters placed within 24 hours of hospitalization were enrolled. Data collection, including demographic variables and health conditions, was conducted within 48 hours after admission. Patients with catheters in place were followed-up every day. If the patient had catheter reinsertion, the reinsertion information was reviewed from medical records. Adverse outcomes were collected at discharge. A total of 321 patients were enrolled. Urinary catheters were reinserted in 66 patients (20.6%), with 95 reinsertions; 49.5% of catheter reinsertions were found to be inappropriate. "No evident reason for urinary catheter use" was the most common rationale for inappropriate reinsertion. Inappropriate reinsertion was found to be a significant predictor for prolonged length of hospital stay, development of catheter-associated urinary tract infections and catheter-related complications, and decline in activities of daily living. This study indicates a considerable percentage of inappropriate urinary catheter reinsertions in hospitalized older patients. Inappropriate reinsertion was significantly associated with worsening outcomes. Efforts to improve appropriateness of reinsertion and setting clinical policies for catheterization are necessary to reduce the high rate of inappropriate reinsertion. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  16. 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

  17. Modeling correlation indices between bladder and Foley′s catheter balloon dose with CT-based planning using limited CT slices in intracavitary brachytherapy for carcinoma of cervix

    Directory of Open Access Journals (Sweden)

    Oinam Arun

    2008-01-01

    Full Text Available Purpose: To derive and validate an index to correlate the bladder dose with the catheter balloon dose using limited computed tomography (CT slices. Materials and Methods: Applicator geometry reconstructed from orthogonal radiographs were back-projected on CT images of the same patients for anatomy-based dosimetric evaluation. The correlation indices derived using power function of the catheter balloon dose and the bladder volume dose were validated in 31 patients with cervical cancer. Results: There was significant correlation between International Commission on Radiation Units (ICRU-38 balloon reference dose (Dr and the dose received by 25% bladder volume (D 25 (P < 0.0001. Significant correlation was also found between the reference dose of mid-balloon point (D rm and the dose to D 25 (P < 0.0001. Average percentage difference [100 x (observed index - expected index / expected index] of observed value of I′ 25 (index for the dose to D25 bladder with respect to mid-balloon reference point from that of expected value was 0.52%, when the index was modeled with reference dose alone. Similarly the average percentage difference for I′10cc (index for the dose to 10 cc volume of bladder with respect to mid balloon point was 0.84%. When this index was modeled with absolute bladder volume and reference dose, standard deviation of the percentage difference between observed and expected index for D rm reduced by approximately 2% when compared to D r . Conclusion: For clinical applications, correlation index modeled with reference dose and volume predicts dose to absolute volume of bladder. Correlation index modeled with reference dose gives a good estimate of dose to relative bladder volume. From our study, we found D rm to be a better indicator of bladder dose than D r .

  18. Antimicrobial Agents and Catheter Complications in Outpatient Parenteral Antimicrobial Therapy.

    Science.gov (United States)

    Keller, Sara C; Dzintars, Kathryn; Gorski, Lisa A; Williams, Deborah; Cosgrove, Sara E

    2018-03-01

    Debate about whether certain antimicrobial agents traditionally considered vesicants increase the risk of catheter complications has led to uncertainty in venous catheter placement protocols. To understand whether patients requiring home-based outpatient parenteral antimicrobial therapy (OPAT) should receive peripheral catheters (e.g., midline catheters) versus central venous catheters, and to understand whether certain antimicrobial agents place home-based OPAT patients at higher risk for catheter complications, we investigated associations between antimicrobial agent(s) and catheter complications. We performed a prospective cohort study of patients requiring home-based OPAT discharged from two urban tertiary care academic medical centers, including telephone surveys and chart abstractions. Multivariable Poisson regressions were used to evaluate: (i) associations between antimicrobial agents traditionally considered vesicants, based on pH or osmolarity, and catheter complication rates, and (ii) associations between antimicrobial agent and rates of catheter complications. Vesicant antimicrobials defined using pH or osmolarity criteria were not associated with an increased rate of catheter complications (adjusted incidence rate ratio [aIRR]: 1.63, 95% confidence interval [CI]: 0.89-2.96). Vancomycin was associated with an increased rate of catheter complications, as was daptomycin (aIRR: 2.32 [95% CI: 1.20-4.46] and 4.45 [95% CI: 1.02-19.41], respectively). Staphylococcus aureus infections were also associated with an increased rate of catheter complications (aIRR: 2.13, 95% CI: 1.09-4.19), as were midline catheters (aIRR: 9.44, 95% CI: 2.12-41.97). Our study supports recent guidance identifying vancomycin as a vesicant, among a subset of antimicrobial agents, and removal of pH criteria for identification of vesicants. © 2018 Pharmacotherapy Publications, Inc.

  19. 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)

  20. A new central venous catheter cap: decreased microbial growth and risk for catheter-related bloodstream infection.

    Science.gov (United States)

    Buchman, A L; Spapperi, J; Leopold, P

    2009-01-01

    Catheter-related blood stream infection (CRBI) is a major cause of morbidity and mortality, and is a source of significant healthcare expenditures in patients that require central venous catheters for intravenous nutrition, chemotherapy, and other products. The source of many catheter-related infections is contamination of the catheter hub. Herein an antimicrobial catheter cap, the AB Cap is described. The AB Cap device is a catheter cleaning device designed to keep needleless luer valves clean by encapsulating them in a cleaning solution. This device was evaluated using an in vitro model of hub contamination with Staphylococcus aureus, Staphylococcus epidermidis (S. epidermidis), Klebsiella pneumonia (K. pneumonia), Pseudomonas aeruginosa, Escherichia coli and Candida albicans (C. albicans). Following hub contamination on days 1, 3, 5 and 7, saline was infused through the AB Cap and effluent collected from the efferent end. The effluent fluid was cultured for the index organisms, and allowed to incubate in culture for up to 7 days. Negative control caps were not contaminated and positive controls lacked cleaning solution and were contaminated. Microbial growth developed for all index organisms, and generally within 1 day of culture growth following the first day of contamination (day 1) in effluent from all positive controls, while no growth occurred in effluent from negative controls. No growth of any organism occurred in any of the test items after the first day of contamination. Growth of three organisms was detected in two of the three test AB Caps following contamination day 3, after 1-4 days of incubation. All organisms could be cultured in the effluent from two of the three test items at contamination day 5, generally by the second day of incubation. One test item remained free of growth for the entire test period except for one organism. By day 7, this particular test item grew an additional organism and the testing was concluded. All positive growth test

  1. 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

    -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......STUDY DESIGN: Cost-effectiveness analysisObjective:To establish a model to investigate the cost effectiveness for people with spinal cord injury (SCI), from a lifetime perspective, for the usage of two different single-use catheter designs: hydrophilic-coated (HC) and uncoated (UC). The model...... 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...

  2. Bladder Morphology Using 2 Different Catheter Designs

    Science.gov (United States)

    2017-04-10

    Urologic Injuries; Urologic Diseases; Bladder Infection; Urinary Tract Infections; Mucosal Inflammation; Mucosal Infection; Bladder Injury; Catheter-Related Infections; Catheter Complications; Catheter; Infection (Indwelling Catheter); Pelvic Floor Disorders; Urinary Incontinence

  3. [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.

  4. A Dynamical Training and Design Simulator for Active Catheters

    Directory of Open Access Journals (Sweden)

    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.

  5. 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.

  6. CHLORHEXIDINE-IMPREGNATED DRESSING FOR PREVENTION OF CATHETER-RELATED BLOODSTREAM INFECTION: A META-ANALYSIS

    Science.gov (United States)

    Safdar, Nasia; O’Horo, John C.; Ghufran, Aiman; Bearden, Allison; Didier, Maria Eugenia; Chateau, Dan; Maki, Dennis G.

    2014-01-01

    Background Catheter related bloodstream infections (CRBSI) are associated with significant morbidity and mortality and effective methods for their prevention are needed. Objective To assess the efficacy of a chlorhexidine-impregnated dressing for prevention of central venous catheter-related colonization and CRBSI using meta-analysis. Data Sources Multiple computerized database searches supplemented by manual searches including relevant conference proceedings. Study Selection Randomized controlled trials (RCT) evaluating the efficacy of a chlorhexidine-impregnated dressing compared with conventional dressings for prevention of catheter colonization and CRBSI. Data Extraction Data were extracted on patient and catheter characteristics and outcomes. Data Synthesis Pooled estimates of the relative risk (RR) and 95% confidence intervals (CI) were obtained using the DerSimonian and Laird random effects model and the Mantel-Haenszel fixed effects model. Heterogeneity was assessed using the Cochran Q statistic and I2. Subgroup analyses were used to explore heterogeneity. Results Nine RCTs met the inclusion criteria. Use of a chlorhexidine-impregnated dressing resulted in a reduced incidence of CRBSI (random effects RR 0.57, 95% CI 0.42–0.79, P=0.002). The incidence of catheter colonization was also markedly reduced in the chlorhexidine-impregnated dressing group (random effects RR 0.51, 95% CI 0.39–0.67, Pchlorhexidine-impregnated dressing is beneficial in preventing catheter colonization and, more importantly, CRBSI and warrants routine use in patients at high risk of CRBSI and CVC or arterial catheter colonization in ICUs. PMID:24674924

  7. 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

  8. Impact of catheter insertion using the radial approach on vasodilatation in humans.

    Science.gov (United States)

    Dawson, Ellen A; Rathore, Sudhir; Cable, N Timothy; Wright, D Jay; Morris, John L; Green, Daniel J

    2010-02-23

    The aim of this study was to determine the impact of catheter sheath insertion, a model of endothelium disruption in humans, on the conventional FMD (flow-mediated dilatation) response in vivo. Seventeen subjects undergoing transradial catheterization were recruited and assessed prior to, the day after, and 3-4 months postcatheterization. The catheter sheath's external diameter was 2.7 mm, and the average preprocedure internal radial artery diameter was 2.8 mm, indicating a high likelihood of endothelial denudation as a consequence of sheath placement. Radial artery flow-mediated and endothelium-derived NO (nitric oxide)-dependent function (FMD) was assessed within the region of sheath placement (sheath site) and also above the sheath (catheter site). GTN (glyceryl trinitrate) endothelium-independent NO-mediated function was also assessed distally. Measurements were made in both arms at all time points; the non-catheterized arm provided an internal control. Neither sheath (4.5+/-0.9%) nor catheter (4.4+/-0.9%) insertion abolished FMD, although both significantly decreased FMD from preintervention levels (9.0+/-0.8% sheath segment; 8.4+/-0.8% catheter segment; P<0.05). The impact of sheath and catheter placement on FMD was no longer evident after approximately 3 months recovery (8.0+/-1.5 and 8.1+/-1.7%, sheath and catheter, respectively). GTN responses also decreased from 14.8+/-1.7 to 7.9+/-1.0% (P<0.05) as a result of sheath placement, but values returned to baseline at approximately 3 months (13.0+/-1.8%). These results suggest that the presence of an intact, functional endothelial layer and consequent NO release may not be obligatory for some component of the FMD response. This raises the possibility of an endothelium-independent contribution to the flow-induced vasodilatation in humans.

  9. Catheter-related bloodstream infection.

    Science.gov (United States)

    Goede, Matthew R; Coopersmith, Craig M

    2009-04-01

    Catheter-related bloodstream infections (CR-BSIs) are a common, frequently preventable complication of central venous catheterization. CR-BSIs can be prevented by strict attention to insertion and maintenance of central venous catheters and removing unneeded catheters as soon as possible. Antiseptic- or antibiotic-impregnated catheters are also an effective tool to prevent infections. The diagnosis of CR-BSI is made largely based on culture results. CR-BSIs should always be treated with antibiotics, and except in rare circumstances the infected catheter needs to be removed.

  10. First In Vivo Use of a Capacitive Micromachined Ultrasound Transducer Array–Based Imaging and Ablation Catheter

    Science.gov (United States)

    Stephens, Douglas N.; Truong, Uyen T.; Nikoozadeh, Amin; Oralkan, Ömer; Seo, Chi Hyung; Cannata, Jonathan; Dentinger, Aaron; Thomenius, Kai; de la Rama, Alan; Nguyen, Tho; Lin, Feng; Khuri-Yakub, Pierre; Mahajan, Aman; Shivkumar, Kalyanam; O’Donnell, Matt; Sahn, David J.

    2012-01-01

    Objectives The primary objective was to test in vivo for the first time the general operation of a new multifunctional intracardiac echocardiography (ICE) catheter constructed with a microlinear capacitive micromachined ultrasound transducer (ML-CMUT) imaging array. Secondarily, we examined the compatibility of this catheter with electroanatomic mapping (EAM) guidance and also as a radiofrequency ablation (RFA) catheter. Preliminary thermal strain imaging (TSI)-derived temperature data were obtained from within the endocardium simultaneously during RFA to show the feasibility of direct ablation guidance procedures. Methods The new 9F forward-looking ICE catheter was constructed with 3 complementary technologies: a CMUT imaging array with a custom electronic array buffer, catheter surface electrodes for EAM guidance, and a special ablation tip, that permits simultaneous TSI and RFA. In vivo imaging studies of 5 anesthetized porcine models with 5 CMUT catheters were performed. Results The ML-CMUT ICE catheter provided high-resolution real-time wideband 2-dimensional (2D) images at greater than 8 MHz and is capable of both RFA and EAM guidance. Although the 24-element array aperture dimension is only 1.5 mm, the imaging depth of penetration is greater than 30 mm. The specially designed ultrasound-compatible metalized plastic tip allowed simultaneous imaging during ablation and direct acquisition of TSI data for tissue ablation temperatures. Postprocessing analysis showed a first-order correlation between TSI and temperature, permitting early development temperature-time relationships at specific myocardial ablation sites. Conclusions Multifunctional forward-looking ML-CMUT ICE catheters, with simultaneous intracardiac guidance, ultrasound imaging, and RFA, may offer a new means to improve interventional ablation procedures. PMID:22298868

  11. First in vivo use of a capacitive micromachined ultrasound transducer array-based imaging and ablation catheter.

    Science.gov (United States)

    Stephens, Douglas N; Truong, Uyen T; Nikoozadeh, Amin; Oralkan, Omer; Seo, Chi Hyung; Cannata, Jonathan; Dentinger, Aaron; Thomenius, Kai; de la Rama, Alan; Nguyen, Tho; Lin, Feng; Khuri-Yakub, Pierre; Mahajan, Aman; Shivkumar, Kalyanam; O'Donnell, Matt; Sahn, David J

    2012-02-01

    The primary objective was to test in vivo for the first time the general operation of a new multifunctional intracardiac echocardiography (ICE) catheter constructed with a microlinear capacitive micromachined ultrasound transducer (ML-CMUT) imaging array. Secondarily, we examined the compatibility of this catheter with electroanatomic mapping (EAM) guidance and also as a radiofrequency ablation (RFA) catheter. Preliminary thermal strain imaging (TSI)-derived temperature data were obtained from within the endocardium simultaneously during RFA to show the feasibility of direct ablation guidance procedures. The new 9F forward-looking ICE catheter was constructed with 3 complementary technologies: a CMUT imaging array with a custom electronic array buffer, catheter surface electrodes for EAM guidance, and a special ablation tip, that permits simultaneous TSI and RFA. In vivo imaging studies of 5 anesthetized porcine models with 5 CMUT catheters were performed. The ML-CMUT ICE catheter provided high-resolution real-time wideband 2-dimensional (2D) images at greater than 8 MHz and is capable of both RFA and EAM guidance. Although the 24-element array aperture dimension is only 1.5 mm, the imaging depth of penetration is greater than 30 mm. The specially designed ultrasound-compatible metalized plastic tip allowed simultaneous imaging during ablation and direct acquisition of TSI data for tissue ablation temperatures. Postprocessing analysis showed a first-order correlation between TSI and temperature, permitting early development temperature-time relationships at specific myocardial ablation sites. Multifunctional forward-looking ML-CMUT ICE catheters, with simultaneous intracardiac guidance, ultrasound imaging, and RFA, may offer a new means to improve interventional ablation procedures.

  12. 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

  13. The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): a prospective cohort study.

    Science.gov (United States)

    Sharp, Rebecca; Cummings, Melita; Fielder, Andrea; Mikocka-Walus, Antonina; Grech, Carol; Esterman, Adrian

    2015-03-01

    Peripherally inserted central catheters (PICCs) are a common vascular access device used in clinical practice. Their use may be complicated by adverse events such as venous thromboembolism (VTE). The size of the vein used for PICC insertion and thus the catheter to vein ratio is thought to be a controllable factor in the reduction of VTE rates in patients who have a PICC. However, an optimal catheter to vein ratio for PICC insertion has not previously been investigated to inform clinical practice. To determine the effect of the catheter to vein ratio (proportion of the vein measured at the insertion point taken up by the catheter) on rates of symptomatic VTE in patients with a PICC and identify the optimal ratio cut-off point to reduce rates of this adverse event. Adult patients waiting for PICC insertion at a large metropolitan teaching hospital were recruited between May and December 2013. Vein diameter at the PICC insertion site was measured using ultrasound with in-built callipers. Participants were followed up at eight weeks to determine if they developed symptomatic VTE. Data were available for 136 patients (50% cancer; 44% infection; 6% other indication for PICC). Mean age was 57 years with 54% males. There were four cases of confirmed symptomatic VTE (two involving the deep veins, one peripheral vein and one pulmonary embolism). Receiver operator characteristic (ROC) analysis determined that a 45% catheter to vein ratio was the ideal cut off point to maximise sensitivity and specificity (AUC 0.761; 95% CI 0.681-0.830). When a ratio of 46% or above was compared to one that was less than or equal to 45% using a log binomial generalised linear model it was found that participants with a catheter to vein ratio >45% were 13 times more likely to suffer VTE (relative risk 13, p=0.022; CI 1.445-122.788). It was found that a 45% catheter to vein ratio was the optimal cut off with high sensitivity and specificity to reduce the risk of VTE. However, further research

  14. Foley catheter for cervical priming in induction of labour at University Obstetrics Unit, Colombo, Sri Lanka: a clinical audit with a patient satisfaction survey.

    Science.gov (United States)

    Patabendige, M; Jayawardane, A

    2017-04-12

    Intracervical insertion of a Foley catheter (FC) has shown to be a safe, effective and relatively feasible mechanical method of cervical priming in induction of labour (IOL). We evaluated indications, effectiveness, patient acceptability and outcomes of FC use in IOL adhering to the ward protocol in our unit. A clinical audit with a patient satisfaction survey conducted between July and September 2013 in University Obstetric Unit, Colombo, Sri Lanka. Patients selected for IOL for obstetric reasons were primed with Foley as per ward protocol. All had singleton pregnancies with cephalic presentation, intact membranes and period of gestation of 37 weeks or above. Women with a history of more than one caesarean section or uterine surgery, low-lying placenta and fetal growth restriction were excluded. Subjects who had a Modified Bishop Score (MBS) of less than 3, a 16Fr FC was inserted into cervical canal. Catheter was left undisturbed until spontaneous expulsion or no longer than 48 h. In women with MBS of less than 6 at 48 h after FC insertion, 3 mg prostaglandin E2 vaginal tablet was used subsequently. Artificial membrane rupture with or without oxytocin was used if MBS of 6 or more and in women not in labour 24 h after prostaglandins. Patient satisfaction for Foley insertion was assessed with regards to the degree of comfort using a validated visual analogue scale (0-10). There were a total of 910 deliveries during the study period. Fifty-six women were primed with FC. Thirty-two (57%) were nulliparous. During induction of labour, 53(95%) reported mild or no discomfort. MBS of 6 or more was achieved in 36/56 (64%) Foley insertions. Twenty needed further intervention with prostaglandins. FC only group had 5 caesarean sections and 31 vaginal deliveries and Foley/prostaglandin group had 7 caesarean sections and 13 vaginal deliveries. Of the 24 women who were induced due to completion of 41 weeks of gestation with otherwise uncomplicated pregnancies, 17 had MBS >6

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

    Science.gov (United States)

    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.

  16. Pacemaker implantation after catheter ablation for atrial fibrillation.

    Science.gov (United States)

    Deshmukh, Abhishek J; Yao, Xiaoxi; Schilz, Stephanie; Van Houten, Holly; Sangaralingham, Lindsey R; Asirvatham, Samuel J; Friedman, Paul A; Packer, Douglas L; Noseworthy, Peter A

    2016-01-01

    Sinus node dysfunction requiring pacemaker implantation is commonly associated with atrial fibrillation (AF), but may not be clinically apparent until restoration of sinus rhythm with ablation or cardioversion. We sought to determine frequency, time course, and predictors for pacemaker implantation after catheter ablation, and to compare the overall rates to a matched cardioversion cohort. We conducted a retrospective analysis using a large US commercial insurance database and identified 12,158 AF patients who underwent catheter ablation between January 1, 2005 and December 31, 2012. Over an average of 2.4 years of follow-up, 5.6 % of the patients underwent pacemaker implantation. Using the Cox proportional hazards models, we found that risk of risks of pacemaker implantation was associated with older age (50-64 and ≥65 versus pacemaker implantation between ablation patients and propensity score (PS)-matched cardioversion groups (3.5 versus. 4.1 % at 1 year and 8.8 versus 8.3 % at 5 years). Overall, pacemaker implantation occurs in about 1/28 patients within 1 year of catheter ablation. The overall implantation rate decreased between 2005 and 2012. Furthermore, the risk after ablation is similar to cardioversion, suggesting that patients require pacing due to a common underlying electrophysiologic substrate, rather than the ablation itself.

  17. 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...

  18. 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

  19. Crystalline bacterial biofilm formation on urinary catheters by urease-producing urinary tract pathogens: a simple method of control.

    Science.gov (United States)

    Broomfield, Robert J; Morgan, Sheridan D; Khan, Azhar; Stickler, David J

    2009-10-01

    The problem of catheter encrustation stems from infection by urease-producing bacteria. These organisms generate ammonia from urea, elevate the pH of urine and cause crystals of calcium and magnesium phosphates to form in the urine and the biofilm that develops on the catheter. In this study, a laboratory model was used to compare the ability of 12 urease-positive species of urinary tract pathogens to encrust and block catheters. Proteus mirabilis, Proteus vulgaris and Providencia rettgeri were able to raise the urinary pH above 8.3 and produce catheter-blocking crystalline biofilms within 40 h. Morganella morganii and Staphylococcus aureus elevated the pH of urine to 7.4 and 6.9, respectively, and caused some crystal deposition in the biofilms but did not block catheters in the 96 h experimental period. Isolates of Klebsiella pneumoniae, Klebsiella oxytoca, Enterobacter cloacae, Serratia marcescens, Pseudomonas aeruginosa and Providencia stuartii were only capable of raising the pH of urine to a maximum of 6.4 and failed to cause crystal deposition in the biofilm. The most effective way to prevent catheter encrustation was shown to be diluting urine and increasing its citrate concentration. This strategy raises the nucleation pH (pH(n)) at which calcium and magnesium phosphates crystallize from urine. Increasing the fluid intake of a healthy volunteer with citrated drinks resulted in urine with a pH(n) of >8.0 in which catheter encrustation was inhibited. It is suggested that this dietary strategy will be an effective means of controlling catheter encrustation, whichever bacterial species is causing the problem.

  20. 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

  1. Virtual ablation for atrial fibrillation in personalized in-silico three-dimensional left atrial modeling: comparison with clinical catheter ablation.

    Science.gov (United States)

    Hwang, Minki; Kwon, Soon-Sung; Wi, Jin; Park, Mijin; Lee, Hyun-Seung; Park, Jin-Seo; Lee, Young-Seon; Shim, Eun Bo; Pak, Hui-Nam

    2014-09-01

    Although catheter ablation is an effective rhythm control strategy for atrial fibrillation (AF), empirically-based ablation has a substantial recurrence rate. The purposes of this study were to develop a computational platform for patient-specific virtual AF ablation and to compare the anti-fibrillatory effects of 5 different virtual ablation protocols with empirically chosen clinical ablations. We included 20 patients with AF (65% male, 60.1 ± 10.5 years old, 80% persistent AF [PeAF]) who had undergone empirically-based catheter ablation: circumferential pulmonary vein isolation (CPVI) for paroxysmal AF (PAF) and additional posterior box lesion (L1) and anterior line (L2) for PeAF. Using patient-specific three-dimensional left atrial (LA) geometry, we generated a finite element model and tested the AF termination rate after 5 different virtual ablations: CPVI alone, CPVI + L1, CPVI + L1,2, CPVI with complex fractionated atrial electrogram (CFAE) ablation, and CFAE ablation alone. 1. Virtual CPVI + L1,2 ablation showed the highest AF termination rate in overall patients (55%) and PeAF patients (n = 16, 62.5%). 2. The virtual AF maintenance duration was shortest in the case of virtual CPVI + L1,2 ablation in overall patients (2.19 ± 1.28 vs. 2.91 ± 1.04 s, p = 0.009) and in patients with PeAF (2.05 ± 1.23 vs. 2.93 ± 10.2 s, p = 0.004) compared with other protocols. Virtual AF ablation using personalized in-silico model of LA is feasible. Virtual ablation with CPVI + L1,2 shows the highest antifibrillatory effect, concordant with the empirical ablation protocol in patients with PeAF. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. An artifice in the insertion of the Hickman catheter in small children

    African Journals Online (AJOL)

    catheter kit (Safe Guide Microneedle Seldinger kit,. Product ID – 1916–8GE; Nippon Covidien Co., Tokyo,. Japan) is inserted. This is necessary because the 0.018 inch guide wire cannot pass through all 24G peripheral intravenous catheters. The internal diameter, especially at the tip, varies even with catheters of the same ...

  3. Comparison of Standard Catheters Versus Radial Artery-Specific Catheter in Patients Who Underwent Coronary Angiography Through Transradial Access.

    Science.gov (United States)

    Chen, On; Goel, Sunny; Acholonu, Michael; Kulbak, Guy; Verma, Shivani; Travlos, Efstratios; Casazza, Richard; Borgen, Elliot; Malik, Bilal; Friedman, Michael; Moskovits, Norbert; Frankel, Robert; Shani, Jacob; Ayzenberg, Sergey

    2016-08-01

    In this prospective, randomized controlled study, we aim to compare the performance outcomes of standard catheters with the radial artery-specific catheter. Over the past decade, transradial cardiac catheterization has gained widespread popularity because of its low complication rates compared with transfemoral access. Operators have the choice of using either standard catheters (used for both transfemoral and transradial approach, with need for separate catheter use for either right or left coronary artery engagement) or a dedicated radial artery catheter, which is specifically designed to engage both coronary arteries through radial artery access. A total of 110 consecutive patients who underwent coronary angiography at our institution from March 2015 to April 2015 were prospectively randomized to either radial artery-specific Tiger catheter (5Fr; Terumo Interventional Systems, Somerset, New Jersey) versus standard Judkins left and right catheters (5Fr R4, L4; Cordis Corporation, Miami, Florida). The end points of the study included fluoroscopy time, dose-area product, contrast volume used, and total procedure time for the coronary angiography. A total of 57 patients (52%) were randomized to radial artery-specific catheter and 53 (48%) to the standard catheter. Tiger catheter was associated with significantly lower fluoroscopy time (184 ± 91 vs 238 ± 131 seconds, p = 0.015), which was statistically significant. Other outcome measures such as dose-area product (2,882.4 ± 1,471.2 vs 3,524.6 ± 2,111.7 Gy·cm(2), p = 0.07), total contrast volume (48.1 ± 16.1 vs 53.4 ± 18.5 ml, p = 0.114), and total procedure time (337 ± 382 vs 434 ± 137 seconds, p = 0.085) were also lower in single-catheter group, but it did not reach statistical significance. A total of 8 patients (14%) were crossed over from radial-specific catheter arm to standard catheter arm because of substandard image quality and difficulty in coronary engagement. Six patients had to be

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

    Science.gov (United States)

    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.

  5. Medical catheters thermally manipulated by fiber optic bundles

    Science.gov (United States)

    Chastagner, P.

    1992-10-06

    A maneuverable medical catheter comprising a flexible tube having a functional tip is described. The catheter is connected to a control source. The functional tip of the catheter carries a plurality of temperature activated elements arranged in parallel and disposed about the functional tip and held in spaced relation at each end. These elements expand when they are heated. A plurality of fiber optic bundles, each bundle having a proximal end attached to the control source and a distal end attached to one of the elements carry light into the elements where the light is absorbed as heat. By varying the optic fiber that is carrying the light and the intensity of the light, the bending of the elements can be controlled and thus the catheter steered. In an alternate embodiment, the catheter carries a medical instrument for gathering a sample of tissue. The instrument may also be deployed and operated by thermal expansion and contraction of its moving parts. 10 figs.

  6. 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.

  7. Cost-effectiveness of induction of labour at term with a Foley catheter compared to vaginal prostaglandin E2 gel (PROBAAT trial)

    NARCIS (Netherlands)

    van Baaren, G. J.; Jozwiak, M.; Opmeer, B. C.; Rengerink, K. Oude; Benthem, M.; Dijksterhuis, M. G. K.; van Huizen, M. E.; van der Salm, P. C. M.; Schuitemaker, N. W. E.; Papatsonis, D. N. M.; Perquin, D. A. M.; Porath, M.; van der Post, J. A. M.; Rijnders, R. J. P.; Scheepers, H. C. J.; Spaanderman, M.; van Pampus, M. G.; de Leeuw, J. W.; Mol, B. W. J.; Bloemenkamp, K. W. M.

    Objective To assess the economic consequences of labour induction with Foley catheter compared to prostaglandin E2 gel. Design Economic evaluation alongside a randomised controlled trial. Setting Obstetric departments of one university and 11 teaching hospitals in the Netherlands. Population Women

  8. Foley catheter versus vaginal prostaglandin E2 gel for induction of labour at term (PROBAAT trial): an open-label, randomised controlled trial.

    NARCIS (Netherlands)

    Jozwiak, M.; Oude Rengerink, K.; Benthem, M.; Beek, E. van; Dijksterhuis, M.G.; Graaf, I.M. de; Huizen, M.E. van; Oudijk, M.A.; Papatsonis, D.N.; Perquin, D.A.; Porath, M.; Post, J.A. van der; Rijnders, R.J.; Scheepers, H.C.J.; Spaanderman, M.E.A.; Pampus, M.G. van; Leeuw, J.W. de; Mol, B.W.; Bloemenkamp, K.W.

    2011-01-01

    BACKGROUND: Induction of labour is a common obstetric procedure. Both mechanical (eg, Foley catheters) and pharmacological methods (eg, prostaglandins) are used for induction of labour in women with an unfavourable cervix. We aimed to compare the effectiveness and safety of induction of labour with

  9. Foley catheter versus vaginal prostaglandin E2 gel for induction of labour at term (PROBAAT trial): an open-label, randomised controlled trial

    NARCIS (Netherlands)

    Jozwiak, Marta; Oude Rengerink, Katrien; Benthem, Marjan; van Beek, Erik; Dijksterhuis, Marja G. K.; de Graaf, Irene M.; van Huizen, Marloes E.; Oudijk, Martijn A.; Papatsonis, Dimitri N. M.; Perquin, Denise A. M.; Porath, Martina; van der Post, Joris A. M.; Rijnders, Robbert J. P.; Scheepers, Hubertina C. J.; Spaanderman, Marc E. A.; van Pampus, Maria G.; de Leeuw, Jan Willem; Mol, Ben W. J.; Bloemenkamp, Kitty W. M.; Doornbos, Hans; Drogtrop, Addy; de Groot, Christianne; Huisjes, Anjoke; Kleiverda, Gunilla; van Meir, Claudia; van der Salm, Pauline; Schuitemaker, Nico

    2012-01-01

    Induction of labour is a common obstetric procedure. Both mechanical (eg, Foley catheters) and pharmacological methods (eg, prostaglandins) are used for induction of labour in women with an unfavourable cervix. We aimed to compare the effectiveness and safety of induction of labour with a Foley

  10. Foley catheter versus vaginal prostaglandin E2 gel for induction of labour at term (PROBAAT trial) : an open-label, randomised controlled trial

    NARCIS (Netherlands)

    Jozwiak, Marta; Rengerink, Katrien Oude; Benthem, Marjan; van Beek, Erik; Dijksterhuis, Marja G. K.; de Graaf, Irene M.; van Huizen, Marloes E.; Oudijk, Martijn A.; Papatsonis, Dimitri N. M.; Perquin, Denise A. M.; Porath, Martina; van der Post, Joris A. M.; Rijnders, Robbert J. P.; Scheepers, Hubertina C. J.; Spaanderman, Marc E. A.; van Pampus, Maria G.; de Leeuw, Jan Willem; Mol, Ben W. J.; Bloemenkamp, Kitty W. M.

    2011-01-01

    Background Induction of labour is a common obstetric procedure. Both mechanical (eg, Foley catheters) and pharmacological methods (eg, prostaglandins) are used for induction of labour in women with an unfavourable cervix. We aimed to compare the effectiveness and safety of induction of labour with a

  11. Comparing induction of labour with oral misoprostol or Foley catheter at term: cost-effectiveness analysis of a randomised controlled multi-centre non-inferiority trial

    NARCIS (Netherlands)

    ten Eikelder, Mlg; van Baaren, G.-J.; Oude Rengerink, K.; Jozwiak, M.; de Leeuw, J. W.; Kleiverda, G.; Evers, I.; de Boer, K.; Brons, J.; Bloemenkamp, Kwm; Mol, B. W.

    2018-01-01

    To assess the costs of labour induction with oral misoprostol versus Foley catheter. Economic evaluation alongside a randomised controlled trial. Obstetric departments of six tertiary and 23 secondary care hospitals in the Netherlands. Women with a viable term singleton pregnancy in cephalic

  12. Association between Umbilical Catheters and Neonatal Outcomes in Extremely Preterm Infants.

    Science.gov (United States)

    Elboraee, Mohamed S; Toye, Jennifer; Ye, Xiang Y; Shah, Prakesh S; Aziz, Khalid

    2018-02-01

     The objective of this study was to examine the association between umbilical catheters and a composite outcome of mortality or major neonatal morbidity in extremely preterm infants.  Data were abstracted from the Canadian Neonatal Network database for infants born at catheters, umbilical venous catheters (UVCs), umbilical artery catheters (UACs), and those with both UVCs and UACs. The outcomes were compared among the groups using univariate and multivariable analyses.  Of 4,623 eligible infants, 820 (17.7%) had no catheters, 1,032 (22.3%) a UVC only, 120 (2.6%) a UAC only, and 2,651 (57.3%) had both catheters. After adjustment for acuity and other potential confounders, umbilical catheters were associated with higher odds of mortality or any major morbidity (UVC vs. no catheter: adjusted odds ratio [aOR]: 1.47; 95% CI: 1.18-1.85; UAC vs. no catheter: aOR: 1.67; 95% CI: 1.05-2.63; and both UVC + UAC vs. no catheter: aOR: 2.17; 95% CI: 1.79-2.70).  Most of the infants born at catheter was associated with mortality or major morbidity, and the association was stronger when both catheters were present. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  13. Power injection of iodinated intravenous contrast material through acute and chronic hemodialysis catheters.

    Science.gov (United States)

    Hollander, Scott; Mojibian, Hamid; Emery, Michael; Tal, Michael G

    2012-01-01

    End-stage renal disease patients with hemodialysis catheters in need of contrast enhanced imaging studies often have limited peripheral venous access. In this study we aimed to determine pressures generated in hemodialysis catheters during power injection of computed tomography (CT) contrast media. Three different chronic hemodialysis catheters and two acute hemodialysis catheters were included in this study. All catheters were evaluated in vitro. A total volume of 120 cc of CT contrast material was injected at rate of 10 cc/s using a power injector. The catheters were connected to the power injector using a standard connecting tubing. Pressures were simultaneously measured in the power injector as well as in the hemodialysis catheters. The maximal measured pressures during injection in the power injector averaged 338 PSI (SD ± 8.7 PSI). The maximal measured pressure in the dialysis catheters ranged between 9.17 and 21.2 PSI. Pressures averaged 14.02 PSI (SD ± 3.34 PSI). The average pressure in the power injector was over 23 times higher than the pressure recorded at the hemodialysis catheter. None of the catheters ruptured or deformed during testing. Pressures measured in hemodialysis catheters during power injection are lower than currently believed and markedly lower than the pressures recorded in the power injector. Standard hemodialysis catheters are likely to be amenable to power contrast injection in hemodialysis patients who have limited venous access. In vivo studies are necessary to confirm these findings.

  14. Comparison of the Effectiveness of Three Methods of Recanalization in a Model of the Middle Cerebral Artery: Thrombus Aspiration via a 4F Catheter, Thrombus Aspiration via the GP Thromboaspiration Device, and Mechanical Thrombectomy Using the Solitaire Thrombectomy Device

    Directory of Open Access Journals (Sweden)

    Christopher Tennuci

    2011-01-01

    Full Text Available Introduction. This paper compares different approaches to recanalization in a model of the middle cerebral artery (MCA. Methods. An occlusive thrombus (lamb's blood was introduced into the MCA of a model of the cerebral circulation perfused with Hartmann's solution (80 pulsations/min, mean pressure 90 mm Hg. Three methods of clot retrieval were tested: thrombus aspiration via a 4F catheter (n=26, thrombus aspiration via the GP thrombus aspiration device (GPTAD (n=30, and mechanical thrombectomy via the Solitaire Device (n=30. Results. Recanalization rate was similar for all 3 approaches (62%, 77%, and 85%. Time to recanalization was faster with aspiration devices (41 SD 42 s for 4F and 61 SD 21 s for GPTAD than with the Solitaire (197 SD 64 s P<.05 Kruksal-Wallis. Clot fragmentation was the same in the Solitaire (23% and the GPTAD (23%, but higher with the 4F (53%, P<.05. Conclusion. In this model, thrombus aspiration was faster than mechanical thrombectomy, and similarly effective at recanalization. These results should be confirmed in vivo.

  15. 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.

  16. electrode catheter techniques for treattnent of supraventricular ...

    African Journals Online (AJOL)

    damaged by radiofrequency energy (RP) delivered via catheters insened percutaneously without general anaes- thesia. The technique and results of its use were the main topics of interest at the 9th World Symposium on. Cardiac Pacing and Electrophysiology held in. Washington, DC, in June 1991. Effective cure of WPW.

  17. Novel Antiseptic Urinary Catheters for Prevention of Urinary Tract Infections: Correlation of In Vivo and In Vitro Test Results▿

    Science.gov (United States)

    Hachem, Ray; Reitzel, Ruth; Borne, Agatha; Jiang, Ying; Tinkey, Peggy; Uthamanthil, Rajesh; Chandra, Jyotsna; Ghannoum, Mahmoud; Raad, Issam

    2009-01-01

    Urinary catheters are widely used for hospitalized patients and are often associated with high rates of urinary tract infection. We evaluated in vitro the antiadherence activity of a novel antiseptic Gendine-coated urinary catheter against several multidrug-resistant bacteria. Gendine-coated urinary catheters were compared to silver hydrogel-coated Foley catheters and uncoated catheters. Bacterial biofilm formation was assessed by quantitative culture and scanning electron microscopy. These data were further correlated to an in vivo rabbit model. We challenged 31 rabbits daily for 4 days by inoculating the urethral meatus with 1.0 × 109 CFU streptomycin-resistant Escherichia coli per day. In vitro, Gendine-coated urinary catheters reduced the CFU of all organisms tested for biofilm adherence compared with uncoated and silver hydrogel-coated catheters (P < 0.004). Scanning electron microscopy analysis showed that a thick biofilm overlaid the control catheter and the silver hydrogel-coated catheters but not the Gendine-coated urinary catheter. Similar results were found with the rabbit model. Bacteriuria was present in 60% of rabbits with uncoated catheters and 71% of those with silver hydrogel-coated catheters (P < 0.01) but not in those with Gendine-coated urinary catheters. No rabbits with Gendine-coated urinary catheters had invasive bladder infections. Histopathologic assessment revealed no differences in toxicity or staining. Gendine-coated urinary catheters were more efficacious in preventing catheter-associated colonization and urinary tract infections than were silver hydrogel-coated Foley catheters and uncoated catheters. PMID:19805562

  18. 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

  19. Next generation of ventricular catheters for hydrocephalus based on parametric designs.

    Science.gov (United States)

    Galarza, M; Giménez, A; Amigó, J M; Schuhmann, M; Gazzeri, R; Thomale, U; McAllister, J P

    2018-02-01

    The flow pattern of the cerebrospinal fluid is probably the most important factor related to obstruction of ventricular catheters during the normal treatment of hydrocephalus. To better comprehend the flow pattern, we have carried out a parametric study via numerical models of ventricular catheters. In previous studies, the flow was studied under steady and, recently, in pulsatile boundary conditions by means of computational fluid dynamics (CFD) in three-dimensional catheter models. This study aimed to bring in prototype models of catheter CFD flow solutions as well to introduce the theory behind parametric development of ventricular catheters. A preceding study allowed deriving basic principles which lead to designs with improved flow patterns of ventricular catheters. The parameters chosen were the number of drainage segments, the distances between them, the number and diameter of the holes on each segment, as well as their relative angular position. CFD results of previously unreleased models of ventricular catheter flow solutions are presented in this study. Parametric development guided new designs with better flow distribution while lowering the shear stress of the catheters holes. High-resolution 3D printed catheter solutions of three models and basic benchmark testing are introduced as well. The next generation of catheter with homogeneous flow patterns based on parametric designs may represent a step forward for the treatment of hydrocephalus, by possibly broadening their lifespan.

  20. Novel paclitaxel-coated angioplasty balloon catheter based on cetylpyridinium salicylate: Preparation, characterization and simulated use in an in vitro vessel model

    Energy Technology Data Exchange (ETDEWEB)

    Petersen, Svea, E-mail: svea.petersen@uni-rostock.de [Institute for Biomedical Engineering, University of Rostock, Friedrich-Barnewitz-Straße 4, 18119 Rostock (Germany); Kaule, Sebastian [Institute for Biomedical Engineering, University of Rostock, Friedrich-Barnewitz-Straße 4, 18119 Rostock (Germany); Stein, Florian [Institute for Chemistry, Analytical and Technical Chemistry University of Rostock, Albert-Einstein-Straße 3a, 18059 Rostock (Germany); Minrath, Ingo; Schmitz, Klaus-Peter [Institute for Biomedical Engineering, University of Rostock, Friedrich-Barnewitz-Straße 4, 18119 Rostock (Germany); Kragl, Udo [Institute for Chemistry, Analytical and Technical Chemistry University of Rostock, Albert-Einstein-Straße 3a, 18059 Rostock (Germany); Sternberg, Katrin [Institute for Biomedical Engineering, University of Rostock, Friedrich-Barnewitz-Straße 4, 18119 Rostock (Germany)

    2013-10-15

    Drug-coated balloons (DCB), which have emerged as therapeutic alternative to drug-eluting stents in percutaneous cardiovascular intervention, are well described with regard to clinical efficiency and safety within a number of clinical studies. In vitro studies elucidating the correlation of coating method and composition with DCB performance are however rare but considered important for the understanding of DCB requirements and the improvement of established DCB. In this context, we evaluated the applicability of a pipetting, dip-coating, and spray-coating process for the establishment of DCB based on paclitaxel (PTX) and the ionic liquid cetylpyridinium salicylate (Cetpyrsal) as novel innovative additive in three different compositions. Among tested methods and compositions, the pipetting process with 50 wt.% PTX resulted in most promising coatings as drug load was less controllable by the other processes and higher PTX contents led to considerable drug crystallization, as visualized by electron microscopy, accelerating PTX loss during short-term elution. Applying these conditions, homogeneous coatings could be applied on balloon catheter, whose simulated use in an in vitro vessel model revealed percental drug losses of 36 and 28% during transit and percental drug transfers of 12 and 40% under expansion for coatings applied in expanded and folded balloon condition, respectively. In comparison to literature values, these results support the high potential of Cetpyrsal as novel DCB matrix regarding low drug loss and efficient drug transfer. - Highlights: • We provide detailed in vitro data for definition of DCB coating requirements. • An in vitro vessel model for evaluating drug delivery from DCB is presented. • Innovative ionic liquid-based coatings for DCB are developed. • The coating shows low drug loss and efficient drug transfer.

  1. Novel paclitaxel-coated angioplasty balloon catheter based on cetylpyridinium salicylate: Preparation, characterization and simulated use in an in vitro vessel model

    International Nuclear Information System (INIS)

    Petersen, Svea; Kaule, Sebastian; Stein, Florian; Minrath, Ingo; Schmitz, Klaus-Peter; Kragl, Udo; Sternberg, Katrin

    2013-01-01

    Drug-coated balloons (DCB), which have emerged as therapeutic alternative to drug-eluting stents in percutaneous cardiovascular intervention, are well described with regard to clinical efficiency and safety within a number of clinical studies. In vitro studies elucidating the correlation of coating method and composition with DCB performance are however rare but considered important for the understanding of DCB requirements and the improvement of established DCB. In this context, we evaluated the applicability of a pipetting, dip-coating, and spray-coating process for the establishment of DCB based on paclitaxel (PTX) and the ionic liquid cetylpyridinium salicylate (Cetpyrsal) as novel innovative additive in three different compositions. Among tested methods and compositions, the pipetting process with 50 wt.% PTX resulted in most promising coatings as drug load was less controllable by the other processes and higher PTX contents led to considerable drug crystallization, as visualized by electron microscopy, accelerating PTX loss during short-term elution. Applying these conditions, homogeneous coatings could be applied on balloon catheter, whose simulated use in an in vitro vessel model revealed percental drug losses of 36 and 28% during transit and percental drug transfers of 12 and 40% under expansion for coatings applied in expanded and folded balloon condition, respectively. In comparison to literature values, these results support the high potential of Cetpyrsal as novel DCB matrix regarding low drug loss and efficient drug transfer. - Highlights: • We provide detailed in vitro data for definition of DCB coating requirements. • An in vitro vessel model for evaluating drug delivery from DCB is presented. • Innovative ionic liquid-based coatings for DCB are developed. • The coating shows low drug loss and efficient drug transfer

  2. 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.

  3. New percutaneous and retrieval vena cava catheter filter

    International Nuclear Information System (INIS)

    Pieronne, A.; Cuingnet, P.; Dehont, G.; Boutaud, P.; Delenzenne, A.; Joffre, P.; Lemoinne, J.P.; Quesnel, F.; Fajadet, P.; Rousseau, H.

    1989-01-01

    This paper reports a new percutaneous and retrievable vena cava filter assessed. The authors used the Seldinger technique for percutaneous insertion of the 10-F catheter filter through the right internal jugular vein with fluoroscopic guidance. The authors used fibrinolytic agents (streptokinase) by direct infusion through the catheter filter. Venocavography and pulmonary angiography were performed at day 5 and day 10 before removal of the catheter filter at the patient's bed. This vena cava percutaneous filter was made for use by radiologists, interventional cardiologists, and staff of intensive care units. The compilation rate for this technique was low

  4. Impact of a change in surveillance definition on performance assessment of a catheter-associated urinary tract infection prevention program at a tertiary care medical center.

    Science.gov (United States)

    Sopirala, Madhuri M; Syed, Asma; Jandarov, Roman; Lewis, Margaret

    2018-03-16

    In January 2015, the Centers for Disease Control and Prevention (CDC)/National Health Safety Network (NHSN) changed the definition of catheter-associated urinary tract infection (CAUTI). We evaluated the outcomes of a robust CAUTI prevention program when we performed surveillance using the old definition (before 2015) versus the new definition (after 2015). This is the first study to evaluate how the change in CDC/NHSN definitions affected the outcomes of a CAUTI reduction program. Baseline was from January 2012 to September 2014; the intervention period was from October 2014 to February 2016. Staff nurses were trained to be liaisons of infection prevention (Link Nurses) with clearly defined CAUTI prevention goals and with ongoing monthly activities. CAUTI incidence per 1000 catheter days was compared between the baseline and intervention periods, using the 2 definitions. With the new definition, CAUTIs decreased by 33%, from 2.69 to 1.81 cases per 1000 catheter days (incidence rate ratio [IRR] = 0.67; 95% confidence interval [CI]: 0.48-0.93; P definition, CAUTIs increased by 12%, from 3.38 to 3.80 cases per 1000 catheter days (IRR = 1.12; 95% CI: 0.88-1.43; P = .348). We aggressively targeted CAUTI prevention, but a reduction was observed only with the new definition. Our findings stress the importance of having a reasonably accurate surveillance definition to monitor infection prevention initiatives. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  5. Efficacy and safety of peripherally inserted central venous catheters in acute cardiac care management.

    Science.gov (United States)

    Poletti, Fabrizio; Coccino, Claudio; Monolo, Davide; Crespi, Paolo; Ciccioli, Giorgio; Cordio, Giuseppe; Seveso, Giovanni; De Servi, Stefano

    2018-03-01

    Patients admitted to cardiac intensive care unit need administration of drugs intravenously often in concomitance of therapeutic techniques such as non-invasive ventilation, continuous renal replacement therapy and intra-aortic balloon counterpulsation. Therefore, the insertion of central venous catheters provides a reliable access for delivering medications, laboratory testing and hemodynamic monitoring, but it is associated with the risk of important complications. In our study, we tested the efficacy and safety of peripherally inserted central catheters to manage cardiac intensive care. All patients admitted to cardiac intensive care unit with indication for elective central venous access were checked by venous arm ultrasound for peripherally inserted central catheter's implantation. Peripherally inserted central catheters were inserted by ultrasound-guided puncture. After 7 days from the catheter's placement and at the removal, vascular ultrasound examination was performed searching signs of upper extremity deep venous thrombosis. In case of sepsis, blood cultures peripherally from the catheter and direct culture of the tip of the catheter were done to establish a catheter-related blood stream infection. In our cardiac intensive care unit, 137 peripherally inserted central catheters were placed: 80.3% of patients eligible for a peripherally inserted central catheter were implanted. The rate of symptomatic catheter-related peripheral venous thrombosis was 1.4%. Catheter-related blood stream infection was diagnosed in one patient (0.7%; 5.7 × 1000 peripherally inserted central catheter days). All peripherally inserted central catheters were inserted successfully without other major complications. In patients admitted to cardiac intensive care unit, peripherally inserted central catheters' insertion was feasible in a high percentage of patients and was associated with low infective complications and clinical thrombosis rate.

  6. A device for performing automated balloon catheter inflation ischemia studies.

    Science.gov (United States)

    Leavesley, Silas J; Ledkins, Whitley; Rocic, Petra

    2014-01-01

    Coronary collateral growth (arteriogenesis) is a physiological adaptive response to transient and repetitive occlusion of major coronary arteries in which small arterioles (native collaterals) with minimal to no blood flow remodel into larger conduit arteries capable of supplying adequate perfusion to tissue distal to the site of occlusion. The ability to reliably and reproducibly mimic transient, repetitive coronary artery occlusion (ischemia) in animal models is critical to the development of therapies to restore coronary collateral development in type II diabetes and the metabolic syndrome. Current animal models for repetitive coronary artery occlusion implement a pneumatic occluder (balloon) that is secured onto the surface of the heart with the suture, which is inflated manually, via a catheter connected to syringe, to effect occlusion of the left anterior descending coronary artery (LAD). This method, although effective, presents complications in terms of reproducibility and practicality. To address these limitations, we have designed a device for automated, transient inflation of balloon catheters in coronary artery occlusion models. This device allows repeated, consistent inflation (to either specified pressure or volume) and the capability for implementing very complex, month-long protocols. This system has significantly increased the reproducibility of coronary collateral growth studies in our laboratory, resulting in a significant decrease in the numbers of animals needed to complete each study while relieving laboratory personnel from the burden of extra working hours and enabling us to continue studies over periods when we previously could not. In this paper, we present all details necessary for construction and operation of the inflator. In addition, all of the components for this device are commercially available and economical (Table S1). It is our hope that the adoption of automated balloon catheter inflation protocols will improve the experimental

  7. A device for performing automated balloon catheter inflation ischemia studies.

    Directory of Open Access Journals (Sweden)

    Silas J Leavesley

    Full Text Available Coronary collateral growth (arteriogenesis is a physiological adaptive response to transient and repetitive occlusion of major coronary arteries in which small arterioles (native collaterals with minimal to no blood flow remodel into larger conduit arteries capable of supplying adequate perfusion to tissue distal to the site of occlusion. The ability to reliably and reproducibly mimic transient, repetitive coronary artery occlusion (ischemia in animal models is critical to the development of therapies to restore coronary collateral development in type II diabetes and the metabolic syndrome. Current animal models for repetitive coronary artery occlusion implement a pneumatic occluder (balloon that is secured onto the surface of the heart with the suture, which is inflated manually, via a catheter connected to syringe, to effect occlusion of the left anterior descending coronary artery (LAD. This method, although effective, presents complications in terms of reproducibility and practicality. To address these limitations, we have designed a device for automated, transient inflation of balloon catheters in coronary artery occlusion models. This device allows repeated, consistent inflation (to either specified pressure or volume and the capability for implementing very complex, month-long protocols. This system has significantly increased the reproducibility of coronary collateral growth studies in our laboratory, resulting in a significant decrease in the numbers of animals needed to complete each study while relieving laboratory personnel from the burden of extra working hours and enabling us to continue studies over periods when we previously could not. In this paper, we present all details necessary for construction and operation of the inflator. In addition, all of the components for this device are commercially available and economical (Table S1. It is our hope that the adoption of automated balloon catheter inflation protocols will improve the

  8. Percutaneous catheter drainage of intraabdominal abscesses and fluid

    International Nuclear Information System (INIS)

    Lee, Jong Tae; Kwon, Tae Hee; Yoo, Hyung Sik; Suh, Jung Ho; Lee, Young Ho

    1986-01-01

    Percutaneous catheter drainage has been reported to be an effective method in the management of selected patients with abscess and fluid collection. Its high success rate and relatively low complications make the procedure an alternative to surgery in the individual cases. During past two years percutaneous catheter drainage in 25 patients with intraabdominal abscesses and fluid collection was performed at the Department of Radiology, Yonsei University College of medicine. Here the technique and author's results were summarized. 1. The total 25 patients who had percutaneous catheter drainage are 10 liver abscesses, 3 subphrenic, one subhepatic, 4 renal and perirenal, 2 pelvic, one psoas, one anterior pararenal fluid from acute pancreatitis, one pancreas pseudocyst and 2 malignant tumor necrosis. 2. The modified Seldinger technique used for all cases of abscess and fluid drainage under guidance of ultrasound scan. The used catheters were 10F. Pigtail and 14F. Malecot (Cook c/o) catheters. 3. The abscesses and fluid of 17 patients among 25 were cured by the percutaneous catheter drainage and 4 patients were clinically improved. The catheter drainage was failed in 2 patients and 3 complication were developed. 4. The success rate of this procedure was 91.3%, failure rate was 8.7% and complication rate was 12%.

  9. 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

  10. 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.

  11. Colonization of peripheral intravascular catheters with biofilm ...

    African Journals Online (AJOL)

    Background: Biofilms often colonize catheters and contribute to catheter-related septicemia. However, predictors of catheter colonization by biofilms remain poorly defined. The aim of this study was to evaluate clinical factors that may be associated with biofilm colonization of catheters. Materials and Methods: A total of 54 ...

  12. Open versus closed IV infusion systems: a state based model to predict risk of catheter associated blood stream infections

    Science.gov (United States)

    Barnett, Adrian G; Rosenthal, Victor D

    2011-01-01

    Objectives To quantify the change in risk of central line associated blood stream infection (CLABSI) following the introduction of a closed infusion container in intensive care units (ICUs) in two Latin American cities. Design A state-space model was used to describe the flow of admissions through the ICU. This approach correctly treats infection as a time-dependent covariate. Results A closed system reduced the risk of CLABSI. The hazard ratios for the closed versus open container were between 0.15 and 0.31 (p valuesclosed system reduced the number of infections, costs and deaths. Conclusions The data reveal costs are saved and health benefits gained from fewer cases of CLABSI after adoption of a closed infusion system. Information is required on the costs of implementing the closed system widely in these settings. PMID:22021881

  13. Comparison of utility of blood cultures from intravascular catheters and peripheral veins: a systematic review and decision analysis.

    Science.gov (United States)

    Falagas, Matthew E; Kazantzi, Maria S; Bliziotis, Ioannis A

    2008-01-01

    Blood cultures are sometimes obtained from intravascular catheters for convenience. However, there is controversy regarding this practice. The authors compared the diagnostic test characteristics of blood cultures obtained from intravascular catheters and peripheral veins. Relevant studies for inclusion in this review were identified through PubMed (January 1970-October 2005) and the Cochrane Central Register of Controlled Trials. Studies that reported clear definitions of true bacteraemia were included in the analysis. Two reviewers independently extracted the data. Six studies were included in the analysis, providing data for 2677 pairs of blood cultures obtained from an intravascular catheter and a peripheral venipuncture. A culture obtained from an intravascular catheter was found to be a diagnostic test for bacteraemia with better sensitivity (OR 1.85, 95 % CI 1.14-2.99, fixed effects model) and better negative predictive value (almost with statistical significance) (OR 1.55, 95 % CI 0.999-2.39, fixed effects model) but with less specificity (OR 0.33, 95 % CI 0.18-0.59, random effects model) and lower positive predictive value (OR 0.41, 95 % CI 0.23-0.76, random effects model) compared to a culture taken by peripheral venipuncture. In a group of 1000 patients, eight additional patients with true bacteraemia would be identified and 59 falsely diagnosed as having bacteraemia by a blood culture obtained from an intravascular catheter compared to results of the peripheral blood culture. Given the consequences of undertreating patients with bacteraemia, the authors believe that, based on the available evidence, at least one blood culture should be obtained from the intravascular catheter.

  14. Retrograde prostatic urethroplasty with balloon catheter

    International Nuclear Information System (INIS)

    Castaneda, F.; Reddy, P.; Hulbert, J.; Letourneau, J.G.; Hunter, D.W.; Castaneda-Zuniga, W.R.; Amplatz, K.

    1987-01-01

    The authors performed retrograde prostatic urethroplasty in 18 patients using a 25-mm urethroplasty balloon catheter. The procedure was performed on an outpatient basis under local anesthesia. Voiding cystourethrography, retrograde urethrography, rectal US, and MRE imaging were performed before and immediately after the procedure and at 2 weeks and 3, 6, 12, and 18 months. Long-term results at 18 months and possible clinical implications are discussed

  15. Antibacterial and anti-encrustation biodegradable polymer coating for urinary catheter.

    Science.gov (United States)

    Dayyoub, Eyas; Frant, Marion; Pinnapireddy, Shashank Reddy; Liefeith, Klaus; Bakowsky, Udo

    2017-10-05

    Bacterial biofilm and crystalline deposits are the common causes of failure of long-term indwelling urinary catheter. Bacteria colonise the catheter surface causing serious infections in the urinary tract and encrustations that can block the catheter and induce trauma in patients. In this study, the strategy used to resist bacterial adhesion and encrustation represents a combination of the antibacterial effects of norfloxacin and silver nanoparticles and the PLGA-based neutralisation of alkali products of urea hydrolysis gained through the degradation of the polymer in an aqueous milieu. Silver nanoparticles were coated with tetraether lipids (TEL) to avoid aggregation when dispersed in acetone and during the film formation. The polymer films loaded with the two antibacterial agents were applied on Polyurethane (PUR) and Silicon sheets. We demonstrated the antibacterial and anti-adhesion effectiveness of the coatings whereby commercially available biocompatible polymers PUR and Silicon were used as controls. Using artificial urine and an in vitro encrustation model, it was shown that the coatings resist the encrustation for at least 2 weeks. This combination of a biodegradable polymer and wide-range antibacterial agents represents a potentially attractive biocompatible coating for urinary catheters. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Ultrasound-guided or landmark techniques for central venous catheter placement in critically ill children.

    Science.gov (United States)

    Oulego-Erroz, Ignacio; González-Cortes, Rafael; García-Soler, Patricia; Balaguer-Gargallo, Mónica; Frías-Pérez, Manuel; Mayordomo-Colunga, Juan; Llorente-de-la-Fuente, Ana; Santos-Herraiz, Paula; Menéndez-Suso, Juan José; Sánchez-Porras, María; Palanca-Arias, Daniel; Clavero-Rubio, Carmen; Holanda-Peña, Mª Soledad; Renter-Valdovinos, Luis; Fernández-De-Miguel, Sira; Rodríguez-Núñez, Antonio

    2018-01-01

    To assess whether ultrasound guidance improves central venous catheter placement outcomes compared to the landmark technique in critically ill children. A prospective multicentre observational study was carried out in 26 paediatric intensive care units over 6 months. Children 0-18 years old who received a temporary central venous catheter, inserted using either ultrasound or landmark techniques, were eligible. The primary outcome was the first-attempt success rate. Secondary outcomes included overall placement success, number of puncture attempts, number of procedures requiring multiple punctures (> 3 punctures), number of procedures requiring punctures at more than one vein site and immediate mechanical complications. To account for potential confounding factors, we used propensity scores. Our primary analysis was based on 1:1 propensity score matching. The association between cannulation technique and outcomes in the matched cohort was estimated using generalized estimating equations and mixed-effects models to account for patient-level and hospital-level confounders. Five hundred central venous catheter-placement procedures involving 354 patients were included. Ultrasound was used for 323 procedures, and the landmark technique was used for 177. Two hundred and sixty-six procedures were matched (133 in the ultrasound group and 133 in the landmark group). Ultrasound was associated with an increase in the first-attempt success rate [46.6 vs. 30%, odds ratio 2.09 (1.26-3.46); p central venous catheter placement in critically ill children.

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  18. Peripherally inserted central catheter - insertion

    Science.gov (United States)

    PICC - insertion ... A PICC is a long, thin tube (called a catheter) that goes into your body through a vein in ... into a large vein near your heart. The PICC helps carry nutrients and medicines into your body. ...

  19. Percutaneously inserted central catheter - infants

    Science.gov (United States)

    PICC - infants; PQC - infants; Pic line - infants; Per-Q cath - infants ... A percutaneously inserted central catheter (PICC) is a long, very thin, soft plastic tube that is put into a small blood vessel. This article addresses PICCs in ...

  20. Efficacy of ultraviolet C light at sublethal dose in combination with antistaphylococcal antibiotics to disinfect catheter biofilms of methicillin-susceptible and methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis in vitro

    Science.gov (United States)

    El-Azizi, Mohamed; Khardori, Nancy

    2016-01-01

    Background Biofilm formation inside inserted medical devices leads to their failure and acts as a source of refractory infections. The ultraviolet C (UVC) light is a potential therapy that can be used against the biofilm of bacterial pathogens. Objective We evaluated the efficacy of sublethal dose of UVC light with anti-staphylococcal antibiotics against biofilms made from 30 isolates of methicillin-susceptible Staphylococcus aureus and methicillin-resistant S. aureus and S. epidermidis on vascular catheters. Materials and methods A novel biofilm device was used to assess the combined approach. The biofilms on the catheters were irradiated with the UVC light at 254 nm and irradiance of 6.4 mW followed by treatment with vancomycin or quinupristin/dalfopristin at twice their minimum bactericidal concentrations or with linezolid at 64 µg/mL for 24 hours. The catheters were cut into segments and sonicated, and the number of the sessile cells was determined colorimetrically using XTT viable cells assay. The effect of UVC radiation followed by treatment with an antistaphylococcal antibiotic on the viability of the bacteria in the biofilm was visualized using LIVE/DEAD BacLight bacterial viability stain and confocal laser scanning microscopy. Results Exposure of the bacterial biofilms to the UVC light or each of the antibiotics alone was ineffective in killing the bacteria. Treatment of the biofilms with the antibiotics following their exposure to UVC light significantly (P<0.001) reduced the number of viable cells within the biofilms but did not completely eradicate them. Conclusion To our knowledge, this combinatorial approach has not been investigated before. The combined approach can be used as a therapeutic modality for managing biofilm-associated infections by preventing the establishment of biofilms and/or disrupting the formed biofilms on the inserted medical devices with the goal of increasing their usefulness and preventing infectious complications. Further

  1. Efficacy of ultraviolet C light at sublethal dose in combination with antistaphylococcal antibiotics to disinfect catheter biofilms of methicillin-susceptible and methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis in vitro.

    Science.gov (United States)

    El-Azizi, Mohamed; Khardori, Nancy

    2016-01-01

    Biofilm formation inside inserted medical devices leads to their failure and acts as a source of refractory infections. The ultraviolet C (UVC) light is a potential therapy that can be used against the biofilm of bacterial pathogens. We evaluated the efficacy of sublethal dose of UVC light with anti-staphylococcal antibiotics against biofilms made from 30 isolates of methicillin-susceptible Staphylococcus aureus and methicillin-resistant S. aureus and S. epidermidis on vascular catheters. A novel biofilm device was used to assess the combined approach. The biofilms on the catheters were irradiated with the UVC light at 254 nm and irradiance of 6.4 mW followed by treatment with vancomycin or quinupristin/dalfopristin at twice their minimum bactericidal concentrations or with linezolid at 64 µg/mL for 24 hours. The catheters were cut into segments and sonicated, and the number of the sessile cells was determined colorimetrically using XTT viable cells assay. The effect of UVC radiation followed by treatment with an antistaphylococcal antibiotic on the viability of the bacteria in the biofilm was visualized using LIVE/DEAD BacLight bacterial viability stain and confocal laser scanning microscopy. Exposure of the bacterial biofilms to the UVC light or each of the antibiotics alone was ineffective in killing the bacteria. Treatment of the biofilms with the antibiotics following their exposure to UVC light significantly (P<0.001) reduced the number of viable cells within the biofilms but did not completely eradicate them. To our knowledge, this combinatorial approach has not been investigated before. The combined approach can be used as a therapeutic modality for managing biofilm-associated infections by preventing the establishment of biofilms and/or disrupting the formed biofilms on the inserted medical devices with the goal of increasing their usefulness and preventing infectious complications. Further investigations are needed to assess the effectiveness of the

  2. 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.

  3. 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.

  4. [A blind point of vent catheter: air aspiration].

    Science.gov (United States)

    Inui, K; Orita, H; Shimanuki, T; Fukasawa, M; Gotou, S; Nakamura, C; Washio, M

    1993-05-01

    We experienced a case of saphenous vein air embolism after coronary artery bypass graft, in which case we used vent catheter kept in the left atrium. Though it was considered that air bubbles were never aspirated through vent catheter, we speculated that the origin of air bubbles must be the vent catheter. And we made an experiment on the motion of air in the vent catheter using a model of left heart composed with soft reserver (atrium) and pulsatile pump (ventricle). When the pulsatile pump was arrest, the air bubbles were never aspirated from the vent catheter to the soft reserver even if we vented with strong negative pressure. But, when the pulsatile pump was in motion and the left atrium was vented with some negative pressure, some leaks of air bubbles were recognized. So we must pay much more attention to the degree of venting when the heart is in motion. Sometimes we use overpressure safety valve composed with vent catheter, but measured left atrial pressure showed that decreased left atrial pressure was only 2 mmHg. So its use should be restricted in the patients with good ventricular function.

  5. Increased risk of cervical canal infections with intracervical Foley catheter.

    Science.gov (United States)

    Siddiqui, Salva; Zuberi, Nadeem Faiyaz; Zafar, Afia; Qureshi, Rahat Najam

    2003-03-01

    To evaluate the effect of intracervical Foley catheter insertion, for the induction of labor, on cervical canal infection. A prospective interventional study with paired analysis. The study was conducted in the department of Obstetrics and Gynecology at the Aga Khan University, Karachi, between June 1 and August 31, 2002. SUBJECTS AND METHODS In 45 women undergoing cervical ripening with intracervical Foley catheter for the induction of labour at term, cervical swabs were taken for culture and sensitivity before its insertion and again after its spontaneous expulsion or removal. Intracervical Foley catheter was retained for mean duration of 8.1 +/- 1.7 hours. There was a significant change in the pathogenic organisms (0 % v 16.3 %; p 0.016) from pre-Foley to post-Foley catheter cervical swab cultures. Growth of beta-hemolytic Streptococcus group-B, Candida albicans, Candida glabrata and Gardnerella vaginalis on cervical swab were considered pathogenic. One woman (2.2 %) developed fever following insertion of intracervical Foley catheter. No statistically significant effect of potential confounding factors was observed on change in growth of pathogenic organisms. Induction of labour at term with Foley catheter is associated with a significant increase in intracervical pathogenic organisms despite undertaking routine aseptic measures. We recommend evaluation of this technique for its potential infectious harm in larger studies. Meanwhile, extreme aseptic measures should be undertaken during its insertion to avoid maternal and possible neonatal infections.

  6. [Effectiveness of intracervical catheter as a labor preinduction method].

    Science.gov (United States)

    Patro-Małysza, Jolanta; Marciniak, Beata; Leszczyńska-Gorzelak, Bozena; Bartosiewicz, Jacek; Oleszczuk, Jan

    2010-01-01

    This study was undertaken to determine the efficacy and safety of the Foley catheter as a cervical priming agent. Data analysis concern 327 women undergoing cervical ripening with intracervical Foley catheter. The primary measured outcome was ripening of the cervix as measured with the Bishop score. The secondary outcomes were the timings starting from balloon removal (or from spontaneous expulsion) to delivery the preinduction-delivery interval, mode of delivery frequency of side effects and neonatal outcome. The most common indications for induction were post-term and non-reassuring fetal status. Intracervical Foley catheter was retained for mean duration of 15 hours 35 minutes. Bishop score rise after preinduction time was statistically significant (3.29 +/- 1.16 at the balloon insertion; 6.85 +/- 1.7 at the removal of the Foley catheter). Mean Bishop score change was 3.56 +/- 1.58. The average interval from balloon expulsion to delivery was 8 hours 27 minutes, the preinduction-delivery interval - 24 hours 3 minutes. Out of 327 women undergoing cervical ripening with the Foley catheter 236 (72.17%) had vaginal delivery 91 (27.38%)--cesarean delivery. The rate of vaginal delivery was significantly higher in the multiparous group (85.32%) when compared to nulliparous (65.6%). In 312 neonates (94.8%), the Apgar score at 3 min was more than 8. Intracervical Foley catheter is an effective and safe agent for cervical ripening.

  7. Orthogonal electrode catheter array for mapping of endocardial focal site of ventricular activation

    Energy Technology Data Exchange (ETDEWEB)

    Desai, J.M.; Nyo, H.; Vera, Z.; Seibert, J.A.; Vogelsang, P.J. (Division of Cardiovascular Medicine, University of California, School of Medicine, Davis (USA))

    1991-04-01

    Precise location of the endocardial site of origin of ventricular tachycardia may facilitate surgical and catheter ablation of this arrhythmia. The endocardial catheter mapping technique can locate the site of ventricular tachycardia within 4-8 cm2 of the earliest site recorded by the catheter. This report describes an orthogonal electrode catheter array (OECA) for mapping and radiofrequency ablation (RFA) of endocardial focal site of origin of a plunge electrode paced model of ventricular activation in dogs. The OECA is an 8 F five pole catheter with four peripheral electrodes and one central electrode (total surface area 0.8 cm{sup 2}). In eight mongrel dogs, mapping was performed by arbitrarily dividing the left ventricle (LV) into four segments. Each segment was mapped with OECA to find the earliest segment. Bipolar and unipolar electrograms were obtained. The plunge electrode (not visible on fluoroscopy) site was identified by the earliest wave front arrival times of -30 msec or earlier at two or more electrodes (unipolar electrograms) with reference to the earliest recorded surface ECG (I, AVF, and V1). Validation of the proximity of the five electrodes of the OECA to the plunge electrode was performed by digital radiography and RFA. Pathological examination was performed to document the proximity of the OECA to the plunge electrode and also for the width, depth, and microscopic changes of the ablation. To find the segment with the earliest LV activation a total of 10 {plus minus} 3 (mean {plus minus} SD) positions were mapped. Mean arrival times at the two earlier electrodes were -39 {plus minus} 4 msec and -35 {plus minus} 3 msec. Digital radiography showed the plunge electrode to be within the area covered by all five electrodes in all eight dogs. The plunge electrode was within 1 cm2 area of the region of RFA in all eight dogs.

  8. Evaluation of the Achieve Mapping Catheter in cryoablation for atrial fibrillation: a prospective randomized trial.

    Science.gov (United States)

    Gang, Yi; Gonna, Hanney; Domenichini, Giulia; Sampson, Michael; Aryan, Niloufar; Norman, Mark; Behr, Elijah R; Zuberi, Zia; Dhillon, Paramdeep; Gallagher, Mark M

    2016-03-01

    The purpose of this study is to establish the role of Achieve Mapping Catheter in cryoablation for paroxysmal atrial fibrillation (PAF) in a randomized trial. A total of 102 patients undergoing their first ablation for PAF were randomized at 2:1 to an Achieve- or Lasso-guided procedure. Study patients were systematically followed up for 12 months with Holter monitoring. Primary study endpoint was acute procedure success. Secondary endpoint was clinical outcomes assessed by AF free at 6 and 12 months after the procedure. Of 102 participants, 99 % of acute procedure success was achieved. Significantly shorter procedure duration with the Achieve-guided group than with the Lasso-guided group (118 ± 18 vs. 129 ± 21 min, p < 0.05) was observed as was the duration of fluoroscopy (17 ± 5 vs. 20 ± 7 min, p < 0.05) by subgroup analysis focused on procedures performed by experienced operators. In the whole study patients, procedure and fluoroscopic durations were similar in the Achieve- (n = 68) and Lasso-guided groups (n = 34). Transient phrenic nerve weakening was equally prevalent with the Achieve and Lasso. No association was found between clinical outcomes and the mapping catheter used. The use of second-generation cryoballoon (n = 68) reduced procedure time significantly compared to the first-generation balloon (n = 34); more patients were free of AF in the former than the latter group during follow-up. The use of the Achieve Mapping Catheter can reduce procedure and fluoroscopic durations compared with Lasso catheters in cryoablation for PAF after operators gained sufficient experience. The type of mapping catheter used does not affect procedure efficiency and safety by models of cryoballoon.

  9. Virtual In-Silico Modeling Guided Catheter Ablation Predicts Effective Linear Ablation Lesion Set for Longstanding Persistent Atrial Fibrillation: Multicenter Prospective Randomized Study.

    Science.gov (United States)

    Shim, Jaemin; Hwang, Minki; Song, Jun-Seop; Lim, Byounghyun; Kim, Tae-Hoon; Joung, Boyoung; Kim, Sung-Hwan; Oh, Yong-Seog; Nam, Gi-Byung; On, Young Keun; Oh, Seil; Kim, Young-Hoon; Pak, Hui-Nam

    2017-01-01

    Objective: Radiofrequency catheter ablation for persistent atrial fibrillation (PeAF) still has a substantial recurrence rate. This study aims to investigate whether an AF ablation lesion set chosen using in-silico ablation (V-ABL) is clinically feasible and more effective than an empirically chosen ablation lesion set (Em-ABL) in patients with PeAF. Methods: We prospectively included 108 patients with antiarrhythmic drug-resistant PeAF (77.8% men, age 60.8 ± 9.9 years), and randomly assigned them to the V-ABL ( n = 53) and Em-ABL ( n = 55) groups. Five different in-silico ablation lesion sets [1 pulmonary vein isolation (PVI), 3 linear ablations, and 1 electrogram-guided ablation] were compared using heart-CT integrated AF modeling. We evaluated the feasibility, safety, and efficacy of V-ABL compared with that of Em-ABL. Results: The pre-procedural computing time for five different ablation strategies was 166 ± 11 min. In the Em-ABL group, the earliest terminating blinded in-silico lesion set matched with the Em-ABL lesion set in 21.8%. V-ABL was not inferior to Em-ABL in terms of procedure time ( p = 0.403), ablation time ( p = 0.510), and major complication rate ( p = 0.900). During 12.6 ± 3.8 months of follow-up, the clinical recurrence rate was 14.0% in the V-ABL group and 18.9% in the Em-ABL group ( p = 0.538). In Em-ABL group, clinical recurrence rate was significantly lower after PVI+posterior box+anterior linear ablation, which showed the most frequent termination during in-silico ablation (log-rank p = 0.027). Conclusions: V-ABL was feasible in clinical practice, not inferior to Em-ABL, and predicts the most effective ablation lesion set in patients who underwent PeAF ablation.

  10. [Combination of the ureteral dilation catheter and balloon catheter under the ureteroscope in the treatment of male urethral stricture].

    Science.gov (United States)

    Zhou, Yi; Li, Gong-hui; Yan, Jia-jun; Shen, Cong; Tang, Gui-hang; Xu, Gang

    2016-01-01

    To investigate the clinical application of the ureteral dilation catheter combined with the balloon catheter under the ureteroscope in the treatment of urethral stricture in men. Under the ureteroscope, 45 male patients with urethral stricture received placement of a zebra guide wire through the strictured urethra into the bladder and then a ureteral dilation catheter along the guide wire, followed by dilation of the urethra from F8 initially to F14 and F16. Again, the ureteroscope was used to determine the length of the strictured urethra, its distance to the external urethral orifice, and whether it was normally located. An F24 balloon catheter and then a metal urethral calibrator was used for the dilation of the strictured urethra. After removal of the F18-F22 urethral catheter at 8 weeks, the urinary flow rate was measured immediately and again at 3 months. All the operations were successfully performed without serious complications. The maximum urinary flow rate was (13.3-29.9) ml/s (mean [17.7 ± 3.2] ml/s) at the removal of the catheter and (15.2-30.8) ml/s (mean [19.8 ± 3.9] ml/s) at 3 months after it. Smooth urination was found in all the patients during the 6-24 months follow-up. The application of the ureteral dilation catheter combined with, the balloon catheter under the ureteroscope is a good option for the treatment of male urethral stricture for its advantages of uncomplicatedness, safety, effectiveness, few complications, less pain, high success rate, and repeatable operation.

  11. Urinary incontinence and indwelling urinary catheters in acutely admitted elderly patients: relationship with mortality, institutionalization, and functional decline

    NARCIS (Netherlands)

    Bootsma, A. M. Jikke; Buurman, Bianca M.; Geerlings, Suzanne E.; de Rooij, Sophia E.

    2013-01-01

    To study differences in functional status at admission in acutely hospitalized elderly patients with urinary incontinence, a catheter, or without a catheter or incontinence (controls) and to determine whether incontinence or a catheter are independent risk factors for death, institutionalization, or

  12. Dosimetric equivalence of nonstandard HDR brachytherapy catheter patterns

    Energy Technology Data Exchange (ETDEWEB)

    Cunha, J. A. M.; Hsu, I-C.; Pouliot, J. [University of California, San Francisco, California 94115 (United States)

    2009-01-15

    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{sub 100}{sup Prostate}>90%) and organ-at-risk dose sparing (V{sub 75}{sup Bladder}<1 cc, V{sub 75}{sup Rectum}<1 cc, V{sub 125}{sup 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

  13. Intracorporeal knotting of a femoral nerve catheter

    Directory of Open Access Journals (Sweden)

    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.

  14. Percutaneous catheter drainage of tuberculous psoas abscesses

    International Nuclear Information System (INIS)

    Pombo, F.; Martin-Egana, R.; Cela, A.; Diaz, J.L.; Linares-Mondejar, P.; Freire, M.

    1993-01-01

    Six patients with 7 tuberculous psoas or ilio-psoas abscesses were treated by CT-guided catheter drainage and chemotherapy. The abscesses (5 unilateral and 1 bilateral) were completely drained using a posterior or lateral approach. The abscess volume was 70 to 700 ml (mean 300 ml) and the duration of drainage 5 to 11 days (mean 7 days). Immediate local symptomatic improvement was achieved in all patients, and there were no procedural complications. CT follow-up at 3 to 9 months showed normalization in 5 patients, 2 of whom are still in medical therapy. One patient, who did not take the medication regularly, had a recurrent abscess requiring new catheter drainage after which the fluid collection disappeared. Percutaneous drainage represents an efficient and attractive alternative to surgical drainage as a supplement to medical therapy in the management of patients with large tuberculous psoas abscesses. (orig.)

  15. Magnetic resonance evaluation of renal artery stenosis in a swine model: performance of low-dose gadobutrol versus gadoterate meglumine in comparison with digital subtraction intra-arterial catheter angiography.

    Science.gov (United States)

    Morelli, John N; Runge, Val M; Ai, Fei; Zhang, Wei; Li, Xiaoming; Schmitt, Peter; McNeal, Gary; Miller, Matthew; Lennox, Mark; Wusten, Oliver; Schoenberg, Stefan O; Attenberger, Ulrike I

    2012-06-01

    The aim of this study was to compare low-dose imaging with gadobutrol and gadoterate meglumine (Gd-DOTA) for evaluation of renal artery stenosis with 3-T magnetic resonance angiography (MRA) in a swine model. A total of 12 experimental animals were evaluated using equivalently dosed gadobutrol and Gd-DOTA for time-resolved and static imaging. For time-resolved imaging, the time-resolved imaging with stochastic trajectories (TWIST) technique (temporal footprint, 4.4 seconds) was used; a dose of 1 mL of gadobutrol was injected at 2 mL/s and a dose of 2 mL of Gd-DOTA was injected at both 2 and 4 mL/s. For a separate static acquisition, doses were doubled. The static scans were used for stenosis gradation and the time-resolved scans for comparison of enhancement dynamics, signal-to-noise ratio (SNR), and qualitative assessments. The average magnitude of difference in the stenosis measurements with static gadobutrol scans relative to digital subtraction intra-arterial catheter angiography (mean [SD], 7.4% [5.6%]) was less than with both the 2 mL/s (10.6% [6.2%]) and 4 mL/s (11.5% [7.8%]) Gd-DOTA MRA protocols. On time-resolved scans, peak signal-to-noise ratio was greatest with the gadobutrol protocol (P < 0.05), and the gadobutrol TWIST scan was preferred to the TWIST Gd-DOTA scan in terms of image quality and stenosis visualization in every case for every reader. Low-dose gadobutrol (~0.05 mmoL/kg) contrast-enhanced MRA results in improved accuracy of renal artery stenosis assessments relative to equivalently dosed Gd-DOTA at 3 T.

  16. 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

  17. Central Venous Catheter-Associated Deep Venous Thrombosis in Critically Ill Children.

    Science.gov (United States)

    Faustino, Edward Vincent S

    2018-02-01

    The presence of a central venous catheter and admission to the intensive care unit are the most important risk factors for deep venous thrombosis (DVT) in children. At least 18% of critically ill children with a catheter develop radiologically confirmed catheter-associated thrombosis. Clinically apparent thrombosis occurs in 3% of critically ill children with a catheter and is associated with 8 additional days of mechanical ventilation. Even when the thrombus is initially asymptomatic, 8 to 18% of critically ill children with catheter-associated thrombosis develop postthrombotic syndrome. Thrombosis is uncommon within 24 hours after insertion of a nontunneled catheter in critically ill children, but nearly all thrombi have developed by 4 days after insertion. Hypercoagulability during or immediately after insertion of the catheter plays an essential role in the development of thrombosis. Pharmacologic prophylaxis, including local anticoagulation with heparin-bonded catheter, has not been shown to reduce the risk of catheter-related thrombosis in children. Systemic anticoagulation in critically ill children started soon after the insertion of the catheter, however, may be beneficial. A multicenter clinical trial that is testing this hypothesis is currently underway. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  18. 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.

  19. Rupture of Subcutaneous Peritoneal Dialysis Catheter by Stretching Exercise: A Case Report.

    Science.gov (United States)

    Kaneshiro, Nagayuki; Sakurada, Tsutomu; Hachisuka, Rina; Hisamichi, Michiko; Yazawa, Masahiko; Shibagaki, Yugo

    Rupture of the peritoneal dialysis (PD) catheter is rare complication. Here, we report a case of catheter rupture that occurred because of exercise after partial catheter reimplantation.A 66-year-old man with a history of end-stage kidney disease secondary to diabetic nephropathy experienced refractory exit-site and tunnel infection. After the infected parts of the catheter were excised, a partial catheter reimplantation was performed. At the time of that surgery, a presternal location was selected for the new exit site, and a titanium extender was used to connect the two catheters. The patient was discharged on postoperative day 3, but was readmitted for a pericatheter leak 5 days later. Fluoroscopy performed to investigate the cause demonstrated a pericatheter leak from the connecting portion between the titanium extender and the catheter.Surgery performed to repair the leak revealed that the catheter had ruptured. We believe that the cause of the rupture was mechanical stress induced by the patient's stretching exercise program. The PD catheter was made of silicone rubber with high elasticity. Even when such resilient materials are used, we recommend that, to avoid PD catheter rupture after partial reimplantation, clinicians should discourage the patient from stretching excessively.

  20. Flow characteristics of urethral catheters of the same caliber vary between manufacturers.

    Science.gov (United States)

    Stewart, Carrie A; Yamaguchi, Eiichiro; Teixeira Vaz, Jessica; Gaver, Donald P; Ortenberg, Joseph

    2017-08-01

    Clean intermittent catheterization (CIC) is frequently prescribed for bladder dysfunction, either per urethra or via a continent catheterizable channel. Small catheters may be required for infants or continent channels. Success with CIC is highly dependent upon patient and family compliance. The urinary flow rate through the catheter is an important factor, which can decrease CIC time and improve quality of life. There is little objective information regarding flow rate through urinary catheters to guide catheter recommendation or prescription. Clinically, we noted that there was a difference in flow among catheter brands, and we questioned if catheters of the same-labeled diameter exhibit the same flow characteristics, which could have implications for catheter selection. Twenty-one commercially available male pediatric urinary catheters from nine brands were tested (11 straight tip, 10 coude tip). Nine of the 21 tested catheters had a hydrophilic coating. All tested catheters shared a 10F outer diameter. For each, microscopic imaging and a precision caliper were used to measure the inner diameter and tip inlet area. A hydraulic system modified from ASTM standard testing specifications was used to simulate bladder catheterization. Measurement of each catheter was repeated five times using three different static hydraulic pressures (20, 40 and 50 cmH 2 O). Catheter flow rate and structural measurements were identified and the fastest and slowest of the catheters are presented in the table. The variable flow rates between brands were due to the differences in catheter structural characteristics such as the inner diameter (ID) and the tip inlet area to inner lumen area ratio (AR). The maximum variation of flow rate of all tested 10F catheters was 48%, ID varied up to 22%, from 1.71 to 2.11 mm or 5.13-6.33F. AR varied up to 166%. The table delineates the fastest and slowest rates at three measured pressures. The outer diameter labeled 10F on packaging was true to

  1. Conversion from temporary to tunneled catheters by nephrologists: report of a single-center experience

    Directory of Open Access Journals (Sweden)

    Silva BC

    2016-04-01

    Full Text Available Bruno C Silva, Camila E Rodrigues, Regina CRM Abdulkader, Rosilene M Elias Nephrology Division, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil Background: Nephrologists have increasingly participated in the conversion from temporary catheters (TC to tunneled-cuffed catheters (TCCs for hemodialysis. Objective: To prospectively analyze the outcomes associated with TCC placement by nephrologists with expertise in such procedure, in different time periods at the same center. The impact of vancomycin or cefazolin as prophylactic antibiotics on the infection outcomes was also tested. Patients and methods: Hemodialysis patients who presented to such procedure were divided into two cohorts: A (from 2004 to 2008 and B (from 2013 to 2015. Time from TC to TCC conversion, prophylactic antibiotics, and reasons for TCC removal were evaluated. Results: One hundred and thirty patients were included in cohort A and 228 in cohort B. Sex, age, and follow-up time were similar between cohorts. Median time from TC to TCC conversion was longer in cohort A than in cohort B (14 [3; 30] vs 4 [1; 8] days, respectively; P<0.0001. Infection leading to catheter removal occurred in 26.4% vs 18.9% of procedures in cohorts A and B, respectively, and infection rate was 0.93 vs 0.73 infections per 1,000 catheter-days, respectively (P=0.092. Infection within 30 days from the procedure occurred in 1.4% of overall cohort. No differences were observed when comparing vancomycin and cefazolin as prophylactic antibiotics on 90-day infection-free TCC survival in a Kaplan–Meier model (log-rank = 0.188. TCC removal for low blood flow occurred in 8.9% of procedures. Conclusion: Conversion of TC to TCC by nephrologists had overall infection, catheter patency, and complications similar to data reported in the literature. Vancomycin was not superior to cefazolin as a prophylactic antibiotic. Keywords: renal dialysis, tunneled catheters, interventional nephrology

  2. Analysis and compensation for the effect of the catheter position on image intensities in intravascular optical coherence tomography

    DEFF Research Database (Denmark)

    Liu, Shengnan; Eggermont, Jeroen; Wolterbeek, Ron

    2016-01-01

    Intravascular optical coherence tomography (IVOCT) is an imaging technique that is used to analyze the underlying cause of cardiovascular disease. Because a catheter is used during imaging, the intensities can be affected by the catheter position. This work aims to analyze the effect...... of the catheter position on IVOCT image intensities and to propose a compensation method to minimize this effect in order to improve the visualization and the automatic analysis of IVOCT images. The effect of catheter position is modeled with respect to the distance between the catheter and the arterial wall...

  3. Complications, effects on dialysis dose, and survival of tunneled femoral dialysis catheters in acute renal failure.

    Science.gov (United States)

    Klouche, Kada; Amigues, Laurent; Deleuze, Sebastien; Beraud, Jean-Jacques; Canaud, Bernard

    2007-01-01

    Availability of a functional vascular access is a mandatory prerequisite for extracorporeal renal replacement therapy in patients with acute renal failure. The femoral site of insertion commonly is chosen because it is an easy and convenient access. However, an array of complications may substantially alter the quality of treatment, and it appears that catheter-related morbidity and dysfunction are more frequent with the femoral than internal jugular site. This study is designed to evaluate the potential benefits of using soft silicone tunneled catheters ((ST)Caths) at the femoral site. Thirty patients with acute renal failure treated by intermittent hemodialysis (IHD) and/or continuous venovenous hemodiafiltration (CVVHDF) were assigned to either twin (ST)Caths or twin polyurethane nontunneled femoral catheters. Time necessary for catheter insertion, catheter-related complications, and catheter lifespan were monitored. Catheter performance during IHD and the effect of catheter type on dialysis dose were evaluated. The time necessary for (ST)Cath insertion was significantly longer. The incidence of vein thrombosis and catheter-related infection was lower, and the ratio of venous return pressure to catheter blood flow was better with an (ST)Cath. Recirculation rates were similar for both types of catheters. Whether treated by using IHD or CVVHDF, patients with an (ST)Cath benefited from a greater delivered dialysis dose. Multivariate analysis confirmed that (ST)Cath use was a determinant factor to optimize dialysis dose delivery. (ST)Cath patency was significantly longer. In patients with acute renal failure, use of an (ST)Cath minimizes catheter-related morbidity and improves dialysis efficiency compared with conventional femoral catheters.

  4. Influence of drainage conditions on mucosal bladder damage by indwelling catheters. I. Pressure study.

    Science.gov (United States)

    Glahn, B E

    1988-01-01

    Clinical observations suggest the occurrence of a hydro-dynamically generated negative pressure wave in termination of bladder evacuation in patients with an intermittently clamped indwelling catheter. This in-vitro study confirmed the assumption. At circumstances like those of a bedridden person with a conventional urinary drainage system the transitory suction at the site of the catheter eyes reaches negative peak pressures of about 150-180 cm of water when catheters on a latex base are used and about 300-350 cm by catheters of 100% silicone, which is a less compliant (elastic) material. Catheters, drainage tubes and the combined function were analyzed regarding factors influencing this hydro-dynamical phenomenon, which may occur in some situations of straight drainage too. Clinical aspects are discussed. A noxious effect on the bladder mucosa is demonstrated in a subsequent study. It is concluded that the basal hydro-physical laws involved in bladder drainage by indwelling catheter need more attention.

  5. Upper extremity deep vein thrombosis after migration of peripherally inserted central catheter (PICC): A case report.

    Science.gov (United States)

    Wang, Kai; Sun, Wenyan; Shi, Xiaodong

    2017-12-01

    Peripherally inserted central venous catheters (PICC) are widely used in cancer patients and ultrasound-guided PICC insertion could improve success rate. The tip position of the catheter should be located at the border of lower one-third of the superior vena cava (SVC) and cavo-atrial junction. The migration is malposition at the late stage after PICCs were inserted, and catheter malposition was associated with thrombosis and other complications.After patient's informed consent, we report a case of a 66-year-old male with twice catheter migrations resulting in thrombosis after being diagnosed with cardiac cancer. The correct position of the catheter tip can ensure the normal use of PICC and reduce the complications. For the migrated catheter, it should be removed as soon as possible, and when thrombosis has been developed, standard anticoagulant therapy should be given. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  6. Upper extremity deep vein thrombosis after migration of peripherally inserted central catheter (PICC)

    Science.gov (United States)

    Wang, Kai; Sun, Wenyan; Shi, Xiaodong

    2017-01-01

    Abstract Introduction: Peripherally inserted central venous catheters (PICC) are widely used in cancer patients and ultrasound-guided PICC insertion could improve success rate. The tip position of the catheter should be located at the border of lower one-third of the superior vena cava (SVC) and cavo-atrial junction. The migration is malposition at the late stage after PICCs were inserted, and catheter malposition was associated with thrombosis and other complications. After patient's informed consent, we report a case of a 66-year-old male with twice catheter migrations resulting in thrombosis after being diagnosed with cardiac cancer. Conclusion: The correct position of the catheter tip can ensure the normal use of PICC and reduce the complications. For the migrated catheter, it should be removed as soon as possible, and when thrombosis has been developed, standard anticoagulant therapy should be given. PMID:29390472

  7. 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

  8. Pulmonary vein stenosis after catheter ablation: electroporation versus radiofrequency.

    Science.gov (United States)

    van Driel, Vincent J H M; Neven, Kars G E J; van Wessel, Harry; du Pré, Bastiaan C; Vink, Aryan; Doevendans, Pieter A F M; Wittkampf, Fred H M

    2014-08-01

    Radiofrequency ablation inside pulmonary vein (PV) ostia can cause PV stenosis. A novel alternative method of ablation is irreversible electroporation, but the long-term response of PVs to electroporation ablation is unknown. In ten 6-month-old pigs (60-75 kg), the response of PVs to circular electroporation and radiofrequency ablation was compared. Ten consecutive, nonarcing, electroporation applications of 200 J were delivered 5 to 10 mm inside 1 of the 2 main PVs, using a custom-deflectable, 18-mm circular decapolar catheter. Inside the other PV, circular radiofrequency ablation was performed using 30 W radiofrequency applications via an irrigated 4-mm ablation catheter. PV angiograms were made before ablation, immediately after ablation, and after 3-month survival. PV diameters and heart size were measured. With electroporation ablation, PV ostial diameter decreased 11±10% directly after ablation, but had increased 19±11% after 3 months. With radiofrequency ablation, PV ostial diameter decreased 23±15% directly after ablation and remained 7±17% smaller after 3 months compared with preablation diameter despite a 21±7% increase in heart size during aging from 6 to 9 months. In this porcine model, multiple circumferential 200-J electroporation applications inside the PV ostia do not affect PV diameter at 3-month follow-up. Radiofrequency ablation inside PV ostia causes considerable PV stenosis directly after ablation, which persists after 3 months. © 2014 American Heart Association, Inc.

  9. 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.

  10. A survey of the use of arterial catheters in anesthetized dogs and cats: 267 cases.

    Science.gov (United States)

    Trim, Cynthia M; Hofmeister, Erik H; Quandt, Jane E; Shepard, Molly K

    2017-01-01

    To describe the clinical practice of insertion of arterial catheters in anesthetized dogs and cats, to document complications of arterial catheterization, and to determine risk factors associated with the complications. Prospective clinical study and retrospective evaluation of medical records. University teaching hospital. Dogs (n = 251) and 13 cats anesthetized for clinical procedures with arterial catheters inserted for blood pressure monitoring. None. Details of the animal and catheter were collected at the time of anesthesia. On the following day, the catheter site was palpated and observed for abnormalities and the medical records of all animals were reviewed retrospectively for complications. Details of catheter placement were available for 216 catheters: 158 catheters in a dorsal pedal artery, 50 catheters in the median caudal (coccygeal) artery, 6 in the median artery, and 1 each in a cranial tibial and lingual artery. Blood pressure was obtained from 200 catheters, and 12 catheters failed before the end of anesthesia. Postoperative observational data obtained from 112 catheters described a palpable arterial pulse at 73 sites and no pulse at 21 sites. No risk factor for arterial occlusion was identified. No complications resulting from arterial catheterization were noted in the medical records. Arterial catheterization resulted in loss of a peripheral pulse postoperatively in 21/94 (22.3%) of animals examined, although no evidence of tissue ischemia was noted in the medical records of any of the patients in this study. These results suggest that insertion of a catheter in the dorsal pedal or coccygeal arteries was not associated with a high risk for complications. However, the course of arterial occlusion postoperatively warrants further investigation. © Veterinary Emergency and Critical Care Society 2016.

  11. PO-02 - Retrospective audit of the Peripherally Inserted Central Catheter (PICC) associated thrombosis in patients with haematological malignancies at Cork University Hospital.

    Science.gov (United States)

    McAuliffe, E; O'Shea, S; Khan, M I

    2016-04-01

    Peripherally inserted central catheters (PICC) have been increasingly used for administration of chemotherapy, antibiotics and blood products in patients with haematological malignancies. Although generally regarded safe, infections and thrombotic events have occurred with PICC use, necessitating study to guide future clinical prophylaxis and management. 1) Determine the incidence of PICC associated thrombosis in patients with haematological malignancies 2) To identify clinically significant risk factors contributing to these complications. This was a cohort study, conducted in Cork University Hospital, between January 2010 and June 2015. After ethical approval Picture Archiving and Communication System (PACS) in radiology was used. All adult patients with PICC inserted under haematology were identified. A total of 90 patients with haematological malignancies who had PICC line placement were included. Patients' charts were reviewed in the medical record department. Data was collected using proforma sheets. This included patients demographs, type of malignancy, size of the PICC line, and total days of insertion. Haematological laboratory parameters were also recorded. The main outcome measures were PICC associated thrombosis and/or infection Of 131 PICC placements in a total of 90 patients. Out of these total PICC episodes 28.2% developed complications (n=37) and lead to removal. Thrombosis was found in 14.5% (n=19), 13.7% developed infection (n=18) and remaining were without complications. Of those with thrombosis (n=19), 7 patients had a diagnosis of Multiple Myeloma and 6 had Acute Myeloid Leukaemia. Whereas those with PICC associated infection (n=18), 5 had Non-Hodgkin's lymphoma and 5 had Acute Lymphoid Leukaemia. Diagnosis was significantly associated with complication (p=0.019). The mean age of patients who has PICC associated thrombosis was 51.6 years (±8.1 years). PICC removal as a result of complications was associated with increasing PICC lumen size; 30

  12. 3D Catheter Shape Determination for Endovascular Navigation Using a Two-Step Particle Filter and Ultrasound Scanning.

    Science.gov (United States)

    Chen, Fang; Liu, Jia; Liao, Hongen

    2017-03-01

    In endovascular catheter interventions, the determination of the three-dimensional (3D) catheter shape can increase navigation information and help reduce trauma. This study describes a shape determination method for a flexible interventional catheter using ultrasound scanning and a two-step particle filter without X-ray fluoroscopy. First, we propose a multi-feature, multi-template particle filter algorithm for accurate catheter tracking from ultrasound images. Second, we model the mechanical behavior of the catheter and apply a particle filter shape optimization algorithm to refine the results from the first step. Finally, the acquired catheter's 3D shapes are displayed together with the preoperative 3D images of the cardiac structures to provide intuitive endovascular navigation. We validated our method using ultrasound scanning of the straight and curved catheters in a water tank, and the shape determination errors were 1.44 ± 0.38 mm and 1.95 ± 0.46 mm, respectively. Further, endovascular catheter shape determination was validated in a catheter intervention experiment with a heart phantom. The error of the acquired endovascular catheter shape was 2.23 ± 0.87 mm. These results demonstrate that our two-step method is both accurate and effective. Using ultrasound scanning for shape determination of a flexible catheter will be helpful in endovascular interventions, reducing exposure to radiation and providing rich navigation information.

  13. Efficacy of ultraviolet C light at sublethal dose in combination with antistaphylococcal antibiotics to disinfect catheter biofilms of methicillin-susceptible and methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis in vitro

    Directory of Open Access Journals (Sweden)

    El-Azizi M

    2016-08-01

    Full Text Available Mohamed El-Azizi,1 Nancy Khardori2 1Department of Microbiology, Immunology and Biotechnology, Faculty of Pharmacy and Biotechnology, German University in Cairo, New Cairo City, Egypt; 2Department of Internal Medicine, Division of Infectious Diseases, Eastern Virginia Medical School, Norfolk, VA, USA Background: Biofilm formation inside inserted medical devices leads to their failure and acts as a source of refractory infections. The ultraviolet C (UVC light is a potential therapy that can be used against the biofilm of bacterial pathogens. Objective: We evaluated the efficacy of sublethal dose of UVC light with anti-staphylococcal antibiotics against biofilms made from 30 isolates of methicillin-susceptible Staphylococcus aureus and methicillin-resistant S. aureus and S. epidermidis on vascular catheters. Materials and methods: A novel biofilm device was used to assess the combined approach. The biofilms on the catheters were irradiated with the UVC light at 254 nm and irradiance of 6.4 mW followed by treatment with vancomycin or quinupristin/dalfopristin at twice their minimum bactericidal concentrations or with linezolid at 64 µg/mL for 24 hours. The catheters were cut into segments and sonicated, and the number of the sessile cells was determined ­colorimetrically using XTT viable cells assay. The effect of UVC radiation followed by treatment with an ­antistaphylococcal antibiotic on the viability of the bacteria in the biofilm was visualized using LIVE/DEAD BacLight bacterial viability stain and confocal laser scanning microscopy. Results: Exposure of the bacterial biofilms to the UVC light or each of the antibiotics alone was ineffective in killing the bacteria. Treatment of the biofilms with the antibiotics following their exposure to UVC light significantly (P<0.001 reduced the number of viable cells within the biofilms but did not completely eradicate them. Conclusion: To our knowledge, this combinatorial approach has not been

  14. Transhepatic venous catheters for hemodialysis

    Directory of Open Access Journals (Sweden)

    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.

  15. Cryo-balloon catheter position planning using AFiT

    Science.gov (United States)

    Kleinoeder, Andreas; Brost, Alexander; Bourier, Felix; Koch, Martin; Kurzidim, Klaus; Hornegger, Joachim; Strobel, Norbert

    2012-02-01

    Atrial fibrillation (AFib) is the most common heart arrhythmia. In certain situations, it can result in life-threatening complications such as stroke and heart failure. For paroxsysmal AFib, pulmonary vein isolation (PVI) by catheter ablation is the recommended choice of treatment if drug therapy fails. During minimally invasive procedures, electrically active tissue around the pulmonary veins is destroyed by either applying heat or cryothermal energy to the tissue. The procedure is usually performed in electrophysiology labs under fluoroscopic guidance. Besides radio-frequency catheter ablation devices, so-called single-shot devices, e.g., the cryothermal balloon catheters, are receiving more and more interest in the electrophysiology (EP) community. Single-shot devices may be advantageous for certain cases, since they can simplify the creation of contiguous (gapless) lesion sets around the pulmonary vein which is needed to achieve PVI. In many cases, a 3-D (CT, MRI, or C-arm CT) image of a patient's left atrium is available. This data can then be used for planning purposes and for supporting catheter navigation during the procedure. Cryo-thermal balloon catheters are commercially available in two different sizes. We propose the Atrial Fibrillation Planning Tool (AFiT), which visualizes the segmented left atrium as well as multiple cryo-balloon catheters within a virtual reality, to find out how well cryo-balloons fit to the anatomy of a patient's left atrium. First evaluations have shown that AFiT helps physicians in two ways. First, they can better assess whether cryoballoon ablation or RF ablation is the treatment of choice at all. Second, they can select the proper-size cryo-balloon catheter with more confidence.

  16. 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.

  17. Catheter Migration After Implantationan Intrathecal Baclofen Infusion Pump for Severe Spasticity: A Case Report

    Directory of Open Access Journals (Sweden)

    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.

  18. Bowel migration of dormant chronic ambulatory peritoneal dialysis catheter: A vexed problem not avoided by flushing

    Directory of Open Access Journals (Sweden)

    P Vincent

    2017-01-01

    Full Text Available Delayed bowel erosion by peritoneal dialysis catheter is rare with fewer than thirty cases having been reported in the literature. This complication is usually encountered when the catheter is kept dormant. Two cases have also been reported with catheters in active use. The risk factors for bowel erosion include immunosuppression, diverticulosis, and amyloidosis. An 80-year-old male with chronic kidney disease Stage 5 due to hypertensive nephrosclerosis underwent chronic ambulatory peritoneal dialysis catheter insertion. Due to improvement in the glomerular filtration rate and clinical parameters including extracellular fluid volume status, peritoneal dialysis was not initiated. Weekly catheter flushes were performed. After 5 months, he developed watery diarrhea after a regular flushing episode. Computed tomography scan revealed the catheter displaced into the sigmoid colon with the tip in the rectum. He was managed successfully with catheter removal alone and conservative treatment. He remains asymptomatic at 3-month follow-up. This case is presented to emphasize the fact that delayed bowel erosion can happen with dormant catheter even in the absence of risk factors. Periodic flushing has not prevented this complication in our patient. Perforations can be self-curing when diagnosed early and when patients present without features of peritonitis or sepsis. Such cases can be managed successfully with catheter removal alone.

  19. 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.

  20. Semi-automated location identification of catheters in digital chest radiographs

    Science.gov (United States)

    Keller, Brad M.; Reeves, Anthony P.; Cham, Matthew D.; Henschke, Claudia I.; Yankelevitz, David F.

    2007-03-01

    Localization of catheter tips is the most common task in intensive care unit imaging. In this work, catheters appearing in digital chest radiographs acquired by portable chest x-rays were tracked using a semi-automatic method. Due to the fact that catheters are synthetic objects, its profile does not vary drastically over its length. Therefore, we use forward looking registration with normalized cross-correlation in order to take advantage of a priori information of the catheter profile. The registration is accomplished with a two-dimensional template representative of the catheter to be tracked generated using two seed points given by the user. To validate catheter tracking with this method, we look at two metrics: accuracy and precision. The algorithms results are compared to a ground truth established by catheter midlines marked by expert radiologists. Using 12 objects of interest comprised of naso-gastric, endo-tracheal tubes, and chest tubes, and PICC and central venous catheters, we find that our algorithm can fully track 75% of the objects of interest, with a average tracking accuracy and precision of 85.0%, 93.6% respectively using the above metrics. Such a technique would be useful for physicians wishing to verify the positioning of catheter tips using chest radiographs.

  1. Frequency of colonization and isolated bacteria from the tip of epidural catheter implanted for postoperative analgesia.

    Science.gov (United States)

    Stabille, Débora Miranda Diogo; Diogo Filho, Augusto; Mandim, Beatriz Lemos da Silva; de Araújo, Lúcio Borges; Mesquita, Priscila Miranda Diogo; Jorge, Miguel Tanús

    2015-01-01

    The increased use of epidural analgesia with catheter leads to the need to demonstrate the safety of this method and know the incidence of catheter colonization, inserted postoperatively for epidural analgesia, and the bacteria responsible for this colonization. From November 2011 to April 2012, patients electively operated and maintained under epidural catheter for postoperative analgesia were evaluated. The catheter tip was collected for semiquantitative and qualitative microbiological analysis. Of 68 cultured catheters, six tips (8.8%) had positive cultures. No patient had superficial or deep infection. The mean duration of catheter use was 43.45 h (18-118) (p=0.0894). The type of surgery (contaminated or uncontaminated), physical status of patients, and surgical time showed no relation with the colonization of catheters. Microorganisms isolated from the catheter tip were Staphylococcus aureus, Pseudomonas aeruginosa and Sphingomonas paucimobilis. Postoperative epidural catheter analgesia, under these study conditions, was found to be low risk for bacterial colonization in patients at surgical wards. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  2. Effect of steel and teflon infusion catheters on subcutaneous adipose tissue blood flow and infusion counter pressure in humans

    DEFF Research Database (Denmark)

    Højbjerre, Lise; Skov-Jensen, Camilla; Kaastrup, Peter

    2009-01-01

    BACKGROUND: Subcutaneous tissue is an important target for drug deposition or infusion. A local trauma may induce alterations in local microcirculation and diffusion barriers with consequences for drug bioavailability. We examined the influence of infusion catheters' wear time on local...... microcirculation and infusion counter pressure. METHODS: One steel catheter and one Teflon (Dupont, Wilmington, DE) catheter were inserted in subcutaneous, abdominal adipose tissue (SCAAT) in 10 healthy, lean men. The catheters were infused with isotonic saline at a rate of 10 microL/h for 48 h. Another steel...... catheter and a Teflon catheter were inserted contralateral to the previous catheters after 48 h. The infusion counter pressure was measured during a basal infusion rate followed by a bolus infusion. The measurements during a basal rate infusion were repeated after the bolus infusion. Adipose tissue blood...

  3. Model United Nations at CERN

    CERN Multimedia

    2012-01-01

    From 20 to 22 January, 300 young people from international secondary schools in Switzerland, France and Turkey will meet at CERN to debate scientific topics at a Model UN Conference.   Representing some 50 countries, they will form committees and a model General Assembly to discuss the meeting’s chosen topic: “UN – World Science Pole for Progress”.

  4. A novel technique of axillary vein puncture involving peripherally inserted central venous catheters for a small basilic vein.

    Science.gov (United States)

    Saijo, Fumito; Odaka, Yoshinobu; Mutoh, Mitsuhisa; Katayose, Yu; Tokumura, Hiromi

    2018-03-01

    Peripherally inserted central venous catheters are some of the most useful devices for vascular access used globally. Peripherally inserted central venous catheters have a low rate of fatal mechanical complications when compared to non-tunnel central venous catheters. However, as peripherally inserted central venous catheter access requires a smaller vein, there is a high risk of thrombosis. The axillary vein (confluence of the basilic and brachial veins) can serve as an access for cannulation. Moreover, as this vein is larger than the basilic or brachial vein, it might be a superior option for preventing thrombosis. The risk of catheter-related bloodstream infection should be considered when the puncture site is at the axillary fossa. The aim of this study was to present our new protocol involving peripherally inserted central venous catheters (non-tunneled/tunneled) and a tunneling technique and assess its feasibility and safety for improving cannulation and preventing thrombosis and infection. The study included 20 patients. The axillary vein in the upper arm was used for peripherally inserted central venous catheters in patients with a small-diameter basilic vein (venous catheter. The observed catheter duration was 645 days (median ± standard deviation, 26 ± 22.22 days). Catheterization was successful in all cases, however, two accidental dislodgements were identified. No fatal or serious complications were observed after catheterization. Our new protocol for axillary peripherally inserted central venous catheters/tunneled axillary peripherally inserted central venous catheters use for a small-diameter basilic vein is safe and feasible.

  5. Fantoni’s Tracheostomy using Catheter High Frequency Jet Ventilation

    Directory of Open Access Journals (Sweden)

    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.

  6. Rising charges and costs for pediatric catheter ablation.

    Science.gov (United States)

    Burns, Kristin M; Evans, Frank; Pearson, Gail D; Berul, Charles I; Kaltman, Jonathan R

    2013-02-01

    Catheter ablation has been shown to be effective for pediatric tachyarrhythmias, but the associated charges and costs have not been described in the recent era. Understanding such contemporary trends may identify ways to keep an effective therapy affordable while optimizing clinical outcomes. We used the 1997-2009 Kids' Inpatient Databases to examine trends in charges and costs for pediatric catheter ablation and identify determinants of temporal changes. There were 7,130 discharges for catheter ablation in the sample. Mean age at ablation was 12.1 ± 0.2 years. Patients with congenital heart disease (CHD) made up 10% of the sample. Complications occurred in 8% of discharges. Mean total charges rose 219% above inflation (from $23,798 ± 1,072 in 1997 to $75,831 ± 2,065 in 2009). From 2003 to 2009, costs rose 25% (from $20,459 ± 780 in 2003 to $25,628 ± 992 in 2009). Charges for ablation increased markedly relative to surgical procedures, but with a similar slope to other catheter-based interventions. Multivariable analysis revealed that year (P charges. The same factors also predicted increased costs. Charges and costs varied considerably by region, particularly for high-volume centers (P Charges and costs for pediatric catheter ablation increased relative to other procedures and significantly outstripped inflation. Further study of complications, length of stay, and regional differences may help control rising costs while maintaining quality of care. © 2012 Wiley Periodicals, Inc.

  7. Foley Catheter versus Vaginal Misoprostol for Labour Induction

    Directory of Open Access Journals (Sweden)

    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.

  8. A 4-DOF Robot for Positioning Ultrasound Imaging Catheters.

    Science.gov (United States)

    Loschak, Paul M; Degirmenci, Alperen; Tenzer, Yaroslav; Howe, Robert D

    2015-08-01

    In this paper we present the design, fabrication, and testing of a robot for automatically positioning ultrasound imaging catheters. Our system will point ultrasound (US) catheters to provide real-time imaging of anatomical structures and working instruments during minimally invasive surgeries. Manually navigating US catheters is difficult and requires extensive training in order to aim the US imager at desired targets. Therefore, a four DOF robotic system was developed to automatically navigate US imaging catheters for enhanced imaging. A rotational transmission enables three DOF for pitch, yaw, and roll of the imager. This transmission is translated by the fourth DOF. An accuracy analysis was conducted to calculate the maximum allowable joint motion error. Rotational joints must be accurate to within 1.5° and the translational joint must be accurate within 1.4 mm. Motion tests were then conducted to validate the accuracy of the robot. The average resulting errors in positioning of the rotational joints were measured to be 0.28°-0.38° with average measured backlash error 0.44°. Average translational positioning and backlash errors were measured to be significantly lower than the reported accuracy of the position sensor. The resulting joint motion errors were well within the required specifications for accurate robot motion. Such effective navigation of US imaging catheters will enable better visualization in various procedures ranging from cardiac arrhythmia treatment to tumor removal in urological cases.

  9. Rising Charges and Costs for Pediatric Catheter Ablation

    Science.gov (United States)

    BURNS, KRISTIN M.; EVANS, FRANK; PEARSON, GAIL D.; BERUL, CHARLES I.; KALTMAN, JONATHAN R.

    2018-01-01

    Introduction Catheter ablation has been shown to be effective for pediatric tachyarrhythmias, but the associated charges and costs have not been described in the recent era. Understanding such contemporary trends may identify ways to keep an effective therapy affordable while optimizing clinical outcomes. Methods We used the 1997-2009 Kids’ Inpatient Databases to examine trends in charges and costs for pediatric catheter ablation and identify determinants of temporal changes. Results There were 7,130 discharges for catheter ablation in the sample. Mean age at ablation was 12.1 ± 0.2 years. Patients with congenital heart disease (CHD) made up 10% of the sample. Complications occurred in 8% of discharges. Mean total charges rose 219% above inflation (from $23,798 ± 1,072 in 1997 to $75,831 ± 2,065 in 2009). From 2003 to 2009, costs rose 25% (from $20,459 ± 780 in 2003 to $25,628 ± 992 in 2009). Charges for ablation increased markedly relative to surgical procedures, but with a similar slope to other catheter-based interventions. Multivariable analysis revealed that year (P pediatric catheter ablation increased relative to other procedures and significantly outstripped inflation. Further study of complications, length of stay, and regional differences may help control rising costs while maintaining quality of care. PMID:23066833

  10. Medically Attended Catheter Complications Are Common in Patients With Outpatient Central Venous Catheters.

    Science.gov (United States)

    Spires, Steven S; Rebeiro, Peter F; Miller, Mickie; Koss, Katie; Wright, Patty W; Talbot, Thomas R

    2018-04-01

    OBJECTIVE Outpatient central venous catheters (CVCs) are being used more frequently; however, data describing mechanical complications and central-line-associated bloodstream infections (CLABSI) in the outpatient setting are limited. We performed a retrospective observational cohort study to understand the burden of these complications to elucidate their impact on the healthcare system. METHODS Data were retrospectively collected on patients discharged from Vanderbilt University Medical Center with a CVC in place and admitted into the care of Vanderbilt Home Care Services. Risk factors for medically attended catheter-associated complications (CACs) and outpatient CLABSIs were analyzed. RESULTS A CAC developed in 143 patients (21.9%), for a total of 165 discrete CAC events. Among these, 76 (46%) required at least 1 visit to the emergency department or an inpatient admission, while the remaining 89 (54%) required an outpatient clinic visit. The risk for developing a CAC was significantly increased in female patients, patients with a CVC with >1 lumen, and patients receiving total parenteral nutrition. The absolute number of CLABSIs identified in the study population was small at 16, or 2.4% of the total cohort. CONCLUSIONS Medically attended catheter complications were common among outpatients discharged with a CVC, and reduction of these events should be the focus of outpatient quality improvement programs. Infect Control Hosp Epidemiol 2018;39:439-444.

  11. 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.

  12. Outcomes in a nurse-led peripherally inserted central catheter program: a retrospective cohort study.

    Science.gov (United States)

    McDiarmid, Sheryl; Scrivens, Nicholas; Carrier, Marc; Sabri, Elham; Toye, Baldwin; Huebsch, Lothar; Fergusson, Dean

    2017-06-30

    Peripherally inserted central catheters (PICCs) provide enormous benefit to patients. However, recent publications have highlighted relatively high PICC-associated complication rates. We report on patient and device outcomes from a nurse-led program. We performed a retrospective analysis of a prospective cohort of consecutive patients undergoing PICC insertion at The Ottawa Hospital between Jan. 1, 2013 and Dec. 31, 2014. Of the 8314 BioFlo PASV PICCs inserted, we randomly selected a sample of 700 and obtained a complete data set for 656. We measured the cumulative incidence of major complications (catheter-related bloodstream infections and deep vein thrombosis) and use of a thrombolytic to alleviate occlusions. The total number of catheter days was 58 486, and the median dwell time 45 days. We observed 4 cases of catheter-related bloodstream infection (0.6% [95% CI 0.17%-1.55%]) (0.07/1000 catheter days). Ten patients (1.5% [95% CI 0.83%-2.78%]) (0.17/1000 catheter days) had catheter-related deep venous thrombosis. At least 1 dose of thrombolytic was required in 75 catheters (11.4% [95% CI 8.61%-13.39]), 31 (7.1%) of the 436 single-lumen catheters and 113 (25.7%) of the 440 lumina of dual-lumen catheters ( p < 0.001). We attribute our low rates of major complications to a nurse-led expert insertion team, standardized care and maintenance protocols, high insertion volumes, novel catheter material and continuous quality-improvement initiatives that are implemented and evaluated regularly. We conclude that the considerable benefits PICCs provide to patients are attained with a low risk of major complications. Copyright 2017, Joule Inc. or its licensors.

  13. Tunneled dialysis catheter exchange with fibrin sheath disruption is not associated with increased rate of bacteremia.

    Science.gov (United States)

    Valliant, Amanda M; Chaudhry, Muhammad K; Yevzlin, Alexander S; Astor, Brad; Chan, Micah R

    2015-01-01

    Tunneled dialysis catheters are the most common form of vascular access among incident dialysis patients in the United States. Fibrin sheath formation is a frequent cause of late catheter dysfunction requiring an exchange procedure with balloon disruption of the fibrin sheath. It is unknown whether fibrin sheath disruption is associated with increased incidence of bacteremia or catheter failure. We reviewed all tunneled dialysis catheter exchange procedures at the University of Wisconsin between January 2008 and December 2011. The primary outcome was incidence of bacteremia, defined as positive blood cultures within 2 weeks of the procedure. Catheter failure, requiring intervention or replacement, was examined as a secondary outcome. Baseline characteristics examined included diabetic status, gender, race and age. A total of 163 procedures were reviewed; 67 (41.1%) had fibrin sheath disruption and 96 did not. Bacteremia occurred in 4.5% (3/67) of those with and 3.1% (3/97) of those without fibrin sheath disruption (p=0.65). Fibrin sheath disruption was not significantly associated with the risk of catheter failure (adjusted hazard ratio [aHR]=1.34; 95% confidence interval [CI]: 0.87-2.10; p=0.18). Diabetes was associated with greater risk of catheter failure (aHR=1.88; 95% CI: 1.19-2.95; p=0.006), whereas higher age was associated with a lower risk of catheter failure (aHR per 10 years=0.83; 95% CI: 0.72-0.96; p=0.01). This study demonstrates that there is no significant increase in bacteremia and subsequent catheter dysfunction rates after fibrin sheath disruption compared to simple over the wire exchange. These results are encouraging given the large numbers of patients utilizing tunneled catheters for initial hemodialysis access and the known rates of fibrin sheath formation leading to catheter failure.

  14. Inactivation of Bacteria on Explanted Dialysis Catheter Lumens with Fiber Optically Delivered Ultraviolet Light.

    Science.gov (United States)

    Lin, Roger C; Prologo, J David

    2015-12-01

    To evaluate the germicidal effect of fiber optically delivered ultraviolet (UV) light on colonized explanted dialysis catheters. Explanted dialysis catheters were screened for intraluminal colonization by culturing 1 mL of a saline flush. Catheters growing >10 colony-forming units were treated with doses of fiber optically delivered UV light (range, 40-1,300 mJ/cm2). For each UV-treated catheter, an unexposed segment was first cut and set aside as a control sample. A sterile optical fiber was inserted into the catheter hub and advanced to the catheter tip. The fiber was slowly withdrawn at a constant rate while exposing the inner lumen to UV light. A second UV-exposed segment was then removed. The UV-exposed and control segments were split and sonicated to remove the adherent bacteria. The bacteria were counted and identified. There were 14 colonized catheters treated with UV light. The catheters were primarily colonized with coagulase-negative staphylococci (60%) and Staphylococcus aureus (33%). There was a significant reduction in viable bacteria between the UV-treated versus untreated segments of each infected catheter (P = .04). In the seven treated catheters with >100,000 colony-forming units per cm2 of luminal surface area, there was a >99.5% reduction of viable bacteria in all UV-exposed samples, with no residual viable bacteria in four of seven (57%) of the samples. This study demonstrates the technical feasibility and benchtop efficacy of using fiber optics to deliver UV light into the lumen of a colonized dialysis catheter and inactivating bacteria on the intraluminal surface. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

  15. Laparoscopic versus open peritoneal dialysis catheter insertion, the LOCI-trial: a study protocol

    Directory of Open Access Journals (Sweden)

    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

  16. The Incidence of Peripheral Catheter-Related Thrombosis in Surgical Patients

    Science.gov (United States)

    Leung, Amy; Heal, Clare; Banks, Jennifer; Abraham, Breanna; Capati, Gian; Pretorius, Casper

    2016-01-01

    Background. Central venous catheters and peripherally inserted central catheters are well established risk factors for upper limb deep vein thrombosis. There is limited literature on the thrombosis rates in patients with peripheral catheters. A prospective observational study was conducted to determine the incidence of peripheral catheter-related thrombosis in surgical patients. Methods. Patients deemed high risk for venous thrombosis with a peripheral catheter were considered eligible for the study. An ultrasound was performed on enrolment into the study and at discharge from hospital. Participants were reviewed twice a day for clinical features of upper limb deep vein thrombosis during their admission and followed up at 30 days. Results. 54 patients were included in the study. The incidence of deep vein thrombosis and superficial venous thrombosis was 1.8% and 9.2%, respectively. All cases of venous thrombosis were asymptomatic. Risk factor analysis was limited by the low incidence of thrombosis. Conclusion. This study revealed a low incidence of deep vein thrombosis in surgical patients with peripheral catheters (1.8%). The study was underpowered; therefore the association between peripheral catheters and thrombosis is unable to be established. Future studies with larger sample sizes are required to determine the association between peripheral catheters and thrombosis. PMID:26904283

  17. [Interventional catheter treatment of tricuspid valve regurgitation].

    Science.gov (United States)

    Wißt, T; Kreidel, F; Schlüter, M; Kuck, K-H; Frerker, C

    2017-11-01

    The tricuspid valve can be considered the "forgotten" valve because in the past hardly any research has been conducted in this field and as a result only few therapeutic options existed. The prognosis of untreated tricuspid regurgitation (TR) is poor and mortality is high for patients with severe TR. Patients frequently return to medical practices and hospitals because of cardiac decompensation, with shortness of breath and leg edema. Recent years have seen more development in catheter-based treatment options. Currently, several devices are in clinical evaluation, which are presented in this article. A web-based literature search was carried out and information was gathered at international cardiology meetings (TCT 2016 in Washington, DGK 2017 in Mannheim, EuroPCR 2017 in Paris). There are various options for interventional catheter procedures for TR, which are being investigated within the scope of clinical studies. Most aim at reducing the tricuspid annular diameter and optimizing leaflet coaptation. Because of these new therapy options patients can now be treated who were considered untreatable in the past because of the high perioperative mortality.

  18. Reduced cell attachment to poly(2-hydroxyethyl methacrylate)-coated ventricular catheters in vitro.

    Science.gov (United States)

    Hanak, Brian W; Hsieh, Chia-Yun; Donaldson, William; Browd, Samuel R; Lau, Kenneth K S; Shain, William

    2018-04-01

    The majority of patients with hydrocephalus are dependent on ventriculoperitoneal shunts for diversion of excess cerebrospinal fluid. Unfortunately, these shunts are failure-prone and over half of all life-threatening pediatric failures are caused by obstruction of the ventricular catheter by the brain's resident immune cells, reactive microglia and astrocytes. Poly(2-hydroxyethyl methacrylate) (PHEMA) hydrogels are widely used for biomedical implants. The extreme hydrophilicity of PHEMA confers resistance to protein fouling, making it a strong candidate coating for ventricular catheters. With the advent of initiated chemical vapor deposition (iCVD), a solvent-free coating technology that creates a polymer in thin film form on a substrate surface by introducing gaseous reactant species into a vacuum reactor, it is now possible to apply uniform polymer coatings on complex three-dimensional substrate surfaces. iCVD was utilized to coat commercially available ventricular catheters with PHEMA. The chemical structure was confirmed on catheter surfaces using Fourier transform infrared spectroscopy and X-ray photoelectron spectroscopy. PHEMA coating morphology was characterized by scanning electron microscopy. Testing PHEMA-coated catheters against uncoated clinical-grade catheters in an in vitro hydrocephalus catheter bioreactor containing co-cultured astrocytes and microglia revealed significant reductions in cell attachment to PHEMA-coated catheters at both 17-day and 6-week time points. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1268-1279, 2018. © 2017 Wiley Periodicals, Inc.

  19. Multicenter experience with the new SOFIA Plus catheter as a primary local aspiration catheter for acute stroke thrombectomy.

    Science.gov (United States)

    Möhlenbruch, M A; Kabbasch, C; Kowoll, A; Broussalis, E; Sonnberger, M; Müller, M; Wiesmann, M; Trenkler, J; Killer-Oberpfalzer, M; Weber, W; Mpotsaris, A; Bendszus, M; Stampfl, S

    2017-12-01

    The direct aspiration first pass technique (ADAPT) has been introduced as a rapid and safe endovascular treatment strategy in patients with ischemic stroke. To determine the technical feasibility, safety, and functional outcome with ADAPT using the new large-bore 6F SOFIA Plus catheter. A retrospective analysis of prospectively collected data from six university hospitals was performed. The following parameters of all acute stroke procedures (June 2015- January 2016) using the SOFIA Plus catheter were analyzed: accessibility of the thrombus with the catheter, recanalization success (Thrombolysis in Cerebral Infarction ≥2b), time to recanalization, procedure-related complications. Furthermore, National Institutes of Health Stroke Scale (NIHSS) scores at presentation and discharge and the modified Rankin scale (mRS) score at 90 days were recorded. 85 patients were treated using the SOFIA Plus catheter. The occlusion site was the anterior circulation in 94.1%. Median baseline NIHSS score was 18. In 64.7%, ADAPT alone was successful after a median procedure time of 21 min. With additional use of stent retrievers in the remaining cases, the recanalization rate was 96.5%. No catheter-related complications such as dissections were observed. Thrombus migration to a new vascular territory occurred in 4.7% and symptomatic hemorrhage in 4.7%. After 3 months, mRS 0-2 was achieved in 49.4%. Mortality rate was 20%. In the majority of cases, thrombus aspiration using the SOFIA Plus catheter results in successful recanalization after a short procedure time. With additional use of stent retrievers, a high recanalization rate can be achieved (96.5%). The complication rate was in line with those of previous publications. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  20. Real-time x-ray fluoroscopy-based catheter detection and tracking for cardiac electrophysiology interventions

    Energy Technology Data Exchange (ETDEWEB)

    Ma Yingliang; Housden, R. James; Razavi, Reza; Rhode, Kawal S. [Division of Imaging Sciences and Biomedical Engineering, King' s College London, London SE1 7EH (United Kingdom); Gogin, Nicolas; Cathier, Pascal [Medisys Research Group, Philips Healthcare, Paris 92156 (France); Gijsbers, Geert [Interventional X-ray, Philips Healthcare, Best 5680 DA (Netherlands); Cooklin, Michael; O' Neill, Mark; Gill, Jaswinder; Rinaldi, C. Aldo [Department of Cardiology, Guys and St. Thomas' Hospitals NHS Foundation Trust, London SE1 7EH (United Kingdom)

    2013-07-15

    Purpose: X-ray fluoroscopically guided cardiac electrophysiology (EP) procedures are commonly carried out to treat patients with arrhythmias. X-ray images have poor soft tissue contrast and, for this reason, overlay of a three-dimensional (3D) roadmap derived from preprocedural volumetric images can be used to add anatomical information. It is useful to know the position of the catheter electrodes relative to the cardiac anatomy, for example, to record ablation therapy locations during atrial fibrillation therapy. Also, the electrode positions of the coronary sinus (CS) catheter or lasso catheter can be used for road map motion correction.Methods: In this paper, the authors present a novel unified computational framework for image-based catheter detection and tracking without any user interaction. The proposed framework includes fast blob detection, shape-constrained searching and model-based detection. In addition, catheter tracking methods were designed based on the customized catheter models input from the detection method. Three real-time detection and tracking methods are derived from the computational framework to detect or track the three most common types of catheters in EP procedures: the ablation catheter, the CS catheter, and the lasso catheter. Since the proposed methods use the same blob detection method to extract key information from x-ray images, the ablation, CS, and lasso catheters can be detected and tracked simultaneously in real-time.Results: The catheter detection methods were tested on 105 different clinical fluoroscopy sequences taken from 31 clinical procedures. Two-dimensional (2D) detection errors of 0.50 {+-} 0.29, 0.92 {+-} 0.61, and 0.63 {+-} 0.45 mm as well as success rates of 99.4%, 97.2%, and 88.9% were achieved for the CS catheter, ablation catheter, and lasso catheter, respectively. With the tracking method, accuracies were increased to 0.45 {+-} 0.28, 0.64 {+-} 0.37, and 0.53 {+-} 0.38 mm and success rates increased to 100%, 99

  1. Effect of an acrylic terpolymer barrier film beneath transparent catheter dressings on skin integrity, risk of dressing disruption, catheter colonisation and infection.

    Science.gov (United States)

    Pivkina, A I; Gusarov, V G; Blot, S I; Zhivotneva, I V; Pasko, N V; Zamyatin, M N

    2018-03-23

    We assessed the effect of a skin-protective terpolymer barrier film around the catheter insertion site on frequency of dressing disruptions and skin integrity issues (hyperaemia, skin irritation, residues of adhesives and moisture under the dressing). Secondary outcomes included colonisation of the central venous catheter (CVC) and rates of central line-associated bloodstream infection. A monocentric, open-label, randomised controlled trial was performed comparing a control group receiving standard transparent catheter dressings without the skin-protecting barrier film and an intervention group receiving a transparent chlorhexidine-impregnated dressing with use of the skin-protective acrylic terpolymer barrier film (3M™ Cavilon™ No - Sting Barrier Film, 3 M Health Care, St. Paul, MN, USA). Sixty patients were enrolled and randomised in the study accounting for 60 central venous catheters and a total of 533 catheter days. Dressing disruptions occurred more frequently and at sooner time point in the control group. Skin integrity issues were significantly less observed in the intervention group. No differences in CVC colonisation or central line-associated bloodstream infection were observed. The application of a barrier film creating a skin-protective polymer layer beneath transparent catheter dressings is associated with less dressing disruptions and skin integrity issues without altering the risk of infectious complications if used in combination with a chlorhexidine-impregnated catheter dressing. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  2. [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.

  3. Co-release of dicloxacillin and thioridazine from catheter material containing an interpenetrating polymer network for inhibiting device-associated Staphylococcus aureus infection

    DEFF Research Database (Denmark)

    Stenger, Michael; Klein, Kasper; Grønnemose, Rasmus B

    2016-01-01

    Approximately half of all nosocomial bloodstream infections are caused by bacterial colonization of vascular catheters. Attempts have been made to improve devices using anti-adhesive or antimicrobial coatings; however, it is often difficult to bind coatings stably to catheter materials, and the low...... to an enhanced loading capacity of DCX when co-loaded with TDZ. Lastly, the IPN catheters were tested in a novel porcine model of central venous catheter-related infection, in which drug-loaded IPN catheters were found to significantly decrease the frequency of infection....

  4. Convectively Dominated Heparin Leakage From Multiple Catheter Designs: An In Vitro Experimental Study.

    Science.gov (United States)

    Barbour, Michael Coleman; Gow, Kenneth W; Aliseda, Alberto

    2018-03-16

    Central venous catheters (CVCs) are routinely filled with a heparin lock while not in use to avoid thrombus formation near the tip. However, heparin leakage is known to occur, and the lock effectiveness remains in question. It was recently shown that convective fluxes from the blood flow in the host vein transport the majority of locking solution away from the tip of hemodialysis catheters immediately after instillation. Combined with the low diffusivity of heparin, this results in concentrations of heparin at the catheter tip that are orders of magnitude lower than at instillation for the majority of the interdialytic phase, diminishing the antithrombotic effectiveness of the lock. In this study, heparin losses from three different CVCs with different tip designs are measured in a pulsatile flow loop. Planar laser-induced fluorescence and particle image velocimetry measurements of heparin concentration and fluid velocity are recorded downstream of the catheters and combined to evaluate heparin losses from each of the different catheter designs. Additionally, locking solution losses are measured from one catheter (Hickman) subjected to three different flow conditions. Heparin losses are shown to depend weakly on flow condition but be highly dependent on catheter design. Convective losses from the Hickman catheter, with no side holes, are minimal (1-2%), although losses from the other two catheter types, both with a number of side holes, are significantly higher (7%). These results indicate the potential to maintain a high concentration of locking solution during the interdialytic phase with proper catheter design, particularly focusing on side hole distribution and shape.

  5. Timing for Removal of Peritoneal Dialysis Catheters in Pediatric Renal Transplant Patients.

    Science.gov (United States)

    Melek, Engin; Baskın, Esra; Gülleroğlu, Kaan Savaş; Kırnap, Mahir; Moray, Gökhan; Haberal, Mehmet

    2016-11-01

    Peritoneal dialysis, the preferred long-term renal replacement modality in the pediatric population, can also be used during the post transplant period. Although it is well known that peritonitis or other complications may occur related to the peritoneal dialysis catheter, less is known about complications related to the peritoneal dialysis during the posttransplant period. Our objective was to evaluate the complications related to use of a peritoneal dialysis catheter during the posttransplant period and to determine the optimum time for removal of the peritoneal dialysis catheter. We retrospectively analyzed 33 chronic peritoneal dialysis patients. Pretransplant and posttransplant demographics and clinical and laboratory data for each patient were recorded, including incidence of peritonitis and incidence of peritoneal dialysis catheter requirement after transplant. Mean age of patients at transplant was 12.8 ± 4.0 years (range, 3.5-18.0 y). Mean catheter removal time was 81.1 ± 36.2 days (range, 22.0-152.0 d). The peritoneal dialysis catheter was used in 6 of 33 patients (18.2%); none of these patients developed peritonitis. In contrast, 2 of the 27 patients who did not use the peritoneal dialysis catheter developed peritonitis. Our data suggest that the need for catheter use occurs predominantly during the first month, and infectious complications usually happen later. Previously, the trend was to not remove the peritoneal dialysis catheter at the time of transplant. However, in light of recent literature and our present study, we recommend that the time of catheter removal should be modified and decided for each patient on an individual basis.

  6. 21 CFR 870.1210 - Continuous flush catheter.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Continuous flush catheter. 870.1210 Section 870.1210 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... that permits continuous intravascular flushing at a slow infusion rate for the purpose of eliminating...

  7. a randomised trial comparing Foley catheter plus titrated oral ...

    African Journals Online (AJOL)

    Labour induction at term - a randomised trial comparing. Foley catheter plus titrated oral misoprostol solution, titrated oral misoprostol solution alone, and dinoprostone. Baron B Matonhodze, G Justus Hofmeyr, Jonathan Levin. Objectives. To compare three methods of labour induction. Design. Randomised controlled trial.

  8. Standard Model at LHC 2016

    CERN Document Server

    2016-01-01

    The meeting aims to bring together experimentalists and theorists to discuss the phenomenology, observational results and theoretical tools for Standard Model physics at the LHC. The agenda is divided into four working groups: Electroweak physics Higgs physics QCD (hard, soft & PDFs) Top & flavour physics

  9. 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...

  10. Length of Catheter Use After Hysterectomy as a Risk Factor for Urinary Tract Infection.

    Science.gov (United States)

    Karp, Natalie E; Kobernik, Emily K; Kamdar, Neil S; Fore, Amanda M; Morgan, Daniel M

    2017-09-13

    The aims of this study were to determine the effect of length of postoperative catheterization on risk of urinary tract infection (UTI) and to identify risk factors for postoperative UTI. This was a retrospective case-control study. Demographic and perioperative data, including duration of indwelling catheter use and postoperative occurrence of UTI within 30 days of surgery, were analyzed for hysterectomies using the Michigan Surgical Quality Collaborative database. Catheter exposure was categorized as low-no catheter placed/catheter removed the day of surgery, intermediate-catheter removed postoperative day 1, high-catheter removal on postoperative day 2 or later, or highest-patient discharged home with catheter. A multivariable logistic regression model was developed to identify factors associated with UTI. An interaction term was included in the final model. Overall, UTI prevalence was 2.3% and increased with duration of catheter exposure (low: 1.3% vs intermediate: 2.1% vs high: 4.1% vs highest: 6.5%, P < 0.0001). High (odds ratio [OR] = 2.54 [1.51-4.27]) and highest (OR = 3.39 [1.86-6.17]) catheter exposure, operative time (OR = 1.15 [1.03-1.29]), and dependent functional status (OR = 4.62 [1.90-11.20]) were independently associated with UTI. Women who had a vaginal hysterectomy with sling/pelvic organ prolapse repair were more likely to have a UTI than those who had a vaginal hysterectomy alone (OR = 2.58 [1.10-6.07]) and more likely to have a UTI than women having an abdominal or laparoscopic hysterectomy with a sling/pelvic organ prolapse repair (OR = 2.13 [1.12-4.04]). Length of catheterization and operative time are modifiable risk factors for UTI after hysterectomy. An interaction between vaginal hysterectomy and concomitant pelvic reconstruction increases the odds of UTI.

  11. 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...

  12. 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

  13. 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.

  14. Bladder catheter protocol: technical modification for the change of Long-Term bladder catheters

    Directory of Open Access Journals (Sweden)

    Susana Rueda Pérez

    2013-09-01

    Full Text Available The replacement of urinary catheters is a common practice in chronic patients for both outpatients and inpatients. This action involves a large number of nursing interventions either planned or caused by emergency (obstruction, incorrect implantation, etc.... This modification of the catheter technique tries to improve the patient’s quality of life by minimizing the stress produced by urethral catheter replacements and reducing malpractice risks. This change in the urinary catheter technique also intends to alleviate some of the side effects of permanent urethral catheterization. By filling the bladder with saline prior to the change of catheter, it is possible to get a quick and safe implantation, dragging possible sediment and microorganisms and thereby reducing the number of nursing actions related to the process of the urinary catheter replacement (obstruction or incorrect catheter implantations etc.

  15. Multifractal Value at Risk model

    Science.gov (United States)

    Lee, Hojin; Song, Jae Wook; Chang, Woojin

    2016-06-01

    In this paper new Value at Risk (VaR) model is proposed and investigated. We consider the multifractal property of financial time series and develop a multifractal Value at Risk (MFVaR). MFVaR introduced in this paper is analytically tractable and not based on simulation. Empirical study showed that MFVaR can provide the more stable and accurate forecasting performance in volatile financial markets where large loss can be incurred. This implies that our multifractal VaR works well for the risk measurement of extreme credit events.

  16. Transparent polyurethane film as an intravenous catheter dressing. A meta-analysis of the infection risks.

    Science.gov (United States)

    Hoffmann, K K; Weber, D J; Samsa, G P; Rutala, W A

    1992-04-15

    To obtain a quantitative estimate of the impact on infectious complications of using transparent dressings with intravenous catheters. Meta-analysis of all studies published in the English literature, including abstracts, letters, and reports that examined the primary research question of infection risks associated with transparent compared with gauze dressings for use on central and peripheral venous catheters. Studies were identified by use of the MEDLINE database using the indexing terms occlusive dressings, transparent dressings, and infection and by review of referenced bibliographies. Seven of the 15 studies (47%) of central venous catheters and seven of 12 studies (58%) of peripheral catheters met our inclusion criteria for analysis. All studies used a prospective cohort design, utilized hospitalized patients, and reported at least one of our defined outcomes. Data for each study were abstracted independently by three investigators. At least three studies were used in the analysis of each outcome. Applying a Mantel-Haenszel chi 2 analysis, use of transparent dressings on central venous catheters was significantly associated with an elevated relative risk (RR) of catheter tip infection (RR = 1.78; 95% confidence interval [CI], 1.38 to 2.30). Catheter-related sepsis (RR = 1.69; 95% CI, 0.97 to 2.95) and bacteremia (RR = 1.63; 95% CI, 0.76 to 3.47) were both associated with an elevated RR. Use of transparent dressings on peripheral catheters was associated with an elevated RR of catheter-tip infection (RR = 1.53; 95% CI, 1.18 to 1.99) but not phlebitis (RR = 1.02; 95% CI, 0.86 to 1.20), infiltration (RR = 1.12; 95% CI, 0.92 to 1.37), or skin colonization (RR = 0.99; 95% CI, 0.90 to 1.09). The results demonstrated a significantly increased risk of catheter-tip infection with the use of transparent compared with gauze dressings when used with either central or peripheral catheters. An increased risk of bacteremia and catheter sepsis associated with the use of

  17. Effect of Catheter Gauge on the Success of Intravenous Catheter Placement by Veterinary Students.

    Science.gov (United States)

    Hofmeister, Erik H; Quandt, Jane

    2017-11-03

    The purposes of this study were to determine if senior veterinary students find it easier to place a smaller-bore catheter, and to relate patient variables with student success in catheter placement. For dogs between 10 kg and 20 kg, the catheter size options were 20 gauge or 22 gauge. For dogs larger than 20 kg, the catheter size options were 18 gauge or 20 gauge. Variables recorded included time for catheter placement, number of catheterization attempts, number of catheters used, number of legs used, difficulty of catheterization, student success, and patient characteristics including signalment, weight, body condition score, premedication drugs given, tentative diagnosis, and procedure. If the student could not place an IV catheter after three attempts, it was graded as a student catheter placement failure. For the 55 students participating in the study over 28 months, we recorded 192 individual catheterization attempts. In small patients, students were successful in 19/20 attempts with 22-gauge catheters and in 24/30 with 20-gauge catheters. In large patients, students were successful in 59/68 attempts with 20-gauge catheters and 61/74 with 18-gauge catheters. The overall success rate was 164/192 (85%). Students were more likely to be successful when attempting placement in those dogs receiving acepromazine than in those not receiving acepromazine (p=.02). There were no significant differences among any of the other variables for difficulty, placement time, number of attempts, or student success. Clinicians and educators may select a size catheter for the patient without concern for the effects on student catheter placement success.

  18. Performing Gram stain directly on catheter tips: assessment of the quality of the observation process.

    Science.gov (United States)

    Guembe, M; Pérez-Granda, M J; Rivera, M L; Martín-Rabadán, P; Bouza, E

    2015-06-01

    A previous study performed in our institution showed that catheter tip (CT) staining by combining acridine orange and Gram stain (GS) before culture anticipated catheter colonization with exhaustive and careful observation by a highly trained technician. Our objective was to assess the validity values of GS without acridine orange on an external smear of CT for predicting catheter colonization and catheter-related bloodstream infection (C-RBSI). We compared different periods of observation and the results of two technicians with different levels of professional experience. Over a 5-month period, the roll-plate technique was preceded by direct GS of all CTs sent to the microbiology laboratory. The reading was taken at ×100 by two observers with different skill levels. Each observer performed a routine examination (3 min along three longitudinal lines) and an exhaustive examination (5 min along five longitudinal lines). The presence of at least one cell was considered positive. All slides were read before culture results were known. We included a total of 271 CTs from 209 patients. The prevalence of catheter colonization and C-RBSI was 16.2 % and 5.1 %, respectively. Routine and exhaustive examinations revealed only 29.5 % and 40.9 % of colonized catheters, respectively (p staining is performed exhaustively. However, the decision to implement this approach in daily routine will depend on the prevalence rate of catheter colonization at each institution.

  19. Bi-layer sandwich film for antibacterial catheters.

    Science.gov (United States)

    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.

  20. Bi-layer sandwich film for antibacterial catheters

    Directory of Open Access Journals (Sweden)

    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.

  1. Transvaginal closure of urethra and correction of uterovaginal prolapse in neurologically impaired patient with chronic indwelling catheter.

    Science.gov (United States)

    Kubal, U; Arunkalaivanan, A S; Baptiste, M

    2009-08-01

    We report the case of a 38-year-old neurologically impaired woman with continuous urinary incontinence as a result of a chronic indwelling catheter for neurogenic bladder. Long-term catheter resulted in dilatation of urethra and pressure necrosis of urethra, with subsequent incontinence despite the catheter. She also had a stage 3 uterovaginal prolapse. She underwent cystoscopy, closure of urethra and bladder neck by transvaginal route (Feneley procedure), insertion of a suprapubic catheter, sacrospinous fixation and posterior colporrhaphy with prolene mesh (Apogee). Vaginal hysterectomy was declined by the patient and her family. She remained dry at follow-up visit and is happy with the outcome.

  2. Broken Wings: First Reported Cases of Fractured Angel®Catheters, a Temporary Combined Femoral Venous Catheter and Retrievable IVC Filter Device.

    Science.gov (United States)

    Akhtar, Mohammed Rashid; Tun, Jimmy Kyaw; Alchanan, Riad; Jaffer, Ounali; Patel, Snehal; Chun, Joo-Young; Bunker, Nicholas; Fotheringham, Tim

    2018-03-14

    There has been increasing use of a novel combined femoral venous sheath, catheter and retrievable self-expanding and collapsible diamond-shaped IVC filter (Angel ® Catheter, BiO2 Medical), in severely injured patients who cannot receive anticoagulation. As the filter is not detached from the catheter/sheath, it should be easily retrieved. Outcomes included in large registries demonstrate a high safety profile and a 100% retrieval rate. However, at our institution-a Level 1 major UK trauma centre with 4 years of substantial experience in using this device-we've encountered three cases of device fracture and subsequent complicated retrieval dating from Dec 2016 to March 2017. To the best of the authors' knowledge, we describe the first documented case series of fractured Angel ® Catheters and their retrieval.

  3. Is 2% chlorhexidine gluconate in 70% isopropyl alcohol more effective at preventing central venous catheter-related infections than routinely used chlorhexidine gluconate solutions: A pilot multicenter randomized trial (ISRCTN2657745)?

    Science.gov (United States)

    McCann, Margaret; Fitzpatrick, Fidelma; Mellotte, George; Clarke, Michael

    2016-08-01

    A pilot randomized trial in 3 Irish outpatient hemodialysis units compared 2% chlorhexidine gluconate (CHG) in 70% isopropyl alcohol with routinely used CHG solutions for central venous catheter exit site antisepsis. We found no significant difference between the groups for the prevention of catheter-related bloodstream infections (1/53 vs 2/52; relative risk [RR], 0.49; 95% confidence interval [CI], 0.05-5.25; P = .55) and catheter-associated bloodstream infections (1/53 vs 4/52; RR, 0.25; 95% CI, 0.03-2.12; P = .16). Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  4. CENTRAL VENOUS CATHETER AS A VASCULAR APPROACH TO HEMODIALYSTS

    Directory of Open Access Journals (Sweden)

    Verica Djordjevic

    2001-03-01

    Full Text Available The application of the central venous catheter (CVC as a temporary orpermanent vascular approach to hemodialysis has been practiced in our Center since1994. So far 30 (12,6% patients have been thus treated. The primary application hasbeen done in 25 patients, namely: the first making of the A V fistula has been done in16, the ABT in 6, while the vascular approach correction in 3 patients. The secondaryapplication has been done in 5 patients. The infection episode incidence concerningthe CVC application is 20 infections per 1.000 patients. This is the upper limitaccording to the data given in the literature (5, rang 3-20. The average duration of thecatheter is 21 + - 13 days (rang 1-47. Two-volume catheters have been used for ajugular approach though less often for a femoral one. The unsuccessful placing due tothe catheter thrombosis has occurred in 4 patients, the catheter drop-out and itsreplacing have been done in 2 patients, while no replacement has happened in onečaše. The treatment has been stopped in one patient. Tn four patients the cerebrovascularinsult has happened after placing the CVC. The mortality rate is 26,6%,that is, K patients, namely: 4 due to cerebrovascular insult, one due to lung emboly,one due to heart weakness and one due to the sepsis from the V fistula. One patientdied at home for unknown reason. A high infection episode incidence rate is related toinadequate patients' placing so that their location in the rooms for intensive care is away of reducing it. It is necessary to provide for general aseptic procedure at work aswell as for betterment of the accompanying procedures (hemoculture, antibiograms,sterilization in order to maintain a safe catheter function.

  5. Radiological Interventions for Correction of Central Venous Port Catheter Migrations

    International Nuclear Information System (INIS)

    Gebauer, Bernhard; Teichgraeber, Ulf Karl; Podrabsky, Petr; Werk, Michael; Haenninen, Enrique Lopez; Felix, Roland

    2007-01-01

    The purpose of the study is to evaluate radiological-interventional central venous port catheter corrections in migrated/malpositioned catheter tips. Thirty patients with migrated/malpositioned port catheter tips were included in this retrospective analysis. To visualize the catheter patency, a contrast-enhanced port catheter series was performed, followed by transfemoral port catheter correction with various 5F angiographic catheters (pigtail, Sos Omni), goose-neck snare, or combinations thereof. One patient showed spontaneous reposition of the catheter tip. In 27 of 29 patients (93%), radiological-interventional port catheter correction was successful. In two patients, port catheter malposition correction was not possible because of the inability to catch either the catheter tip or the catheter in its course, possibly due to fibrin sheath formation with attachment of the catheter to the vessel wall. No disconnection or port catheter dysfunction was observed after correction. In migrated catheter tips, radiological-interventional port catheter correction is a minimally invasive alternative to port extraction and reimplantation. In patients with a fibrin sheath and/or thrombosis, port catheter correction is often more challenging

  6. Convexity Adjustments for ATS Models

    DEFF Research Database (Denmark)

    Murgoci, Agatha; Gaspar, Raquel M.

    . As a result we classify convexity adjustments into forward adjustments and swaps adjustments. We, then, focus on affine term structure (ATS) models and, in this context, conjecture convexity adjustments should be related of affine functionals. In the case of forward adjustments, we show how to obtain exact...... formulas. Concretely for LIBOR in arrears (LIA) contracts, we derive the system of Riccatti ODE-s one needs to compute to obtain the exact adjustment. Based upon the ideas of Schrager and Pelsser (2006) we are also able to derive general swap adjustments useful, in particular, when dealing with constant...

  7. [Frequency of colonization and isolated bacteria from the tip of the epidural catheter implanted for postoperative analgesia].

    Science.gov (United States)

    Stabille, Débora Miranda Diogo; Filho, Augusto Diogo; Mandim, Beatriz Lemos da Silva; Araújo, Lúcio Borges de; Mesquita, Priscila Miranda Diogo; Jorge, Miguel Tanús

    2015-01-01

    The increased use of epidural analgesia with catheter leads to the need to demonstrate the safety of this method and know the incidence of catheter colonization, inserted postoperatively for epidural analgesia, and the bacteria responsible for this colonization. From November 2011 to April 2012, patients electively operated and maintained under epidural catheter for postoperative analgesia were evaluated. The catheter tip was collected for semiquantitative and qualitative microbiological analysis. Of 68 cultured catheters, six tips (8.8%) had positive cultures. No patient had superficial or deep infection. The mean duration of catheter use was 43.45hours (18-118) (p=0.0894). The type of surgery (contaminated or uncontaminated), physical status of patients, and surgical time showed no relation with the colonization of catheters. Microorganisms isolated from the catheter tip were Staphylococcus aureus, Pseudomonas aeruginosa and Sphingomonas paucimobilis. Postoperative epidural catheter analgesia, under this study conditions, was found to be low risk for bacterial colonization in patients at surgical wards. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  8. The incidence of symptomatic upper limb venous thrombosis associated with midline catheter: Prospective observation.

    Science.gov (United States)

    Lisova, Katerina; Hromadkova, Jaroslava; Pavelková, Katerina; Zauška, Vladimir; Havlin, Jan; Charvat, Jiri

    2018-03-01

    The evaluation of the incidence of symptomatic upper limb venous thrombosis (ULVT) associated with midline catheters in patients admitted to the hospital. The frequency of symptomatic ULVT diagnosed in a group of patients with midline catheters confirmed by sonographic examination in hospitalised patients at Faculty Hospital over the period of 1 year. Four hundred thirty-nine midline catheters were inserted in 430 patients (250 women and 180 men) during year 2015. Nine patients had two midline catheters. The average age of the patient was 68 years (range: 19-96 years). The median time of midline catheter introduction into a vein was 10 days (range: 1-112 days). Symptomatic thrombosis was diagnosed in 20 patients (4.5%), 3.3/1000 catheter days. It was associated with gender (male) and midline insertion in the cephalic vein. The risk of upper limb symptomatic thrombosis associated with midline catheters during a stay in the hospital should be taken into consideration when indicating optimal venous access.

  9. Protein adsorption on ex vivo catheters and polymers exposed to peritoneal dialysis effluent.

    Science.gov (United States)

    Yanagisawa, Naoko; Li, Dai-Qing; Ljungh, Asa

    2004-01-01

    Deposition of proteins on surfaces of medical devices has been recognized to putatively relate to the process of regulation of biomaterial-associated complications by attachment of fibrin clots, eukaryotic cells, and microbes. The molecules adsorb to a varying extent, depending not only on the physicochemical properties of the biomaterial, but also on the composition of the host fluid. Adsorption of proteins on catheters exposed both ex vivo and in vitro to dialysate of patients on peritoneal dialysis (PD) was studied. Peritoneal dialysis effluent was collected from 5 patients with end-stage renal disease on continuous ambulatory PD. Tenckhoff catheters were obtained from 16 patients. Deposition of proteins on excised Tenckhoff catheters and tubing of different materials exposed to PD effluent in vitro was studied using 125iodine-labeled antibodies. Adhesion of Staphylococcus aureus and Staphylococcus epidermidis strains was quantified on tubing exposed to PD effluent in vitro. The presence of albumin, transferrin, immunoglobulin G, fibrinogen, fibronectin, von Willebrand factor, vitronectin, and thrombospondin was determined at various concentrations in PD effluent. All proteins analyzed were detected on PD catheters removed from patients. The extent of protein deposition on Tenckhoff catheters exposed to PD effluent, in vitro, rapidly reached a plateau and remained constant, as it did on polyvinyl chloride and polyethylene tubing. Adhesion of staphylococci was enhanced on Tenckhoff catheters exposed to PD effluent compared to unused PD solution. The data identify surface exposed proteins that may serve as adhesion sites for microbes on peritoneal catheters indwelled in patients undergoing PD.

  10. Intra-vesical knot of bladder catheter in an extremely low birthweight neonate: A case report

    Directory of Open Access Journals (Sweden)

    Paula M.Y. Tang

    2015-07-01

    Full Text Available Premature and extremely low birth weight (ELBW neonates are at high risk of developing multiple co-morbidities and often require urinary catheterization for various medical indications. Intra-vesical knotting of bladder catheter is a known but uncommon complication of this procedure. We report a case of an ELBW baby boy with a knotted bladder catheter requiring surgical retrieval. After an elective operation for the closure of patent ductus arteriosus, a 4 French urinary catheter was inserted into an ELBW baby boy for urine output monitoring and left in-situ. Resistance was encountered in attempt to remove the urinary catheter. Abdominal X Ray confirmed intra-vesical knotting of the tube. Knot unravelling by interventional radiology was attempted but was unsuccessful. Open extra-peritoneal bladder exploration was performed for the retrieval of the tightly knotted catheter. A 6 French transurethral Foley catheter was inserted for bladder drainage. Upon removal of the Foley's catheter on day 5 post op, the baby was able to void spontaneously. With literature review, we postulated the potential risk factors resulting in this potentially avoidable iatrogenic unusual complication. Recommendations were suggested to avoid further incidences.

  11. Pigtail Catheter: A Less Invasive Option for Pleural Drainage in Egyptian Patients with Recurrent Hepatic Hydrothorax

    Directory of Open Access Journals (Sweden)

    Mohamed Sharaf-Eldin

    2016-01-01

    Full Text Available Background and Aims. Treatment of hepatic hydrothorax is a clinical challenge. Chest tube insertion for hepatic hydrothorax is associated with high complication rates. We assessed the use of pigtail catheter as a safe and practical method for treatment of recurrent hepatic hydrothorax as it had not been assessed before in a large series of patients. Methods. This study was conducted on 60 patients admitted to Tanta University Hospital, Egypt, suffering from recurrent hepatic hydrothorax. The site of pigtail catheter insertion was determined by ultrasound guidance under complete aseptic measures and proper local anesthesia. Insertion was done by pushing the trocar and catheter until reaching the pleural cavity and then the trocar was withdrawn gradually while inserting the catheter which was then connected to a collecting bag via a triple way valve. Results. The use of pigtail catheter was successful in pleural drainage in 48 (80% patients with hepatic hydrothorax. Complications were few and included pain at the site of insertion in 12 (20% patients, blockage of the catheter in only 2 (3.3% patients, and rapid reaccumulation of fluid in 12 (20% patients. Pleurodesis was performed on 38 patients with no recurrence of fluid within three months of observation. Conclusions. Pigtail catheter insertion is a practical method for treatment of recurrent hepatic hydrothorax with a low rate of complications. This trial is registered with ClinicalTrials.gov Identifier: NCT02119169.

  12. Previous PICC placement may be associated with catheter-related infections in hemodialysis patients.

    Science.gov (United States)

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

    2011-02-01

    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. 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. 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 PICC placement. There was no difference between the two groups in age or number of catheters placed. Previous PICC placement may be associated with catheter-related infections in hemodialysis patients.

  13. 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.

  14. Reducing catheter-associated urinary tract infections in a neuro-spine intensive care unit.

    Science.gov (United States)

    Schelling, Kimberly; Palamone, Janet; Thomas, Kathryn; Naidech, Andrew; Silkaitis, Christina; Henry, Jennifer; Bolon, Maureen; Zembower, Teresa R

    2015-08-01

    A collaborative effort reduced catheter-associated urinary tract infections in the neuro-spine intensive care unit where the majority of infections occurred at our institution. Our stepwise approach included retrospective data review, daily rounding with clinicians, developing and implementing an action plan, conducting practice audits, and sharing of real-time data outcomes. The catheter-associated urinary tract infection rate was reduced from 8.18 to 0.93 per 1,000 catheter-days and standardized infection ratio decreased from 2.16 to 0.37. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  15. Central Venous Catheter Retention and Mortality in Children With Candidemia: A Retrospective Cohort Analysis.

    Science.gov (United States)

    Fisher, Brian T; Vendetti, Neika; Bryan, Matthew; Prasad, Priya A; Russell Localio, A; Damianos, Andreas; Coffin, Susan E; Bell, Louis M; Walsh, Thomas J; Gross, Robert; Zaoutis, Theoklis E

    2016-12-01

    Candidemia causes significant morbidity and mortality among children. Removal of a central venous catheter (CVC) is often recommended for adults with candidemia to reduce persistent and metastatic infection. Pediatric-specific data on the impact of CVC retention are limited. A retrospective cohort study of inpatients candidemia at the Children's Hospital of Philadelphia between 2000 and 2012 was performed. The final cohort included patients that had a CVC in place at time of blood culture and retained their CVC at least 1 day beyond the blood culture being positive. A structured data collection instrument was used to retrieve patient data. A discrete time failure model, adjusting for age and the complexity of clinical care before onset of candidemia, was used to assess the association of CVC retention and 30-day all-cause mortality. Two hundred eighty-five patients with candidemia and a CVC in place at the time of blood culture were identified. Among these 285 patients, 30 (10%) died within 30 days. Central venous catheter retention was associated with a significant increased risk of death on a given day (odds ratio, 2.50; 95% confidence interval, 1.06-5.91). Retention of a CVC was associated with an increased risk of death after adjusting for age and complexity of care at candidemia onset. Although there is likely persistence of unmeasured confounding, given the strong association between catheter retention and death, our data suggest that early CVC removal should be strongly considered. © The Author 2015. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  16. Development of an X-Ray Catheter Final Report CRADA No. TC-1265-96

    Energy Technology Data Exchange (ETDEWEB)

    Trebes, J. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Schlossberg, M. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2017-11-01

    Toe goal of this CRADA project was to develop a catheter-based x-ray source to provide treatment of restenosis in arteries with a radiation source which can be precisely controlled and turned on and off at will.

  17. Accuracy of chest radiography for positioning of the umbilical venous catheter

    Directory of Open Access Journals (Sweden)

    Adriana F.M. Guimarães

    Full Text Available Abstract Objectives: To evaluate the accuracy of the simultaneous analysis of three radiographic anatomical landmarks - diaphragm, cardiac silhouette, and vertebral bodies - in determining the position of the umbilical venous catheter distal end using echocardiography as a reference standard. Methods: This was a cross-sectional, observational study, with the prospective inclusion of data from all neonates born in a public reference hospital, between April 2012 and September 2013, submitted to umbilical venous catheter insertion as part of their medical care. The position of the catheter distal end, determined by the simultaneous analysis of three radiographic anatomical landmarks, was compared with the anatomical position obtained by echocardiography; sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Results: Of the 162 newborns assessed by echocardiography, only 44 (27.16% had the catheter in optimal position, in the thoracic portion of the inferior vena cava or at the junction of the inferior vena cava with the right atrium. The catheters were located in the left atrium and interatrial septum in 54 (33.33% newborns, in the right atrium in 26 (16.05%, intra-hepatic in 37 (22.84%, and intra-aortic in-one newborn (0.62%. The sensitivity, specificity and accuracy of the radiography to detect the catheter in the target area were 56%, 71%, and 67.28%, respectively. Conclusion: Anteroposterior radiography of the chest alone is not able to safely define the umbilical venous catheter position. Echocardiography allows direct visualization of the catheter tip in relation to vascular structures and, whenever possible, should be considered to identify the location of the umbilical venous catheter.

  18. Accuracy of chest radiography for positioning of the umbilical venous catheter.

    Science.gov (United States)

    Guimarães, Adriana F M; Souza, Aline A C G de; Bouzada, Maria Cândida F; Meira, Zilda M A

    To evaluate the accuracy of the simultaneous analysis of three radiographic anatomical landmarks - diaphragm, cardiac silhouette, and vertebral bodies - in determining the position of the umbilical venous catheter distal end using echocardiography as a reference standard. This was a cross-sectional, observational study, with the prospective inclusion of data from all neonates born in a public reference hospital, between April 2012 and September 2013, submitted to umbilical venous catheter insertion as part of their medical care. The position of the catheter distal end, determined by the simultaneous analysis of three radiographic anatomical landmarks, was compared with the anatomical position obtained by echocardiography; sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Of the 162 newborns assessed by echocardiography, only 44 (27.16%) had the catheter in optimal position, in the thoracic portion of the inferior vena cava or at the junction of the inferior vena cava with the right atrium. The catheters were located in the left atrium and interatrial septum in 54 (33.33%) newborns, in the right atrium in 26 (16.05%), intra-hepatic in 37 (22.84%), and intra-aortic in-one newborn (0.62%). The sensitivity, specificity and accuracy of the radiography to detect the catheter in the target area were 56%, 71%, and 67.28%, respectively. Anteroposterior radiography of the chest alone is not able to safely define the umbilical venous catheter position. Echocardiography allows direct visualization of the catheter tip in relation to vascular structures and, whenever possible, should be considered to identify the location of the umbilical venous catheter. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  19. Retained Fractured Fragment of A Central Venous Catheter: A ...

    African Journals Online (AJOL)

    BACKGROUND: Complication following fracture of a central venous catheter can be catastrophic to both the patient and the attending doctor. Catheter fracture has been attributed to several factors namely prolong mechanical force acting on the catheter, and forceful removal or insertion of the catheter. CASE DETAILS: In ...

  20. 21 CFR 870.1290 - Steerable catheter control system.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Steerable catheter control system. 870.1290... catheter control system. (a) Identification. A steerable catheter control system is a device that is connected to the proximal end of a steerable guide wire that controls the motion of the steerable catheter...

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

    African Journals Online (AJOL)

    J.O. Bello

    duration of catheter use and median out-of-pocket payment per catheter change was 65 years (range 20–90 years), 12 months (range .... pocket payments per catheter change and reasons for prolonged catheter use was collected. ... ing almost half (44.7%) of the average annual income of an adult in the study region of ...

  2. 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

  3. Percutaneous catheter dilatation of carotid stenoses

    International Nuclear Information System (INIS)

    Mathias, K.; Mittermayer, C.; Ensinger, H.; Neff, W.

    1980-01-01

    Thirty-one carotid artery stenoses were produced in thirty dogs by three different techniques. Twenty-three of these could be cured by transfemoral percutaneous catheter dilatation. High grade tight stenoses may present resistance which cannot be overcome by the catheter. Histological examination of the dilated vessels showed circumscribed changes in the vessel wall, with destruction of elastic membranes. From our experience of catheter dilatation of pelvic and lower limb arteries and of renal arteries, we consider it feasible to use this technique in selected patients with carotid stenosis. (orig.) [de

  4. Cryoballoon Catheter Ablation in Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    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.

  5. Antimicrobial Efficacy of a New Chlorhexidine-based Device Against Staphylococcus aureus Colonization of Venous Catheters

    Science.gov (United States)

    Kowalewska, Paulina M.; Petrik, Shawn M.; Di Fiore, Attilio E.; Fox-Robichaud, Alison E.

    2018-01-01

    Vascular catheters are a major cause of nosocomial bloodstream infections. ChloraLock (ATTWILL Medical Solutions, Inc, West Jordan, UT, and ICU Medical, Inc, San Clemente, CA) is a novel antimicrobial device containing chlorhexidine digluconate (CHG) that is fitted onto a syringe and infuses CHG into the catheter lumen during locking. The objective of this study was to evaluate the antimicrobial efficacy of ChloraLock with in vitro tests and its ability to reduce Staphylococcus aureus contamination of catheters in the external jugular veins of Yorkshire swine. ChloraLock significantly reduced the bacterial load in the in vitro tests by up to 6 log10 colony-forming units (CFU) and by 3 to 4 log10 CFU/lumen in vivo in a swine model with 0.9% NaCl catheter locks. PMID:29489705

  6. Catheter-based flow measurements in hemodialysis fistulas - Bench testing and clinical performance

    DEFF Research Database (Denmark)

    Heerwagen, Søren T; Lönn, Lars; Schroeder, Torben V

    2012-01-01

    Purpose: The purpose of this study was to perform bench and clinical testing of a catheter-based intravascular system capable of measuring blood flow in hemodialysis vascular accesses during endovascular procedures. Methods: We tested the Transonic ReoCath Flow Catheter System which uses...... the thermodilution method. A simulated vascular access model was constructed for the bench test. In total, 1960 measurements were conducted and the results were used to determine the accuracy and precision of the catheters, the effects of external factors (e.g., catheter placement, injection duration), and to test....... Blood flow measurements provide unique information on the hemodynamic status of a vascular access and have the potential to optimize results of interventions....

  7. Impact of balloon inflation pressure on cell viability with single and multi lumen catheters.

    Science.gov (United States)

    Dib, N; Schwalbach, D B; Plourde, B D; Kohler, R E; Dana, D; Abraham, J P

    2014-12-01

    Infusion catheters, when used in combination with balloons, are subjected to pressure created by inflation of the balloon. The compression can reduce the catheter flow area and cause elevated shear stresses in the fluid. A model and experiments were developed with a range of applied balloon pressures to investigate whether such situations may cause cell lysis during stem-cell infusion through single-lumen catheters. It was found that for balloon inflation pressures in excess of ~7 atm, it is possible for cell injury to occur, although the critical pressure depends on the fluid viscosity. The study was then applied to a multi-lumen catheter which was designed to resist compression. That device was able to handle very elevated balloon pressures and flow rates before cell lysis became a concern.

  8. DSGE modeling at the fund

    CERN Document Server

    Botman, Dennis P J; Laxton, Douglas; Karam, Philippe D

    2007-01-01

    Researchers in policymaking institutions have expended significant effort to develop a new generation of macro models with more rigorous microfoundations. This paper provides a summary of the applications of two of these models. The Global Economy Model is a quarterly model that features a large assortment of nominal and real rigidities, which are necessary to create plausible short-run dynamics. However, because this model is based on a representative-agent paradigm, its Ricardian features make it unsuitable to study many fiscal policy issues. The Global Fiscal Model, which is an annual model

  9. Does age at the time of elective cardiac surgery or catheter intervention in children influence the longitudinal development of psychological distress and styles of coping of parents?

    NARCIS (Netherlands)

    Utens, Elisabeth M.; Versluis-den Bieman, Herma J.; Witsenburg, Maarten; Bogers, Ad J. J. C.; Hess, John; Verhulst, Frank C.

    2002-01-01

    To assess the influence of age at a cardiac procedure of children, who underwent elective cardiac surgery or interventional cardiac catheterisation for treatment of congenital cardiac defects between 3 months and 7 years of age, on the longitudinal development of psychological distress and styles of

  10. 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.

  11. THE KISSING BALLOON TECHNIQUE WITH 2 OVER-THE-WIRE BALLOON CATHETERS THROUGH A SINGLE 8-FRENCH GUIDING CATHETER

    NARCIS (Netherlands)

    DENHEIJER, P; BERNINK, PJLM; VANDIJK, RB; TWISK, SPM; LIE, KI

    Some of the newer over-the-wire coronary angioplasty catheters have shaft sizes of 3.0 French (F) or less. The inner diameter of modern 8-F guiding catheters is large enough to accommodate two of such balloon catheters. We report a kissing balloon procedure with two over-the-wire catheters through a

  12. Modeling subsurface contamination at Fernald

    International Nuclear Information System (INIS)

    Jones, B.W.; Flinn, J.C.; Ruwe, P.R.

    1994-01-01

    The Department of Energy's Fernald site is located about 20 miles northwest of Cincinnati. Fernald produced refined uranium metal products from ores between 1953 and 1989. The pure uranium was sent to other DOE sites in South Carolina, Tennessee, Colorado,and Washington in support of the nation's strategic defense programs. Over the years of large-scale uranium production, contamination of the site's soil and groundwater occurred.The contamination is of particular concern because the Fernald site is located over the Great Miami Aquifer, a designated sole-source drinking water aquifer. Contamination of the aquifer with uranium was found beneath the site, and migration of the contamination had occurred well beyond the site's southern boundary. As a result, Fernald was placed on the National Priorities (CERCLA/Superfund) List in 1989. Uranium production at the site ended in 1989,and Fernald's mission has been changed to one of environmental restoration. This paper presents information about computerized modeling of subsurface contamination used for the environmental restoration project at Fernald

  13. Use of a contact force-sensing ablation catheter with advanced catheter location significantly reduces fluoroscopy time and radiation dose in catheter ablation of atrial fibrillation.

    Science.gov (United States)

    Lee, Geoffrey; Hunter, Ross J; Lovell, Matthew J; Finlay, Malcom; Ullah, Waqas; Baker, Victoria; Dhinoja, Mehul B; Sporton, Simon; Earley, Mark J; Schilling, Richard J

    2016-02-01

    The aim of this study was to evaluate the 'real-world' impact of a novel contact force (CF)-sensing (SmartTouch™, Biosense Webster, Diamond Bar, CA, USA) catheter coupled with an advanced catheter location (ACL) system on fluoroscopy time and fluoroscopy dose during atrial fibrillation (AF) ablation. This was a retrospective observational cohort study of prospectively collected data of 1515 consecutive patients undergoing paroxysmal AF (PAF) and persistent AF (PerAF) ablation at a single institution between 2009 and 2014. Patients undergoing AF ablation with the SmartTouch catheter and the ACL system (SmartTouch group, n = 510) were compared with those undergoing AF ablation without this technology (control group, n = 1005). The primary outcomes were total fluoroscopy time (min) and fluoroscopy dose as measured by the dose-area product (mGy cm(2)). Secondary endpoints included total procedure time, total ablation time, and major cardiac complications (tamponade, pericardial effusion, and urgent cardiac surgery). The SmartTouch group had significantly lower fluoroscopy times (9.5 vs. 41 min, P fluoroscopy time of 3.5 min (interquartile range 6) for all AF ablations was achieved. There was no difference in the rate of cardiac complications (∼ 1.5%). SmartTouch™ CF-sensing catheter use with ACL™ during AF ablation significantly reduces fluoroscopy times by 77%, radiation dose by 71%, and procedural time by 19% but does not improve overall safety or the risk of cardiac complications. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  14. 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

  15. Preliminary experiment with a newly developed double balloon, double lumen catheter for extracorporeal life support vascular access.

    Science.gov (United States)

    Okamoto, Taisuke; Ichinose, Keisuke; Tanimoto, Hironari; Yoshitake, Atsushi; Sakanashi, Yuji; Tashiro, Masafumi; Terasaki, Hidenori

    2003-01-01

    Recently, venovenous extracorporeal life support (VVECLS) using a double lumen catheter has been clinically used to avoid neurologic complications in the treatment of respiratory failure for neonates. However, recirculation, which is a limiting factor for oxygen delivery, still exists, and thus it does not contribute to oxygenation of the patient. We developed a newly designed double lumen catheter with a double balloon (DBDL) catheter for ECLS vascular access and performed two animal preliminary experiments in normal and hypoxic dog models (normal ventilation and one lung ventilation experiments) to investigate whether the DBDL catheter could prevent recirculation and maintain oxygen delivery to systemic circulation. The DBDL catheter (JCT Co., Hiroshima, Japan) of 15 Fr was fabricated from silicone. It consists of two lumens for drainage and return of blood with two balloons (distal and proximal balloons) that prevent oxygenated blood mixing with unoxygenated blood. VVECLS using a DBDL catheter was performed in 13 mongrel dogs (8 dogs for normal ventilation experiment weighing 12.9 +/- 1.6 kg [mean +/- SD], 5 dogs for one lung ventilation experiment weighing 16.6 +/- 2.5 kg [mean +/- SD]) under anesthesia in the two experiments. The bypass flow ranged from 10-40 ml/kg per minute in the normal ventilation experiment. VVECLS in the one lung ventilation experiment was performed with maximal bypass flow for 6 hours (ranged from 25.2 +/- 8.0-28.3 +/- 8.7 ml/kg per minute at balloon inflation and deflation). Recirculation and oxygen transfer of artificial lung with or without balloon inflation during VVECLS were studied. Recirculation decreased with balloon inflation at varied bypass flows during VVECLS in the normal ventilation experiment (varied from 1.5 +/- 14.6-12.8 +/- 16.7%) and for 6 hours after VVECLS initiation in the one lung ventilation experiment (varied from 12.2 +/- 12.2-19.2 +/- 6.5%). In particular, the values at 3 and 6 hours were significantly lower

  16. Identification and Radiofrequency Catheter Ablation of a Nonsustained Atrial Tachycardia at the Septal Mitral Annulus with the Use of a Noncontact Mapping System: A Case Report

    Directory of Open Access Journals (Sweden)

    Sumito Narita, MD

    2008-01-01

    Full Text Available Here we report a case of a 16-year old female with symptomatic nonsustained atrial tachycardia (NSAT originating from the septal mitral annulus. NSAT was induced by atrial burst pacing after an intravenous isoproterenol (ISP injection. The array mode of the noncontact mapping system (NCM allowed us to quickly identify the tachycardia focus at the septal mitral annulus, where the contact bipolar voltage map revealed no low voltage area (<0.5 mV. The NSAT was eliminated by a radiofrequency energy application to the identified tachycardia focus during sinus rhythm, and the patient has been free from any symptoms during 10 months of follow-up.

  17. Symptomatic spinal cord deformity secondary to a redundant intramedullary shunt catheter

    International Nuclear Information System (INIS)

    Quencer, R.M.; Montalvo Morse, B.M.; Green, B.A.; Eismont, F.J.

    1985-01-01

    Right arm pain, motor and sensory loss in the right arm and right facial numbness recurred in a 27 year old quadraplegic shortly after a posttraumatic spinal cord cyst (PTSCC) was shunted via a catheter into the adjacent subarachnoid space. Although shunt malfunction was clinically suspected, metrizamide computed tomography (MCT) suggested that redundancy of the catheter had caused deformity of the spinal cord. This hypothesis was confirmed at surgery when intraoperative spinal sonography (IOSS) showed that the spinal cord deformity at C 1 -C 2 disappeared when the catheter was withdrawn. This case shows that new or recurrent spinal cord symptoms may be due to a mechanical deformity of the cord rather than shunt malfunction, that restricting the length of the shunt catheter which is used to decompress PTSCCs is important, and that IOSS is an indispensible tool for visualizing the changes in spinal cord morphology during shunting procedures. (orig.)

  18. Intravascular catheter-related bloodstream infection.

    Science.gov (United States)

    Shah, Harshal; Bosch, Wendelyn; Thompson, Kristine M; Hellinger, Walter C

    2013-07-01

    Intravascular catheters required for the care of many hospitalized patients can give rise to bloodstream infection, a complication of care that has occurred most frequently in intensive care unit (ICU) settings. Elucidation of the pathogenesis of catheter-related bloodstream infections (CRBSIs) has guided development of effective diagnostic, management, and prevention strategies. When CRBSIs occur in the ICU, physicians must be prepared to recognize and treat them. Prevention of these infections requires careful attention to optimal catheter selection, insertion and maintenance, and to removal of catheters when they are no longer needed. This review provides a succinct summary of the epidemiology, pathogenesis, and microbiology of CRBSIs and a review of current guidance for the diagnosis, management, and prevention of these infections.

  19. Catheter-Associated Urinary Tract Infections

    Science.gov (United States)

    ... Vaccine Safety Frequently Asked Questions about Catheter-associated Urinary Tract Infections Recommend on Facebook Tweet Share Compartir What is ... an incision above the pubis. What is a urinary tract infection? A urinary tract infection (UTI) is an infection ...

  20. Peripherally inserted central catheter - dressing change

    Science.gov (United States)

    PICC - dressing change ... You have a peripherally inserted central catheter (PICC). This is a tube that goes into a vein in your arm. It carries nutrients and medicines into your body. It may also ...

  1. Persistent left superior vena cava with thrombus formed in the catheter lumen 4 h after dialysis catheter placed.

    Science.gov (United States)

    Kawasaki, Tomoki; Tanaka, Hiroyuki; Oba, Miki; Takada, Megumi; Tanaka, Haruna; Suda, Shin

    2018-02-17

    Persistent left superior vena cava (PLSVC) is one of the most common thoracic venous anomaly and rarely noticed, because it is asymptomatic. However, for nephrologists, it is frequent enough to be encountered while placing hemodialysis catheters through the jugular vein. We report the case of 66-year-old patient with PLSVC presenting intrinsic thrombosis formation 4 h after dialysis catheter placed. Dialysis catheter was placed in the left internal jugular vein without resistance and any complication. PLSVC was detected after dialysis catheter insertion. We decided to remove the catheter, because the patient has other veins in which the catheter can be placed. When it was removed 4 h after catheter placing, thrombus was recognized in the catheter lumen. Transesophageal echocardiography was performed and no thrombus formation was observed in the heart chamber. For patients with PLSVC, if there were other veins in which the catheter can be placed, catheter replacement should be considered.

  2. Biofilm Formation by Pseudomonas Species Onto Graphene Oxide-TiO2 Nanocomposite-Coated Catheters: In vitro Analysis

    Science.gov (United States)

    Deb, Ananya; Vimala, R.

    The present study focuses on the development of an in vitro model system for biofilm growth by Pseudomonas aerouginosa onto small discs of foley catheter. Catheter disc used for the study was coated with graphene oxide-titanium oxide composite (GO-TiO2) and titanium oxide (TiO2) and characterized through XRD, UV-visible spectroscopy. Morphological analysis was done by scanning electron microscopy (SEM). The biofilm formed on the catheter surface was quantified by crystal violet (CV) staining method and a colorimetric assay (MTT assay) which involves the reduction of tetrazolium salt. The catheter coated with GO-TiO2 showed reduced biofilm growth in comparison to the TiO2-coated and uncoated catheter, thus indicating that it could be successfully used in coating biomedical devices to prevent biofilm formation which is a major cause of nosocomial infection.

  3. Use of wound soaker catheters for the administration of local anesthetic for post-operative analgesia: 56 cases.

    Science.gov (United States)

    Abelson, Amanda L; McCobb, Emily C; Shaw, Scott; Armitage-Chan, Elizabeth; Wetmore, Lois A; Karas, Alicia Z; Blaze, Cheryl

    2009-11-01

    To describe the administration of local anesthetic through wound soaker catheters for post-operative veterinary patients and to characterize complications. Retrospective study of hospital records. Records of patients in which a wound soaker catheter was placed post-operatively between November 1, 2004 and July 1, 2006 at a veterinary teaching hospital. Records in which a limb amputation was performed between January 1, 2002 and August 1, 2007 and in which a wound soaker catheter was not placed were reviewed for historic control. A total of 56 cases were identified in which a wound soaker catheter was placed post-operatively including 52 dogs, 2 cats, and 2 goats. Twenty canine cases were identified in which limb amputation was performed and no wound soaker catheter was placed. The majority of surgical procedures for which a wound soaker catheter was placed included thoracic limb amputation (46.4%) and pelvic limb amputation (35.7%). Wound soaker catheters remained in place for an average of 1.6 +/- 0.5 days. Feline and caprine patients received intermittent bupivacaine boluses every 6 hours. Canine patients received continuous lidocaine infusions. Complications included disconnection of the catheter from the infusion (7.7%), one seroma, and one suspected lidocaine neurotoxicity. Incisional infections were noted in 3/56 (5.3%) limb amputations with wound soaker catheters placed which was not higher than the incisional infection rate found in the historic control cases 3/20 (15%). Use of the wound soaker catheter was a viable means of providing local analgesia in post-operative veterinary patients. Studies are needed to evaluate efficacy of pain management, and to further investigate techniques for catheter placement and maintenance which may help to optimize the analgesia achieved using this technique.

  4. REcanalisation and Balloon-Oriented Puncture for Re-Insertion of Dialysis Catheter in Nonpatent Central Veins (REBORN)

    Energy Technology Data Exchange (ETDEWEB)

    Too, Chow Wei, E-mail: toochowwei@gmail.com [Singapore General Hospital (Singapore); Sayani, Raza [Aga Khan University Hospital (Pakistan); Lim, Elvin Yuan Ting; Leong, Sum; Gogna, Apoorva [Singapore General Hospital (Singapore); Teo, Terence K. [Mount Elizabeth Novena Hospital (Singapore)

    2016-08-15

    PurposeTo describe a technique involving REcanalisation and Balloon-Oriented puncture for Re-insertion of dialysis catheter in Nonpatent central veins (REBORN) and to report long-term results.Materials and MethodsThis is a retrospective study of ten subjects in whom dialysis catheters were inserted using the REBORN technique from March 2012 to October 2014 and followed up till April 2016. Data on the duration of catheter usage, complications and reasons for removal were obtained. Seven patients had partially occluded lower internal jugular veins (IJV) recanalised in an antegrade fashion via a more cranial puncture. The balloon was then inflated at usual puncture site with an 18G needle. The collapsed balloon was cannulated with a guide wire, and both balloon and guide wire were advanced together into the superior vena cava. This was followed by tunnelled catheter placement using standard techniques. Two patients had catheters placed in the subclavian vein using a similar antegrade technique, and one patient had catheter placed via the left IJV following retrograde recanalisation from a right femoral puncture.ResultsMean duration of catheter use was 278 days (range 32–503). Three catheters were removed due to matured arteriovenous accesses. Four patients had successful catheter change over the same subcutaneous track due to catheter malfunction. One catheter was removed after 7 months because of sepsis. No complications were reported.ConclusionThe REBORN technique allows for the preservation of central veins for future haemodialysis access, which can be challenging in patients requiring long-term dialysis.

  5. REcanalisation and Balloon-Oriented Puncture for Re-Insertion of Dialysis Catheter in Nonpatent Central Veins (REBORN)

    International Nuclear Information System (INIS)

    Too, Chow Wei; Sayani, Raza; Lim, Elvin Yuan Ting; Leong, Sum; Gogna, Apoorva; Teo, Terence K.

    2016-01-01

    PurposeTo describe a technique involving REcanalisation and Balloon-Oriented puncture for Re-insertion of dialysis catheter in Nonpatent central veins (REBORN) and to report long-term results.Materials and MethodsThis is a retrospective study of ten subjects in whom dialysis catheters were inserted using the REBORN technique from March 2012 to October 2014 and followed up till April 2016. Data on the duration of catheter usage, complications and reasons for removal were obtained. Seven patients had partially occluded lower internal jugular veins (IJV) recanalised in an antegrade fashion via a more cranial puncture. The balloon was then inflated at usual puncture site with an 18G needle. The collapsed balloon was cannulated with a guide wire, and both balloon and guide wire were advanced together into the superior vena cava. This was followed by tunnelled catheter placement using standard techniques. Two patients had catheters placed in the subclavian vein using a similar antegrade technique, and one patient had catheter placed via the left IJV following retrograde recanalisation from a right femoral puncture.ResultsMean duration of catheter use was 278 days (range 32–503). Three catheters were removed due to matured arteriovenous accesses. Four patients had successful catheter change over the same subcutaneous track due to catheter malfunction. One catheter was removed after 7 months because of sepsis. No complications were reported.ConclusionThe REBORN technique allows for the preservation of central veins for future haemodialysis access, which can be challenging in patients requiring long-term dialysis.

  6. A clever technique for placement of a urinary catheter over a wire

    Directory of Open Access Journals (Sweden)

    Joel E Abbott

    2015-01-01

    Conclusion: Placing urinary catheters over a wire is standard practice for urologists, however, use of this technique gives the freedom of performing wire-guided catheterization in more situations than a council-tip allows. This technique facilitates successful transurethral catheterization over wire in the setting of DUC for all catheter types and styles aiding in urologic management of patients at a cost benefit to the health care system.

  7. Pulsatile flow in ventricular catheters for hydrocephalus

    Science.gov (United States)

    Giménez, Á.; Galarza, M.; Thomale, U.; Schuhmann, M. U.; Valero, J.; Amigó, J. M.

    2017-05-01

    The obstruction of ventricular catheters (VCs) is a major problem in the standard treatment of hydrocephalus, the flow pattern of the cerebrospinal fluid (CSF) being one important factor thereof. As a first approach to this problem, some of the authors studied previously the CSF flow through VCs under time-independent boundary conditions by means of computational fluid dynamics in three-dimensional models. This allowed us to derive a few basic principles which led to designs with improved flow patterns regarding the obstruction problem. However, the flow of the CSF has actually a pulsatile nature because of the heart beating and blood flow. To address this fact, here we extend our previous computational study to models with oscillatory boundary conditions. The new results will be compared with the results for constant flows and discussed. It turns out that the corrections due to the pulsatility of the CSF are quantitatively small, which reinforces our previous findings and conclusions. This article is part of the themed issue `Mathematical methods in medicine: neuroscience, cardiology and pathology'.

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

    Science.gov (United States)

    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.

  9. [Assertiveness and peripheral intravenous catheters dwell time with ultrasonography-guided insertion in children and adolescents].

    Science.gov (United States)

    Avelar, Ariane Ferreira Machado; Peterlini, Maria Angélica Sorgini; da Pedreira, Mavilde Luz Gonçalves

    2013-06-01

    Randomized controlled trial which aimed to verify whether the use of vascular ultrasound (VUS) increases assertiveness in the use of peripheral venous catheter in children, and the catheter dwell time, when compared to traditional puncture. Data were collected after approval of theethical merit. Children and adolescents undergoing VUS-guided peripheral intravenous (GVUS) or puncture guided by clinical assessment of the venous conditions(CG) were included in the study. Significance level was set at pAssertiveness was found in 73 (71.6%) GVUS catheters and in 84(71.8%) of the CG (p=0.970), and catheter dwell time presented a median of less than one day in both groups (p=0.121), showing nostatistically significant difference. VUS did not significantly influence the results of the dependent variables investigated. ClinicalTrials.govNCT00930254.

  10. Dosimetric impact of interfraction catheter movement and organ motion on MRI/CT guided HDR interstitial brachytherapy for gynecologic cancer

    International Nuclear Information System (INIS)

    Rey, Felipe; Chang, Chang; Mesina, Carmen; Dixit, Nayha; Kevin Teo, Boon-Keng; Lin, Lilie L.

    2013-01-01

    Purpose: To determine the dosimetric impact of catheter movement for MRI/CT image guided high dose rate (HDR) interstitial brachytherapy (ISBT) for gynecologic cancers. Materials and methods: Ten patients were treated with HDR ISBT. The CTV and organs at risk were contoured using a postimplant MRI and CT. 5 fractions were delivered twice daily on 3 consecutive days. The first fraction was delivered on day 1 (d1), fraction 2–3 on d2 and fraction 4–5 on d3. MRI/CT was acquired prior to the second and fourth fractions. Four scenarios were modeled. (1) The d1 plan was applied to the d2 and d3 CT, using the updated catheter positions. (2) Replanning was performed for d2 and d3. (3) We applied the dwell positions/times from the d2 replan over the d3 CT and compared with a d3 CT replan. (4) Based on daily MRI, target volumes were recontoured and replanned. Dosimetry was analyzed for each plan and compared to the d1 dose distribution. Results: (1) When using the d1 plan on the d2 and d3 CT with the updated catheter positions, the mean CTV D90 was reduced from 93.4% on d1 to 89.3% (p = 0.08) on d2 and to 87.7% (p = 0.005) on d3. (2) Replanning on d2 and d3 compensated for catheter movement, mean CTV D90 of 95.4% on d2 and 94.6% (p = 0.36) on d3. (3) When compared to the replan of d2 applied on the d3 CT vs the d3 replan, there was no significant difference in coverage, mean CTV D90 of 90.9% (p = 0.09). (4) Reoptimization based on daily MRI, significantly improved the CTV coverage for each day. The mean D2 cc for the rectum was significantly higher with model 1 vs model 3 59.1 ± 4.7 vs 60.9 ± 4.8 (p = 0.04) Gy EQD2. There were no significant differences in D2 cc of bladder and sigmoid between models. Conclusions: Interfraction dosimetric changes significantly decreased the CTV coverage of the third day. Rather than replanning on each day, replanning on the day 2 CT before the second or third fraction would give an optimal solution that would compensate for

  11. Trisodium citrate 46.7% selectively and safely reduces staphylococcal catheter-related bacteraemia.

    Science.gov (United States)

    Winnett, Georgia; Nolan, Jonathan; Miller, Michael; Ashman, Neil

    2008-11-01

    Trisodium citrate (TSC) 30% has been shown in a randomized control trial to be an effective antimicrobial catheter locking solution, able to significantly reduce catheter-related bacteraemia (CRB) in haemodialysis patients. Since that report, the formulation in Europe has been changed to 46.7% TSC without confirmatory data on efficacy. We report a 55 915 patient-day at risk experience in tunnelled lines of 46.7% TSC, emphasizing efficacy and changes in microbiology seen. On 1 July 2006, inter-dialytic catheter locking solution was changed from 5000 IU/ml heparin to Citra-lock(TM) (46.7% TSC) in all haemodialysis patients at Barts and the London Renal Unit dialysing through an incident or prevalent tunnelled catheter. Prospectively collected blood culture data for the 6 months prior to the switch and 3 months at the end of the first year of TSC use were analysed. TSC tolerability was excellent with only a single withdrawal for intolerance of the agent. No major adverse events were reported. A major fall in CRB rates was noticed with a change from heparin (2.13/1000 catheter-days) in 2006 to TSC (0.81/1000 catheter-days) in 2007. This was due to significant reductions in staphylococcal CRB, true for sensitive, methicillin-resistant and coagulase-negative staphylococci. No increase in catheter malfunction was observed. We found that 46.7% TSC is a safe, convenient and highly effective catheter locking solution, leading to significant reduction in CRB largely by preventing staphylococcal bloodstream infections. Given that Staphylococcus aureus in particular is associated with serious and often disseminated infection, TSC seems to be a powerful tool for dialysis units.

  12. Control of pathogen growth and biofilm formation using a urinary catheter that releases antimicrobial nitrogen oxides.

    Science.gov (United States)

    Kishikawa, Hiroaki; Ebberyd, Anette; Römling, Ute; Brauner, Annelie; Lüthje, Petra; Lundberg, Jon O; Weitzberg, Eddie

    2013-12-01

    Antibacterial nitrogen oxides including nitric oxide are formed from nitrite under acidic conditions. In a continuous-flow model of the urinary bladder we used the retention cuff of an all-silicone Foley catheter as a depot for export of nitrogen oxides. The cuff was filled with sodium nitrite (50mM) and an acidic buffer solution (pH 3.6) and the growth of nine common uropathogens in the surrounding artificial urine was measured along with biofilm formation on the catheter surface. In experiments with control catheters (NaCl) bacteria grew readily and biofilm developed within hours in five of nine strains. In contrast, with test catheters bacterial counts were markedly reduced and biofilm formation by Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterobacter cloace was prevented, whereas Escherichia coli and Staphylococcus aureus were unaffected. We conclude that antibacterial nitrogen oxides generated in the retention cuff of a urinary catheter diffuse into urine and prevent the growth of urinary pathogens and biofilm formation. Although promising, future studies will reveal if this novel approach can be clinically useful for the prevention of catheter-associated urinary tract infections. © 2013 Elsevier Inc. All rights reserved.

  13. Risk of peritoneal dialysis catheter-associated peritonitis following kidney transplant.

    Science.gov (United States)

    Rizzi, Andrew M; Riutta, Stephen D; Peterson, Joshua M; Gagin, Galina; Fritze, Danielle M; Barrett, Meredith; Sung, Randall S; Woodside, Kenneth J; Lu, Yee

    2018-01-02

    Peritoneal dialysis (PD) patients have equivalent or slightly better kidney transplant outcomes when compared to hemodialysis (HD) patients. However, given the risk for postoperative infection, we sought to determine the risk factors for PD catheter-associated infections for patients who do not have the PD catheter removed at the time of engraftment. Demographic and outcomes data were collected from 313 sequential PD patients who underwent kidney transplant from 2000 to 2015. Risk factors for postoperative peritonitis were analyzed using logistical regression. Of 329 patients with PD catheters at transplant, 16 PD catheters were removed at engraftment. Of the remaining 313 patients, 8.9% suffered post-transplant peritonitis. On univariate analysis, patients with peritonitis were significantly more likely to have used the PD catheter or HD within 6 weeks after transplant. Multivariate analysis had similar findings, with increased risk for those using the PD catheter after transplant, with a trend for those who underwent HD only within 6 weeks of transplant. These results suggest that delayed graft function requiring any type of dialysis is associated with increased post-transplant peritonitis risk. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. Placement of an implantable port catheter in the biliary stent: an experimental study in dogs

    International Nuclear Information System (INIS)

    Ko, Gi Young; Lee, Im Sick; Choi, Won Chan

    2004-01-01

    To investigate the feasibility of port catheter placement following a biliary stent placement. We employed 14 mongrel dogs as test subject and after the puncture of their gaIl bladders using sonographic guidance, a 10-mm in diameter metallic stent was placed at the common duct. In 12 dogs, a 6.3 F port catheter was placed into the duodenum through the common duct and a port was secured at the subcutaneous space following stent placement. As a control group, an 8.5 F drain tube was placed into the gallbladder without port catheter placement in the remaining two dogs. Irrigation of the bile duct was performed every week by injection of saline into the port, and the port catheter was replaced three weeks later in two dogs. Information relating to the success of the procedure, complications and the five-week follow-up cholangiographic findings were obtained. Placement of a biliary stent and a port catheter was technically successful in 13 (93%) dogs, while stent migration (n=3), gallbladder rupture (n=1) and death (n=5) due to subcutaneous abscess and peritonitis also occurred. The follow-up was achieved in eight dogs (seven dogs with a port catheter placement and one dog with a drain tube placement). Irrigation of the bile duct and port catheter replacement were successfully achieved without any complications. Cholangiograms obtained five weeks after stent placement showed diffuse biliary dilation with granulation tissue formation. However, focal biliary stricture was seen in one dog with stent placement alone. Placement of a port catheter following biliary stent placement seems to be feasible. However, further investigation is necessary to reduce the current complications

  15. Placement of an implantable port catheter in the biliary stent: an experimental study in dogs

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Gi Young; Lee, Im Sick; Choi, Won Chan [Asan Medical Center, Seoul (Korea, Republic of)

    2004-04-01

    To investigate the feasibility of port catheter placement following a biliary stent placement. We employed 14 mongrel dogs as test subject and after the puncture of their gaIl bladders using sonographic guidance, a 10-mm in diameter metallic stent was placed at the common duct. In 12 dogs, a 6.3 F port catheter was placed into the duodenum through the common duct and a port was secured at the subcutaneous space following stent placement. As a control group, an 8.5 F drain tube was placed into the gallbladder without port catheter placement in the remaining two dogs. Irrigation of the bile duct was performed every week by injection of saline into the port, and the port catheter was replaced three weeks later in two dogs. Information relating to the success of the procedure, complications and the five-week follow-up cholangiographic findings were obtained. Placement of a biliary stent and a port catheter was technically successful in 13 (93%) dogs, while stent migration (n=3), gallbladder rupture (n=1) and death (n=5) due to subcutaneous abscess and peritonitis also occurred. The follow-up was achieved in eight dogs (seven dogs with a port catheter placement and one dog with a drain tube placement). Irrigation of the bile duct and port catheter replacement were successfully achieved without any complications. Cholangiograms obtained five weeks after stent placement showed diffuse biliary dilation with granulation tissue formation. However, focal biliary stricture was seen in one dog with stent placement alone. Placement of a port catheter following biliary stent placement seems to be feasible. However, further investigation is necessary to reduce the current complications.

  16. Direct thermography-a new in vitro method to characterize temperature kinetics of ablation catheters.

    Science.gov (United States)

    Fiek, M; Gindele, F; von Bary, C; Muessig, D; Lucic, A; Hoffmann, E; Reithmann, C; Steinbeck, G

    2013-10-01

    For the treatment of increasingly complex cardiac arrhythmias, new catheter designs as well as alternative energy sources are constantly being developed. However, there is presently no in vitro method available for assessment of the temperature changes induced at various myocardial levels during energy delivery. Therefore, our study was aimed at developing an in vitro model to record and display the temperature kinetics during ablation in the entire muscle cross section. A sapphire glass pane was inserted into one wall of the in vitro experimental set-up. Due to its thermodynamic properties, the temperature distribution in an adjacent cross section of the cardiac muscle can be measured exactly ( 1 °C) through this pane by means of a thermography camera. Computer-supported image processing enables the colour-coded and two-dimensional display of the temperature kinetics during the energy application at any location of the myocardial cross section (± 0.5 mm). This new measuring methodology was validated by direct temperature measurements utilizing several intramyocardial thermo elements. This new method allows a temporal and spatial analysis of the temperature phenomena during ablation without the interference and spatial limitation of intramyocardial temperature probes. New ablation technologies can thus be evaluated, independent of the catheter configuration or source of energy used.

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

    Science.gov (United States)

    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.

  18. Feasibility and safety of 7F sheathless guiding catheter during transradial coronary intervention.

    Science.gov (United States)

    Kwan, Tak W; Cherukuri, Sanjay; Huang, Yili; Pancholy, Samir; Daggubati, Ramesh; Liou, Michael; Coppola, John; Saito, Shigeru

    2012-08-01

    The aim of our study is to assess the feasibility, safety, and rate of radial artery occlusion (RAO) using 7F sheathless guiding catheter in a large population undergoing transradial intervention (TRI). There is a frequent need for large bore guiding catheter to perform complex coronary interventions. Hydrophilic sheathless guiding catheters are not available in the US, therefore, we present the results of a multicenter study using the modified sheathless technique and readily available catheters. Between December 2010 and February 2011, 116 consecutive patients from four tertiary US centers who underwent TRI using 7F sheathless guiding catheter were included in this study. In our study of 116 patients with 123 coronary lesions, 57 stenoses (49%) were complex interventions, which included patients with acute coronary syndromes, chronic total occlusion (CTO), bifurcation stenting, calcified lesions, left main artery, and saphenous venous graft interventions. Overall procedural success rate was 95%. At 7-day, there were six patients (5%) with RAO, of which two of the six had severe radial artery spasm during the procedure. At 30-day, the overall persistent RAO was only detected in three patients (2.5%), as three patients had return of antegrade radial artery flow. In our multicenter study of 116 consecutive patients, using 7F sheathless guiding catheter to perform TRI is associated with a high procedural success (95%) and a low 30-day RAO rate (2.5%). Copyright © 2012 Wiley Periodicals, Inc.

  19. 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.

  20. Pulmonary vein isolation using the Rhythmia mapping system: Verification of intracardiac signals using the Orion mini-basket catheter.

    Science.gov (United States)

    Anter, Elad; Tschabrunn, Cory M; Contreras-Valdes, Fernando M; Li, Jianqing; Josephson, Mark E

    2015-09-01

    During pulmonary vein isolation (PVI), a circular lasso catheter is positioned at the junction between the left atrium (LA) and the pulmonary vein (PV) to confirm PVI. The Rhythmia mapping system uses the Orion mini-basket catheter with 64 electrodes instead of the lasso catheter. However, its feasibility to determine PVI has not been studied. The purpose of this study was to compare signals between the mini-basket and lasso catheters at the LA-PV junction. In 12 patients undergoing PVI using Rhythmia, the mini-basket and lasso catheters were placed simultaneously at the LA-PV junction for baseline and post-PVI signal assessment. Pacing from both catheters was performed to examine the presence of exit block. At baseline, recordings of LA and PV potentials were concordant in all PVs. However, after PVI, concordance between the catheters was only 68%. Discordance in all cases resulted from loss of PV potentials on the lasso catheter with persistence of PV potentials on the mini-basket catheter. In 9 of 13 PVs (69%), these potentials represented true PV potentials that were exclusively recorded with the smaller and closely spaced mini-basket electrodes. In the other 4 PVs (31%), these potentials originated from neighboring structures and resulted in underestimation of PVI. The use of the mini-basket catheter alone is sufficient to determine PVI. While it improves recording of PV potentials after incomplete ablation, it is also associated with frequent recording of "PV-like" potentials originating from neighboring structures. In these cases, pacing maneuvers are helpful to determine PVI and avoid excessive ablation. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  1. A Novel Nonantibiotic Nitroglycerin-Based Catheter Lock Solution for Prevention of Intraluminal Central Venous Catheter Infections in Cancer Patients.

    Science.gov (United States)

    Chaftari, Anne-Marie; Hachem, Ray; Szvalb, Ariel; Taremi, Mahnaz; Granwehr, Bruno; Viola, George Michael; Sapna, Amin; Assaf, Andrew; Numan, Yazan; Shah, Pankil; Gasitashvili, Ketevan; Natividad, Elizabeth; Jiang, Ying; Slack, Rebecca; Reitzel, Ruth; Rosenblatt, Joel; Mouhayar, Elie; Raad, Issam

    2017-07-01

    For long-term central lines (CL), the lumen is the major source of central line-associated bloodstream infections (CLABSI). The current standard of care for maintaining catheter patency includes flushing the CL with saline or heparin. Neither agent has any antimicrobial activity. Furthermore, heparin may enhance staphylococcal biofilm formation. We evaluated the safety and efficacy of a novel nonantibiotic catheter lock solution for the prevention of CLABSI. Between November 2015 and February 2016, we enrolled 60 patients with hematologic malignancies who had peripherally inserted central catheters (PICC) to receive the study lock solution. The study lock consisted of 15 or 30 μg/ml of nitroglycerin in combination with 4% sodium citrate and 22% ethanol. Each lumen was locked for at least 2 h once daily prior to being flushed. After enrollment of 10 patients at the lower nitroglycerin dose without evidence of toxicity, the dose was escalated to the higher dose (30 μg/ml). There were no serious related adverse events or episodes of hypotension with lock administration. Two patients experienced mild transient adverse events (one headache and one rash) possibly related to the lock and that resolved without residual effect. The CLABSI rate was 0 on lock days versus 1.6/1,000 catheter days (CD) off lock prophylaxis, compared with a rate of 1.9/1,000 CD at the institution in the same patient population. In conclusion, the nitroglycerin-based lock prophylaxis is safe and well tolerated. It may prevent CLABSI when given daily to cancer patients. Large, prospective, randomized clinical trials are needed to validate these findings. (This study has been registered at ClinicalTrials.gov under identifier NCT02577718.). Copyright © 2017 American Society for Microbiology.

  2. Catheter ablation of epicardial ventricular tachycardia

    Directory of Open Access Journals (Sweden)

    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

  3. A Four Degree of Freedom Robot for Positioning Ultrasound Imaging Catheters.

    Science.gov (United States)

    Loschak, Paul M; Degirmenci, Alperen; Tenzer, Yaroslav; Tschabrunn, Cory M; Anter, Elad; Howe, Robert D

    2016-10-01

    In this paper, we present the design, fabrication, and testing of a robot for automatically positioning ultrasound (US) imaging catheters. Our system will point US catheters to provide real-time imaging of anatomical structures and working instruments during minimally invasive procedures. Manually navigating US catheters is difficult and requires extensive training in order to aim the US imager at desired targets. Therefore, a four-degree-of-freedom (4DOF) robotic system was developed to automatically navigate US imaging catheters for enhanced imaging. A rotational transmission enables 3DOF for pitch, yaw, and roll of the imager. This transmission is translated by the 4DOF. An accuracy analysis calculated the maximum allowable joint motion error. Rotational joints must be accurate to within 1.5 deg, and the translational joint must be accurate within 1.4 mm. Motion tests then validated the accuracy of the robot. The average resulting errors in positioning of the rotational joints were 0.04-0.22 deg. The average measured backlash was 0.18-0.86 deg. Measurements of average translational positioning and backlash errors were negligible. The resulting joint motion errors were well within the required specifications for accurate robot motion. The output of the catheter was then tested to verify the effectiveness of the handle motions to transmit torques and translations to the catheter tip. The catheter tip was navigated to desired target poses with average error 1.3 mm and 0.71 deg. Such effective manipulation of US imaging catheters will enable better visualization in various procedures ranging from cardiac arrhythmia treatment to tumor removal in urological cases.

  4. Central Line–Associated Bloodstream Infection in Hospitalized Children with Peripherally Inserted Central Venous Catheters: Extending Risk Analyses Outside the Intensive Care Unit

    Science.gov (United States)

    Advani, Sonali; Reich, Nicholas G.; Sengupta, Arnab; Gosey, Leslie

    2011-01-01

    Background. Increasingly, peripherally inserted central venous catheters (PICCs) are placed for prolonged intravenous access. Few data exist regarding risk factors for central line–associated bloodstream infection (CLABSI) complicating PICCs in hospitalized children, especially children hospitalized outside the intensive care unit (ICU). Methods. We identified all children with a PICC inserted at The Johns Hopkins Hospital (Baltimore, MD) from 1 January 2003 through 31 December 2009 and used Poisson regression models to identify risk factors for PICC-associated CLABSIs. Results. A total of 2592 PICCs were placed in 1819 children. One hundred sixteen CLABSIs occurred over 44,972 catheter-days (incidence rate [IR], 2.58 cases per 1000 catheter-days; 95% confidence interval [CI], 2.07–3.00 cases per 1000 catheter-days). Independent predictors of CLABSI in the entire cohort included PICC dwell time of ≥21 days (IR ratio [IRR], 1.53; 95% CI, 1.05–2.26), parenteral nutrition as indication for insertion (IRR, 2.24; 95% CI, 1.31–3.84), prior PICC-associated CLABSI (IRR, 2.48; 95% CI, 1.18–5.25), underlying metabolic condition (IRR, 2.07; 95% CI, 1.14–3.74), and pediatric ICU exposure during hospitalization (IRR, 1.80; 95% CI, 1.18–2.75). Risk factors for CLABSI in children without PICU exposure included younger age, underlying malignancy and metabolic conditions, PICCs inserted in the lower extremity, and a prior PICC-associated CLABSI. Conclusions. Prolonged catheter dwell time, pediatric ICU exposure, and administration of parenteral nutrition as the indication for PICC insertion are important predictors of PICC-associated CLABSI in hospitalized children. A careful assessment of these risk factors may be important for future success in preventing CLABSIs in hospitalized children with PICCs. PMID:21454298

  5. Generation of a central nervous system catheter-associated infection in mice with Staphylococcus epidermidis.

    Science.gov (United States)

    Snowden, Jessica N

    2014-01-01

    Animal models are valuable tools for investigating the in vivo pathogenesis of Staphylococcus epidermidis infections. Here, we present the procedure for generating a central nervous system catheter-associated infection in a mouse, to model the central nervous system shunt infections that frequently complicate the treatment of hydrocephalus in humans. This model uses stereotactic guidance to place silicone catheters, pre-coated with S. epidermidis, into the lateral ventricles of mice. This results in a catheter-associated infection in the brain, with concomitant illness and inflammation. This animal model is a valuable tool for evaluating the pathogenesis of bacterial infection in the central nervous system, the immune response to these infections and potential treatment options.

  6. Comment on "Comparison of dose rates calculated on Nucletron NPS v11 catheter tracking versus catheter describing"

    CERN Document Server

    Van der Laarse, R

    2003-01-01

    N D MacDougall has reported to Nucletron a dose error in the module MPS v11.33 of the Nucletron NPS brachytherapy program. This dose error occurred when an implant was reconstructed using the image tracking method. MPS v11 offers five methods for reconstruction from radiographs of the 3D localization in space of an iridium wire implant. The method using catheter-describing points is the most accurate one. It is based on digitizing the corresponding images of X-ray markers in the catheters on two radiographs, taken at different angles with an isocentric X-ray machine such as a treatment simulator. The method using tracking is the least accurate one. It tracks wire images on the radiographs to reconstruct a wire in space consisting of maximally 98 wire segments. This is the least accurate method because there is no correspondence between the image points of a wire on the radiographs.

  7. MR guided thermal therapy of pancreatic tumors with endoluminal, intraluminal and interstitial catheter-based ultrasound devices: preliminary theoretical and experimental investigations

    Science.gov (United States)

    Prakash, Punit; Salgaonkar, Vasant A.; Scott, Serena J.; Jones, Peter; Hensley, Daniel; Holbrook, Andrew; Plata, Juan; Sommer, Graham; Diederich, Chris J.

    2013-02-01

    evaluated in tissue mimicking phantoms, ex vivo tissue and in vivo canine model under multi-slice MR thermometry. RF micro-coils were evaluated to enable active catheter-tracking and prescription of thermometry slice positions. Interstitial and intraluminal ultrasound applicators could be used to ablate (t43>240min) tumors measuring 2.3-3.4 cm in diameter when powered with 20-30 W/cm2 at 7 MHz for 5-10 min. Endoluminal applicators with planar and curvilinear transducers operating at 3-4 MHz could be used to treat tumors up to 20-25 mm deep from the stomach wall within 5 min. POC devices were fabricated and successfully integrated into the MRI environment with catheter tracking, real-time thermometry and closed-loop feedback control.

  8. Real-time ultrasound-guided placement of peripherally inserted central venous catheter without fluoroscopy.

    Science.gov (United States)

    Nakamuta, Soshi; Nishizawa, Toshihiro; Matsuhashi, Shiori; Shimizu, Arata; Uraoka, Toshio; Yamamoto, Masato

    2018-03-01

    Malposition of peripherally inserted central catheters placed at the bedside is a well-recognized phenomenon. We report the success rate of the placement of peripherally inserted central catheters with ultrasound guidance for tip positioning and describe the knacks and pitfalls. We retrospectively reviewed the medical case charts of 954 patients who received peripherally inserted central catheter procedure. Patient clinical data included success rate of puncture, detection rate of tip malposition with ultrasonography, adjustment rate after X-ray, and success rate of peripherally inserted central catheter placement. The success rate of puncture was 100% (954/954). Detection rate of tip malposition with ultrasonography was 82.1% (78/95). The success rate of ultrasound-guided tip navigation was 98.2% (937/954). The success rate of ultrasound-guided tip location was 98.0% (935/954). Adjustment rate after X-ray was 1.79% (17/952). The final success rate of peripherally inserted central catheter placement was 99.8% (952/954). Ultrasound guidance for puncturing and tip positioning is a promising option for the placement of peripherally inserted central catheters. Ultrasound guidance could dispense with radiation exposure and the transfer of patients to the X-ray department.

  9. Complications catheter-related infections in patients on hemodialysis (septic infections of patients on hemodialysis

    Directory of Open Access Journals (Sweden)

    Knežević Violeta

    2017-01-01

    Full Text Available Introduction: Hemodialysis catheters are used for quick establishing of an adequate vascular approach, when urgent hemodialysis is indicated in time of maturation of artery-vein fistula and in patients in whom all other vascular approach have been exhausted. Although the placement of the catheter provides the necessary vascular access, carries a risk of both local-infection exit site of a catheter, as well as systemic complications, including catheter-related infection, septic thrombophlebitis, endocarditis, and other metastatic infections such as lung abscess and brain, osteomyelitis and endophthalmitis. Cases series: We have presented a retrospective series of 5 cases of hemodialysis patients hospitalized at the Clinic of Nephrology and Clinical Immunology, of the Clinical Center of Vojvodina in the period of 2010 to 2017, which have developed different complications of catheter-related infections. Three patients diagnosed with spondylodiscitis and endocarditis in two. In one patient with native valve endocarditis, due to the appearance of other complications, there was a death, while the other patients had an adequate response to therapy. Conclusion: Early recognition of potential complications of catheter-related infections to more successful treatment of these patients.

  10. The feasibility of 12-gauge intravenous catheter use in the prehospital setting.

    Science.gov (United States)

    Guisto, J A; Iserson, K V

    1990-01-01

    Intravenous fluid therapy is a mainstay in the treatment of trauma and hypovolemia. However, controversy exists as to its effective use by prehospital personnel. We reasoned that 12-gauge catheters, shown to have significantly greater fluid flow than 14- or 16-gauge catheters, might allow prehospital care providers to have a more significant role in patient resuscitation. This study was designed to see if 12-gauge intravenous catheters can successfully be placed and used in the prehospital care arena. During a six-month period, commercial peripheral 12-gauge catheter-over-needle intravenous units were placed in any hypovolemic or potentially hypovolemic patient in whom paramedics thought that rapid fluid therapy was, or might become, necessary. They experienced an overall success rate of 84% and a success-per-attempt rate of 74%. The catheters were placed under normal field conditions. Per preexisting protocols, departure from the scene and transport to the hospital were not delayed for any paramedic interventions, including starting intravenous lines. The 12-gauge catheters can be successfully used by paramedics, both to establish large bore intravenous access prior to arrival at the emergency department and to institute effective fluid therapy where time and circumstances allow.

  11. Renal artery intervention using a virtual 4.5-Fr guiding catheter.

    Science.gov (United States)

    Takeshita, Satoshi; Matsumi, Junya; Saito, Shigeru

    2013-05-01

    A 6.5-Fr guiding catheter (Parent Plus 45, Medikit, Tokyo, Japan), composed of a hydrophilic sheathless guiding catheter and a dilator, has recently been developed for the treatment of renal artery stenosis. Because of its unique sheathless configuration, its outer diameter is comparable to that of a conventional 4.5-Fr introducer sheath, with the inner diameter being close in size to a 6.5-Fr guiding catheter. These features allow this sheathless system to be used as the sole guiding catheter while the arterial damage at the puncture site remains equivalent to that of a 4.5-Fr introducer sheath. We thus call this novel sheathless guiding catheter a virtual 4.5-Fr system. To demonstrate the potential of this virtual 4.5-Fr system, we report a case of renal artery stenosis successfully treated via the transradial route. This virtual 4.5-Fr system may become a viable alternative to conventional guiding catheters, and provide a favorable impact upon vascular access complications and patient morbidity. Copyright © 2012 Wiley Periodicals, Inc.

  12. Management of postpartum hemorrhage with intrauterine balloon tamponade using a condom catheter in an Egyptian setting.

    Science.gov (United States)

    Kandeel, Mohamed; Sanad, Zakaria; Ellakwa, Hamed; El Halaby, Alaa; Rezk, Mohamed; Saif, Ibrahim

    2016-12-01

    To evaluate uterine balloon tamponade using a condom catheter for the management of early postpartum hemorrhage (PPH). In a prospective observational study at Menoufia University Hospital, Shebin Elkom, Egypt, women with early PPH were enrolled between May 2011 and September 2012. Uterine balloon tamponade with a condom catheter was applied in women who were unresponsive to uterotonics and bimanual compression; patients with successful catheter placement were included in analyses. The primary outcome was successful control (reduction or cessation) of bleeding. A condom catheter was successfully placed for 50 of the 151 women enrolled. The overall success rate of the procedure was 96% (48/50). The condom catheter was successful in all 28 cases of atonic PPH after vaginal or cesarean delivery. It successfully controlled PPH due placental site bleeding in 20 (91%) of 22 patients with placenta previa and a well-contracted uterus. Condom balloon catheter was found to effectively control PPH. The procedure is simple, inexpensive, and safe, and can preserve reproductive capacity, as well as saving the life of the mother. ClinicalTrials.gov:NCT02672891. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  13. A rat model of central venous catheter to study establishment of long-term bacterial biofilm and related acute and chronic infections.

    Directory of Open Access Journals (Sweden)

    Ashwini Chauhan

    Full Text Available Formation of resilient biofilms on medical devices colonized by pathogenic microorganisms is a major cause of health-care associated infection. While in vitro biofilm analyses led to promising anti-biofilm approaches, little is known about their translation to in vivo situations and on host contribution to the in vivo dynamics of infections on medical devices. Here we have developed an in vivo model of long-term bacterial biofilm infections in a pediatric totally implantable venous access port (TIVAP surgically placed in adult rats. Using non-invasive and quantitative bioluminescence, we studied TIVAP contamination by clinically relevant pathogens, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Staphylococcus epidermidis, and we demonstrated that TIVAP bacterial populations display typical biofilm phenotypes. In our study, we showed that immunocompetent rats were able to control the colonization and clear the bloodstream infection except for up to 30% that suffered systemic infection and death whereas none of the immunosuppressed rats survived the infection. Besides, we mimicked some clinically relevant TIVAP associated complications such as port-pocket infection and hematogenous route of colonization. Finally, by assessing an optimized antibiotic lock therapy, we established that our in vivo model enables to assess innovative therapeutic strategies against bacterial biofilm infections.

  14. Emergency Department Catheter-Associated Urinary Tract Infection Prevention: Multisite Qualitative Study of Perceived Risks and Implemented Strategies.

    Science.gov (United States)

    Carter, Eileen J; Pallin, Daniel J; Mandel, Leslie; Sinnette, Corine; Schuur, Jeremiah D

    2016-02-01

    Existing knowledge of emergency department (ED) catheter-associated urinary tract infection (CAUTI) prevention is limited. We aimed to describe the motivations, perceived risks for CAUTI acquisition, and strategies used to address CAUTI risk among EDs that had existing CAUTI prevention programs. In this qualitative comparative case study, we enrolled early-adopting EDs, that is, those using criteria for urinary catheter placement and tracking the frequency of catheters placed in the ED. At 6 diverse facilities, we conducted 52 semistructured interviews and 9 focus groups with hospital and ED participants. All ED CAUTI programs originated from a hospitalwide focus on CAUTI prevention. Staff were motivated to address CAUTI because they believed program compliance improved patient care. ED CAUTI prevention was perceived to differ from CAUTI prevention in the inpatient setting. To identify areas of ED CAUTI prevention focus, programs examined ED workflow and identified 4 CAUTI risks: (1) inappropriate reasons for urinary catheter placement; (2) physicians' limited involvement in placement decisions; (3) patterns of urinary catheter overuse; and (4) poor insertion technique. Programs redesigned workflow to address risks by (1) requiring staff to specify the medical reason for catheter at the point of order entry and placement; (2) making physicians responsible for determining catheter use; (3) using catheter alternatives to address patterns of overuse; and (4) modifying urinary catheter insertion practices to ensure proper placement. Early-adopting EDs redesigned workflow to minimize catheter use and ensure proper insertion technique. Assessment of ED workflow is necessary to identify and modify local practices that may increase CAUTI risk.

  15. Balloon catheter dilatation of benign urethral strictures

    International Nuclear Information System (INIS)

    Perini, L.; Cavallo, A.; Perin, B.; Bighi, G.

    1988-01-01

    The authors report their experience of benign urethral stricture dilatation by balloon catheter in 11 male patients. Ten posterior and 2 anterior urethral strictures were treated; in 1 patients several narrowings coexisted at various levels. Etiology was inflammatory in 4 cases, iatrogen in 3, post-traumatic in 2, and equivocal in 2. The patients were studied both before and soon after dilatation by means of retrograde and voiding cystourethrogram and uroflowgraphy; the follow-up (2-14 months) was performed by urodynamic alone. In all cases, dilatation was followed by the restoration of urethral gauge, together with prompt functional improvement of urodynamic parameters. The latter result subsisted in time in 9 patients. In 2 cases recurrences were observed demonstrated at once by clinics and urodynamics. Both lesions were successfully re-treated. Neither early not late complication occurred. In spite of the limited material, the valuable results obtained, together with the absence of complications, the peculiar morphology of recurrences, and the chance of repeating it make the procedure advisable as a valid alternative to conventional techniques for these pathologies

  16. Catheter-associated bloodstream infections and thrombotic risk in hematologic patients with peripherally inserted central catheters (PICC).

    Science.gov (United States)

    Morano, Salvatore Giacomo; Latagliata, Roberto; Girmenia, Corrado; Massaro, Fulvio; Berneschi, Paola; Guerriero, Alfonso; Giampaoletti, Massimo; Sammarco, Arianna; Annechini, Giorgia; Fama, Angelo; Di Rocco, Alice; Chistolini, Antonio; Micozzi, Alessandra; Molica, Matteo; Barberi, Walter; Minotti, Clara; Brunetti, Gregorio Antonio; Breccia, Massimo; Cartoni, Claudio; Capria, Saveria; Rosa, Giovanni; Alimena, Giuliana; Foà, Robin

    2015-11-01

    The use of peripherally inserted central catheters (PICC) as an alternative to other central venous access devices (CVAD) is becoming very frequent in cancer patients. To evaluate the impact of complications associated to these devices in patients with hematologic malignancies, we revised the catheter-related bloodstream infections (CRBSI) and the catheter-related thrombotic complications (CRTC) observed at our institute between January 2009 and December 2012. A total of 612 PICCs were inserted into 483 patients at diagnosis or in subsequent phases of their hematologic disease. PICCs were successfully inserted in all cases. The median duration of in situ PICC placement was 101 days (interquartile range, 48-184 days). A CRBSI occurred in 47 cases (7.7 %), with a rate of 0.59 per 1000 PICC days. A CRTC was recorded in 16 cases (2.6 %), with a rate of 0.20 per 1000 PICC days. No serious complication was associated to these events. Cox regression analyses of variables associated to CRBSIs and to CRTCs showed that only the type of disease (acute leukemia compared to other diseases) was significantly associated to a higher incidence of CRBSIs, while no feature was predictive for a higher risk of CRTCs. PICCs represent a useful and safe alternative to conventional CVAD for the management of patients with hematologic malignancies.

  17. Anatomical and procedural determinants of catheter-based renal denervation.

    Science.gov (United States)

    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

    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. A total of 564 patients with resistant hypertension underwent bilateral RDN in 9 centers in Europe and Australia using a mono-electrode radiofrequency catheter (Symplicity Flex, Medtronic). Anatomical criteria such as prevalence of accessory renal arteries (ARA), presence of renal artery disease (RAD), length, and diameter were analyzed blinded to patient's characteristics. ARA was present in 171 patients (30%), and RAD was documented in 71 patients (13%). On average 11±2.7 complete 120-s ablations were performed, equally distributed on both sides. After 6months, BP was reduced by 19/8mmHg (p4mm (-29 vs. -26 vs. -17mmHg; p<0.001). Neither the length of the renal artery nor the number of RF ablations influenced BP reduction after 6months. The diameter of renal arteries correlated with SBP change after RDN at 6-month follow-up. Change of SBP was not related to the lengths of the renal artery, presence of ARA, RAD, or the number of RF ablations delivered by a mono-electrode catheter. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Central venous catheter-related bloodstream infections in cancer patients

    International Nuclear Information System (INIS)

    Butt, T.; Afzal, R.K.; Ahmad, R.N.; Hussain, I.; Anwar, M.

    2004-01-01

    Objective: To determine the frequency of central venous catheter-related bloodstream infections (CR-BSI) in cancer patients and the antimicrobial susceptibility pattern of the isolates. Subjects and Methods: Cancer patients requiring short or long-term central venous catheterization at the time of admission or thereafter were included. Catheter tips on removal were cultured quantitatively; specimens of blood and pus were cultured qualitatively. Isolates were identified and antimicrobial susceptibility testing was performed by standard techniques. Results: Eighty-nine patients were included in the study. The frequency of CR-BSI was 17%. Out of the 19 organisms isolated, 10 (53%) were Gram-positive cocci, 8 (42%) were Gram-negative rods and 1 (5%) was a fungus. Coagulase negative staphylococci (27%) were the predominant pathogens. Among the staphylococci, 46% of the isolates were methicillin-resistant. All Gram-positive isolates were susceptive to glycopeptides. Gram-negative rods were resistant to most of the commonly used antimicrobial groups. Conclusion: Central venous catheter is an important source of bloodstream infections in cancer patients. Most of the infections are caused by Gram-positive cocci. Rigorous infection control measures and continuous surveillance is required to curb the frequency of these infections. (author)

  19. Performance of Temporary Hemodialysis Catheter Insertion by Nephrology Fellows and Attending Nephrologists.

    Science.gov (United States)

    McQuillan, Rory F; Clark, Edward; Zahirieh, Alireza; Cohen, Elaine R; Paparello, James J; Wayne, Diane B; Barsuk, Jeffrey H

    2015-10-07

    Concerns have been raised about nephrology fellows' skills in inserting temporary hemodialysis catheters. Less is known about temporary hemodialysis catheter insertion skills of attending nephrologists supervising these procedures. The aim of this study was to compare baseline temporary hemodialysis catheter insertion skills of attending nephrologists with the skills of nephrology fellows before and after a simulation-based mastery learning (SBML) intervention. This pre- post-intervention study with a pretest-only comparison group was conducted at the University of Toronto in September of 2014. Participants were nephrology fellows and attending nephrologists from three university-affiliated academic hospitals who underwent baseline assessment of internal jugular temporary hemodialysis catheter insertion skills using a central venous catheter simulator. Fellows subsequently completed an SBML intervention, including deliberate practice with the central venous catheter simulator. Fellows were expected to meet or exceed a minimum passing score at post-test. Fellows who did not meet the minimum passing score completed additional deliberate practice. Attending nephrologist and fellow baseline performance on the temporary hemodialysis catheter skills assessment was compared. Fellows' pre- and post-test temporary hemodialysis catheter insertion performance was compared to assess the effectiveness of SBML. The skills assessment was scored using a previously published 28-item checklist. The minimum passing score was set at 79% of checklist items correct. In total, 19 attending nephrologists and 20 nephrology fellows participated in the study. Mean attending nephrologist checklist scores (46.1%; SD=29.5%) were similar to baseline scores of fellows (41.1% items correct; SD=21.4%; P=0.55). Only two of 19 attending nephrologists (11%) met the minimum passing score at baseline. After SBML, fellows' mean post-test score improved to 91.3% (SD=6.9%; Pnephrology fellows' skills, with

  20. 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.

  1. Mechanism of prostatic urethroplasty with balloon catheter

    International Nuclear Information System (INIS)

    Castaneda, F.; Maynar, M.; Hulbert, J.

    1988-01-01

    A series of 60 patients have undergone prostatic urethroplasty with balloon catheters at our institution. The follow-up of these patients has ranged from more than 3 years to not less than 6 months. The preliminary results have been excellent, with a success rate of 75% in patients with predominant lateral lobe hypertrophy. This success rate drops to 25% in patients with predominant middle lobe hypertrophy. In previous communications the authors have proposed that the mechanism of prostatic urethral relief of obstruction is due to stretching of the prostatic capsule, tissue compression, and possible subsequent atrophy, as suggested by findings of transrectal US, MR imaging, voiding and retrograde urethrography, and urinary flow studies. Recent clinical information that has led to further animal research has shown that in addition to the previously supposed mechanism of action, separation of the prostatic lobes occurs by splitting of the anterior and posterior commissures of the prostatic gland tissue. This separation of the prostatic lobes is therefore the goal of the procedure. As more experience is gained, the already high success rate can probably be improved

  2. A Fast pH-Switchable and Self-Healing Supramolecular Hydrogel Carrier for Guided, Local Catheter Injection in the Infarcted Myocardium

    OpenAIRE

    Bastings, Maartje M. C.; Koudstaal, Stefan; Kieltyka, Roxanne E.; Nakano, Yoko; Pape, A. C. H.; Feyen, Dries A. M.; van Slochteren, Frebus J.; Doevendans, Pieter A.; Sluijter, Joost P. G.; Meijer, E. W.; Chamuleau, Steven A. J.; Dankers, Patricia Y. W.

    2014-01-01

    Minimally invasive intervention strategies after myocardial infarction use state-of-the-art catheter systems that are able to combine mapping of the infarcted area with precise, local injection of drugs. To this end, catheter delivery of drugs that are not immediately pumped out of the heart is still challenging, and requires a carrier matrix that in the solution state can be injected through a long catheter, and instantaneously gelates at the site of injection. To address this unmet need, a ...

  3. Prevention of Subsequent Catheter-Related Bloodstream Infection Using Catheter Locks in High-Risk Patients Receiving Home Parenteral Nutrition.

    Science.gov (United States)

    Davidson, Jacob B; Edakkanambeth Varayil, Jithinraj; Okano, Akiko; Whitaker, Jennifer A; Bonnes, Sara L; Kelly, Darlene G; Mundi, Manpreet S; Hurt, Ryan T

    2017-05-01

    Catheter-related bloodstream infection (CRBSI) is a serious complication in patients receiving home parenteral nutrition (HPN). Antibiotic lock therapy (ALT) and ethanol lock therapy (ELT) can be used to prevent CRBSI episodes in high-risk patients. Following institutional review board approval, all patients enrolled in the Mayo Clinic HPN program from January 1, 2006, to December 31, 2013, with catheter locking were eligible to be included. Patients without research authorization and ELT were estimated in all patients. A total of 63 patients were enrolled during the study period. Of 59 eligible patients, 29 (49%) were female, and 30 (51%) were male. The median duration of HPN was 3.66 (interquartile range, 0.75-8.19) years. The mean age ± SD at initiation of HPN was 49.89 ± 14.07 years. A total of 51 patients were instilled with ALT, and 8 patients were instilled with ELT during their course of HPN. A total of 313 CRBSI episodes occurred in these patients, 264 before locking and 49 after locking ( P ELT can reduce the overall rate of infections per 1000 catheter days. ALT or ELT can be used in appropriate clinical setting for patients receiving HPN.

  4. Poor value of surveillance cultures for prediction of septicaemia caused by coagulase-negative staphylococci in patients undergoing haemodialysis with central venous catheters

    DEFF Research Database (Denmark)

    Nielsen, J; Kolmos, H J; Rosdahl, V T

    1998-01-01

    Surveillance cultures for the demonstration of coagulase-negative staphylococci in patients on catheter haemodialysis were performed in an attempt to predict dialysis catheter-related septicaemia. In all, 43 patients with 67 haemodialysis catheters were followed for a 1-y period. Once a week, swab...... specimens were obtained from the skin at the insertion site and the hub, and blood cultures were obtained from the catheter. Among coagulase-negative staphylococci, S. epidermidis was the most frequently (80%) isolated species, and two biotypes accounted for 55.7% of the 41 biotypes isolated. 11 septicaemia...... cases due to coagulase-negative staphylococci occurred, all caused by S. epidermidis, and the incidence of S. epidermidis septicaemia was 21% among patients and 16% among catheter periods. S. epidermidis septicaemia occurred in 17%, 31% and 33% of all catheter periods in which S. epidermidis...

  5. Mechanical dysfunction of ventriculoperitoneal shunts caused by calcification of the silicone rubber catheter.

    Science.gov (United States)

    Boch, A L; Hermelin, E; Sainte-Rose, C; Sgouros, S

    1998-06-01

    The authors studied new and calcified shunt catheters to identify the prevalence of failures caused by aging materials in the shunt. Complications associated with these devices have various origins. Among late complications, fracture or migration of the system is related to the subcutaneous adhesion of the distal tubing in a growing child. A review of a cohort of 64 children who underwent shunt placement in 1980 with barium-impregnated distal catheters showed that 10 of these patients underwent reoperation for complications related to aging of the shunt material. This group represents 15% of the whole series and 30% of those children who were followed for more than 3 years. The true impact of aging of materials on shunt function is probably underestimated. The authors performed physical, chemical, and mechanical analyses of the retrieved aged catheters and also of new catheters, resulting in the following findings: 1) calcifications were observed only on the external surface of the catheter, predominantly in its subcutaneous segment at the level of the neck and anterior chest wall; 2) calcifications contained particles of free silicon and barium sulfate, signifying fragmentation of the polymer; 3) the microstructure of the silicone polymer was modified: microfractures and alteration of the polymeric network were observed; 4) silanol groups were observed on the external surface of the catheter; and 5) the mechanical properties of the silicone rubber were degraded, and the aged catheters were more brittle than the new ones, with ruptures at elongations and fracture energy much lower than that seen in new catheters. Furthermore, in vitro testing with a metastable solution of simulated body fluid demonstrated the critical impact of pH variations in liquid media and surface degradation of the catheters on the precipitation of hydroxylapatite crystals. Although most shunt complications can be addressed by better patient management and surgical technique, late

  6. Evaluation of mupirocin ointment in control of central venous catheter related infections: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Rezaei J

    2009-09-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Central venous catheter (CVC related infections are important complications of cathter application. This study assessed the usefulness of mupirocin in prevention and control of these infections."n"nMethods: In this randomized clinical trial, consecutive surgical patients requiring central venous catheter (for more than 2 days in Amir-Alam Hospital from 2006-2008 were enrolled. Patients were divided in two groups; in "case group" patients received topical mupirocin 2% every 48 hours at the time of insertion of catheter and dressing change and for "control group" mupirocin was not used. All of the patients received chlorhexidine and enoxoparin as complementary treatments. Two groups were comparable in regard of age, sex and risk factors."n"nResults: One hundred eighteen patients enrolled in the study (57 in case and 61 in control group completed the study. 84 catheters in case group and 88 catheters in control group were inserted. The catheters in 90% of patients were inserted in jugular vein. At the end of study 29(16.8% patients (16 in control versus 13 in case group had catheter colonization (p=NS. Catheter related bloodstream infection was observed in 16(9.3% patients (6 in

  7. The incidence and risk factors of peripherally inserted central catheter-related infection among cancer patients

    Directory of Open Access Journals (Sweden)

    Gao Y

    2015-05-01

    Full Text Available Yufang Gao,1,* Yuxiu Liu,2,* Xiaoyan Ma,3 Lili Wei,4 Weifen Chen,2 Lei Song2 1President’s Office, 2Oncology Department, the Affiliated Hospital of Qingdao University, Qingdao, 3Intensive Care Unit, Shanghai East Hospital, Shanghai, 4Nursing Department, the Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China *These authors contributed equally to this work Background: As the use of peripherally inserted central catheters (PICCs increased in chemotherapy, the identification of complications and risk factors became essential to prevent patient harm. But little is known about PICC-related infection and risk factors among patients with cancer. Our study was to identify the prevalence, patterns, and risk factors of catheter-related infections associated with PICCs.Methods: A 3-year prospective cohort study was conducted in a university-affiliated hospital. All patients with cancer who met inclusion criteria were enrolled. The patients were followed up until catheter removal. Tip cultures were routinely performed at the time of catheter removal. The general information was recorded at the time of PICC insertion, weekly care, and removal. Univariable and multivariable logistic regression analyses were applied for identification of risk factors.Results: In total, 912 cancer patients with 912 PICCs of 96,307 catheter days were enrolled. Ninety-four developed PICC-related infection; 46 were exit-site infection, 43 were catheter bacterial colonization, and five were PICC-related bloodstream infection. The median time from catheter insertion to infection was 98.26 days. Multivariate analysis showed StatLock fixing (odds ratio [OR] =0.555, 95% confidence interval [CI]: 0.326–0.945 and tip position located in the lower one-third of the superior vena cava (OR =0.340, 95% CI: 0.202–0.571 were associated with lower PICC infection rate. Catheter care delay (OR =2.612, 95% CI: 1.373–4.969 and indwelling mostly in summer (OR =4

  8. Urinary incontinence and indwelling urinary catheters in acutely admitted elderly patients: relationship with mortality, institutionalization, and functional decline.

    Science.gov (United States)

    Bootsma, A M Jikke; Buurman, Bianca M; Geerlings, Suzanne E; de Rooij, Sophia E

    2013-02-01

    To study differences in functional status at admission in acutely hospitalized elderly patients with urinary incontinence, a catheter, or without a catheter or incontinence (controls) and to determine whether incontinence or a catheter are independent risk factors for death, institutionalization, or functional decline. Prospective cohort study conducted between 2006 and 2008 with a 12-month follow-up. Eleven medical wards of 2 university teaching hospitals and 1 teaching hospital in The Netherlands. Participants included 639 patients who were 65 years and older, acutely hospitalized for more than 48 hours. Baseline characteristics, functional status, presence of urinary incontinence or catheter, length of hospital stay, mortality, institutionalization, and functional decline during admission and 3 and 12 months after admission were collected. Regression analyses were done to study a possible relationship between incontinence, catheter use, and adverse outcomes at 3 and 12 months. Of all patients, 20.7% presented with incontinence, 23.3% presented with a catheter, and 56.0% were controls. Patients with a catheter scored worst on all baseline characteristics. A catheter was an independent risk factor for mortality at 3 months (odds ratio [OR] = 1.73, 95% confidence interval [CI] 1.10-2.70), for institutionalization at 12 months (OR = 4.03, 95% CI 1.67-9.75), and for functional decline at 3 (OR = 2.17, 95% CI 1.32-3.54) and 12 months (OR = 3.37, 95% CI 1.81-6.25). Incontinence was an independent risk factor for functional decline at 3 months (OR = 1.84, 95% CI 1.11-3.04). There is an association between presence of a catheter, urinary incontinence, and development of adverse outcomes in hospitalized older patients. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

  9. A Simple Radiological Technique for Demonstration of Incorrect Positioning of a Foley Catheter with Balloon Inflated in the Urethra of a Male Spinal Cord Injury Patient

    Directory of Open Access Journals (Sweden)

    Subramanian Vaidyanathan

    2006-01-01

    Full Text Available In a male patient with cervical spinal cord injury, the urinary bladder may go into spasm when a urethral catheter is removed and a new Foley catheter is inserted. Before the balloon is inflated, the spastic bladder may push the Foley catheter out or the catheter may slip out of a small-capacity bladder. An inexperienced health professional may inflate the balloon of a Foley catheter in the urethra without realizing that the balloon segment of the catheter is lying in the urethra instead of the urinary bladder. When a Foley balloon is inflated in the urethra, a tetraplegic patient is likely to develop autonomic dysreflexia. This is a medical emergency and requires urgent treatment. Before the incorrectly placed Foley catheter is removed, it is important to document whether the balloon has been inflated in the urinary bladder or not. The clinician should first use the always available tools of observation and palpation at the bedside without delays of transportation. A misplaced balloon will often be evident by a long catheter sign, indicating excessive catheter remaining outside the patient. Radiological diagnosis is not frequently required and, when needed, should employ the technique most readily available, which might be a body and pelvic CT without intravenous contrast. An alternative radiological technique to demonstrate the position of the balloon of the Foley catheter is described. Three milliliters of nonionic X-ray contrast medium, Ioversol (OPTIRAY 300, is injected through the side channel of the Foley catheter, which is used for inflating the balloon. Then, with a catheter-tip syringe, 30 ml of sterile Ioversol is injected through the main lumen of the Foley catheter. Immediately thereafter, an X-ray of the pelvis (including perineum is taken. By this technique, both the urinary bladder and balloon of the Foley catheter are visualized by the X-ray contrast medium. When a Foley catheter has been inserted correctly, the balloon of the

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  12. Magnetic resonance imaging guided transatrial electrophysiological studies in swine using active catheter tracking - experience with 14 cases

    Energy Technology Data Exchange (ETDEWEB)

    Grothoff, Matthias; Gutberlet, Matthias [University of Leipzig - Heart Center, Department of Radiology, Leipzig (Germany); Hindricks, Gerhard; Sommer, Philipp; Hilbert, Sebastian [University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig (Germany); Fleiter, Christian [Helios Klinikum Berlin-Buch, Department of Orthopaedic Surgery, Berlin (Germany); Schnackenburg, Bernhard [Philips Healthcare, Hamburg (Germany); Weiss, Steffen; Krueger, Sascha [Philips Innovative Technologies, Hamburg (Germany); Piorkowski, Christopher; Gaspar, Thomas [University of Dresden - Heart Center, Department of Electrophysiology, Dresden (Germany); Wedan, Steve; Lloyd, Thomas [Imricor Medical Systems, Burnsville, MN (United States)

    2017-05-15

    To evaluate the feasibility of performing comprehensive Cardiac Magnetic resonance (CMR) guided electrophysiological (EP) interventions in a porcine model encompassing left atrial access. After introduction of two femoral sheaths 14 swine (41 ± 3.6 kg) were transferred to a 1.5 T MR scanner. A three-dimensional whole-heart sequence was acquired followed by segmentation and the visualization of all heart chambers using an image-guidance platform. Two MR conditional catheters were inserted. The interventional protocol consisted of intubation of the coronary sinus, activation mapping, transseptal left atrial access (n = 4), generation of ablation lesions and eventually ablation of the atrioventricular (AV) node. For visualization of the catheter tip active tracking was used. Catheter positions were confirmed by passive real-time imaging. Total procedure time was 169 ± 51 minutes. The protocol could be completed in 12 swine. Two swine died from AV-ablation induced ventricular fibrillation. Catheters could be visualized and navigated under active tracking almost exclusively. The position of the catheter tips as visualized by active tracking could reliably be confirmed with passive catheter imaging. Comprehensive CMR-guided EP interventions including left atrial access are feasible in swine using active catheter tracking. (orig.)

  13. Utility of transesophageal electrocardiography to guide optimal placement of a transesophageal pacing catheter in dogs.

    Science.gov (United States)

    Sanders, Robert A; Chapel, Emily; Garcia-Pereira, Fernando L; Venet, Katherine E

    2015-01-01

    To determine if the transesophageal atrial (A) wave amplitude or ventricular (V) wave amplitude can be used to guide optimal positioning of a transesophageal pacing catheter in dogs. Prospective clinical study. Fourteen client owned healthy dogs with a median weight of 15.4 kg (IQR = 10.6-22.4) and a median age of 12 months (IQR = 6-12). Transesophageal atrial pacing (TAP) using a 6 Fr pacing catheter was attempted in dogs under general anesthesia. The pacing catheter was inserted orally into the esophagus to a position caudal to the heart. With the pulse generator set at a rate 20 beats/minute(-1) above the intrinsic sinus rate, the catheter was slowly withdrawn until atrial pacing was noted on a surface electrocardiogram (ECG). Then the catheter was withdrawn in 1 cm increments until atrial capture was lost. Minimum pacing threshold (MPT) and transesophageal ECG were recorded at each site. Amplitudes of the A and V waves on transesophageal ECG were then measured and their relationship to MPT was evaluated. TAP was achieved in all dogs. In 9/14 dogs the site of lowest overall MPT was the same as the site of maximal A wave deflection. In dogs with at least three data points, linear regression analysis of the relationship between the estimated site of the lowest overall MPT compared to estimated site of the maximal A and V waveform amplitudes demonstrated a strong correlation (R(2) = 0.99). Transesophageal ECG A and V waveforms were correlated to MPT and could be used to direct the placement of a pacing catheter. However, the technique was technically challenging and was not considered to be clinically useful to guide the placement of a pacing catheter. © 2014 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.

  14. Umbilical venous catheter malposition and errors in interpretation in newborns with Bochdalek hernia

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Patricia T.; Taylor, George A. [Boston Children' s Hospital and Harvard Medical School, Department of Radiology, Boston, MA (United States)

    2015-07-15

    Neonates with congenital diaphragmatic hernia (CDH) often require placement of lines and tubes for supportive therapy. The resulting altered anatomy can result in diagnostic errors when interpreting the location of support lines and tubes such as UVCs (umbilical venous catheters). The purpose of this study was to evaluate the effect of CDH on UVC position and to evaluate the accuracy at which radiologists describe the position on chest radiographs. During a 5-year period, 406 chest radiographs performed within 7 days of birth in infants with congenital diaphragmatic hernia were identified and reviewed for the following data: presence of UVC, location of catheter tip (cavoatrial junction, intracardiac, intrahepatic or umbilical vein), and location of CDH (right or left). The radiologic report of the UVC tip location for each case was then reviewed individually to determine the adequacy of interpretation. Inadequate reports were classified as incorrect (the wrong location of the catheter tip was reported), no mention (the location of the catheter tip was in a suboptimal location but not mentioned), and not specified (the precise location of the catheter tip was not clearly stated in the report when the tip was in a suboptimal location). A total of 60 infants were identified as having CDH (56 on the left, 4 on the right). The most common location for an incorrectly placed UVC was the contralateral chest, accounting for 26.7% (16/60) of the infants, followed by an abdominal intrahepatic location (16.7%) and the umbilical vein (8.3%). Thirty percent (120/406) of the chest radiograph reports were found to be inadequate regarding the interpretation of the location of the catheter tip. The majority of the inadequate reports (48/406, 11.8%) did not specify when the catheter tip was in a suboptimal location. In 37 reports (9.1%), the location of the catheter tip was reported incorrectly, and no mention of the catheter location was made in 35 reports (8.6%). The location of

  15. Accidental Breakage of Lumbar Epidural Catheter - Case report ...

    African Journals Online (AJOL)

    Breakage of epidural catheter is a rare occurrence with only isolated reports. Though insertion of epidural catheter is generally considered a safe procedure, breakage during removal leaving a segment in the patient's back can occur. There are many factors associated with breakage of an epidural catheter, such as the ...

  16. Misplaced left internal jugular venous catheter with an exceptional ...

    African Journals Online (AJOL)

    Large numbers of central venous catheters (CVCs) are placed each year in the intensive care units and misplacement occurs frequently. Many critically ill patients require central venous catheterization for multiple and varied reasons. Internal jugular vein (IJV) catheter is one of the most frequent central venous catheters in ...

  17. 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...

  18. FAQs about Catheter-Associated Urinary Tract Infection

    Science.gov (United States)

    ... the bladder. What are the symptoms of a urinary tract infection? Some of the common symptoms of a urinary tract infection are: • Burning or ... catheter is removed. Sometimes people with catheter-associated urinary tract ... these symptoms of infection. Can catheter-associated urinary tract infections ...

  19. 21 CFR 884.6110 - Assisted reproduction catheters.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Assisted reproduction catheters. 884.6110 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6110 Assisted reproduction catheters. (a) Identification. Assisted reproduction catheters are devices used in in...

  20. Catheter associated urinary tract infection: Aetiologic agents and ...

    African Journals Online (AJOL)

    The objective of this study was to identify microbial pathogens associated with bacteriuria and UTI in patients with indwelling urethral catheters and determine their susceptibility patterns to commonly used antimicrobial agents in our institution. Catheter urine and catheter tip specimens of all the patients were analyzed by ...

  1. Severe Tricuspid Valve Endocarditis Related to Tunneled Catheters ...

    African Journals Online (AJOL)

    The patient improved after catheter removal and treatment with ceftazidime, vancomycin and amikacin. Another patient who was maintained on chronic HD through a tunneled catheter in the right internal jugular vein presented with a limited infection in the sub-cutaneous tunnel of the catheter that improved after treatment ...

  2. 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 ...

  3. ENPEP model enhancements at ANL

    International Nuclear Information System (INIS)

    Guziel, K.A.

    1997-01-01

    Argonne National Laboratory (ANL) has been involved in energy and electricity planning analyses for almost 20 years. Their activities include the development of analytical tools and methodologies along with their application to a wide variety of national energy planning studies. The methodologies cover all aspects of energy planning. In response to a request by the US Department of Energy (USDOE) to integrate existing tools into a package that could be distributed to developing countries for their own use, the ENergy and Power Evaluation Program (ENPEP) was developed. The USDOE wanted an all purpose tool that would allow the user to do a complete energy analysis, from demand forecast through primary energy resources allocation to electricity generation system expansion plan and environmental analysis. Since its original development, the ENPEP modules have been improved and enhanced to incorporate advancements in computer hardware and software technology, as well as to correct bugs that were identified in the programs. In cooperation with other organizations (e.g. The World Bank - IBRD - and the International Atomic Energy Agency - IAEA -), the ENPEP package has been used at national, regional and inter-regional training courses, as well as in the conduct of national energy/electricity planning studies. This paper reviews the development of the ENPEP package and the proposed enhancements to the package. (author). 1 fig., 2 tabs

  4. Postprocedural Aspiration Test to Predict Adequacy of Dialysis Following Tunneled Catheter Placement

    International Nuclear Information System (INIS)

    Smith, Jason C.; Sullivan, Kevin L.; Michael, Beckie

    2006-01-01

    The objective of the study was to determine if a timed aspiration technique with a 20-ml syringe can be used to predict adequacy of blood flow in tunneled dialysis catheters. Sixteen patients referred for de novo placement or manipulation of failing tunneled hemodialysis catheters had the time it takes to fill a 20-ml syringe with the plunger fully withdrawn measured to the nearest tenth of a second. These measurements were correlated with flow rates recorded in dialysis just prior to (if failed catheter) and in the following dialysis session with adequacy determined as at least 300 ml/min. Syringe-filling time (22 catheters in 16 patients) was plotted against adequacy of dialysis. The mean time to fill a 20-ml syringe was 2.2 sec, with a range of 1.0-4.7 sec. The mean time to fill syringes for catheters with adequate dialysis was 1.7 ± 0.5 sec, and for inadequate catheters, it was 2.8 ± 0.8 sec. These differences are statistically significant (p < 0.001). Using a filling time of greater than or equal to 2 sec as a threshold gives the highest sensitivity (100%) for predicting inadequate dialysis while maintaining high specificity (75%). To achieve a specificity of 100%, a 3-sec cutoff would be necessary, but would lead to a sensitivity of only 20%. A simple and objective aspiration technique can be performed at the time of tunneled dialysis catheter placement/manipulation to reasonably predict adequacy of subsequent dialysis

  5. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  7. Percutaneous Placement of Peritoneal Dialysis Catheters in ...

    African Journals Online (AJOL)

    Background: The percutaneous placement of peritoneal dialysis (PD) catheters using conscious sedation with ultrasound and fluoroscopic guidance is underutilised and hasseveral advantages over the open surgical and laparoscopic placement methods, especially in the resource-limited developing world. Objectives: To ...

  8. OCCASIONAL REVIEW 'Map and zap' - electrode catheter ...

    African Journals Online (AJOL)

    Where does this leave surgical treatment of WPW syndrome? Despite the high success rates reported, ·it is acknowledged that not all patients can be successfully treated by catheter ablation. The treatment of those with multiple accessory pathways and associated defects such as Ebstein's anomaly of the tricuspid valve is ...

  9. Ultraminiature manometer-tipped cardiac catheter

    Science.gov (United States)

    Coon, G. W.

    1967-01-01

    Miniature diaphragm-type capacitance transducer capable of being mounted on the end of a cardiac catheter has been developed for measurement of intravascular pressures. The transducer can be inserted in small ducts /arteries and veins/ without disturbing the flow characteristics. It is very useful for making measurements in babies.

  10. Placement issues of hemodialysis catheters with pre-existing central lines and catheters.

    Science.gov (United States)

    Aurshina, Afsha; Hingorani, Anil; Alsheekh, Ahmad; Kibrik, Pavel; Marks, Natalie; Ascher, Enrico

    2018-03-01

    It has been a widely accepted practice that a previous placed pacemaker, automatic implantable cardioverter defibrillators, or central line can be a contraindication to placing a hemodialysis catheter in the ipsilateral jugular vein. Fear of dislodging pacing wires, tunneling close to the battery site or causing venous obstruction has been a concern for surgeons and interventionalists alike. We suggest that this phobia may be unfounded. A retrospective review was conducted of patients in whom hemodialysis catheters were placed over a period of 10 years. For each hemodialysis catheter that was placed, perioperative chest X-ray performed was used to evaluate for pre-existing pacemakers and central lines. The position and laterality of placement of the hemodialysis catheter along with presence of arteriovenous fistula with functional capacity for access were noted. A total of 600 hemodialysis catheters were placed in patients over the period of 10 years. The mean age of the patients was 73.6 ± 12 years with a median age of 76 years. We found 20 pacemakers or automatic implantable cardioverter defibrillators and 19 central lines on the same side of the neck as the hemodialysis catheter that was placed in the ipsilateral jugular vein. No patient exhibited malfunction or dislodgment of the central line, the pacemaker, or automatic implantable cardioverter defibrillator or evidence of upper extremity venous obstruction based upon signs symptoms or duplex exams. Based on our experience, we suggest that placement of hemodialysis catheter in the internal jugular vein ipsilateral to the pre-existing catheter/leads is safe and spares the contralateral limb for arteriovenous fistula creation.

  11. Fibrosis in tubularized skin flaps in rats, using silicon catheters with two different degrees of flexibility: experimental model Fibrose em retalhos tubulizados de pele de ratos usando cateteres de diferentes flexibilidades como molde: modelo experimental

    Directory of Open Access Journals (Sweden)

    Antonio Henrique Rodrigues dos Passos

    2008-06-01

    Full Text Available PURPOSE: Microscopically evaluate the intensity of fibrosis in tubularized skin flaps on the back of Wistar rats, using silicon molds with different degrees of flexibility. METHODS: Twenty rats were submitted to three tubularized skin flaps on their backs. In two tubular flaps, we placed, as a mold, silicon catheters with different degrees of flexibility and removed them on the seventh day after the surgery. They were divided into two groups and euthanized, on the seventh and twenty-first days respectively after the surgery for the collection of the pieces, coloration with Masson tricromic, quantification of the area of each sample and comparison among the groups. RESULTS: Fibrosis was less intense on the tubular flaps where a catheter was not used as a mold. No significant difference was verified among the pieces with the silicon catheters, but there was a tendency of less fibrosis on the tubules with the most flexible catheter. CONCLUSION: There was no significant difference among the two catheter types. Fibrosis was less intense in the flaps where the mold was not used.OBJETIVO: Avaliar microscopicamente a intensidade da fibrose em retalhos tubulares de pele do dorso de ratos Wistar em uso de moldes de silicone de diferentes flexibilidades. MÉTODOS: Vinte animais foram submetidos à confecção de três retalhos tubulizados de pele na região dorsal. Em dois túbulos foram colocados, como molde, cateteres de silicone com flexibilidades diferentes e retirados no sétimo dia após a cirurgia. Foram divididos em dois grupos e sacrificados, respectivamente, no sétimo e vigésimo primeiro dia após a cirurgia para a coleta das peças, coloração pelo tricrômico de Masson, quantificação da área de cada amostra e comparação entre os grupos. RESULTADOS: A fibrose foi menos intensa nos retalhos tubulares em que não se usou cateter como molde. Não se verificou diferença significativa entre os retalhos com os cateteres de silicone, mas sim

  12. 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

  13. Heparin for clearance of peripherally inserted central venous catheter in newborns: an in vitro study

    Science.gov (United States)

    Balaminut, Talita; Venturini, Danielle; da Silva, Valéria Costa Evangelista; Rossetto, Edilaine Giovanini; Zani, Adriana Valongo

    2015-01-01

    Objective: To compare the efficacy of two concentrations of heparin to clear the lumen of in vitro clotted neonatal peripherally inserted central catheters (PICCs). Methods: This is an in vitro, experimental quantitative study of 76 neonatal 2.0-Fr PICCs coagulated in vitro. The catheters were divided into two groups of 38 PICCs each. In both groups an infusion of low molecular weight heparin was administered with a dose of 25IU/mL for Group 1 and 50IU/mL for Group 2. The negative pressure technique was applied to the catheters of both groups at 5, 15 and 30min and at 4h to test their permeability. Kaplan-Meier survival analysis was used to verify the outcome of the groups according to time intervals. Results: The comparison between both groups in the first 5min showed that more catheters from Group 2 were cleared compared to Group 1 (57.9 vs. 21.1%, respectively). Kaplan-Meier survival analysis showed that less time was needed to clear catheters treated with 50IU/mL of heparin (p<0.001). Conclusions: The use of low molecular weight heparin at a concentration of 50IU/mL was more effective in restoring the permeability of neonatal PICCs occluded in vitro by a clot, and the use of this concentration is within the safety margin indicated by scientific literature. PMID:26116325

  14. Catheter replacement structure in home medical care settings and regional characteristics in Tokyo and three adjoining prefectures.

    Science.gov (United States)

    Kimura, Takuma; Yoshie, Satoru; Tsuchiya, Rumiko; Kawagoe, Shohei; Hirahara, Satoshi; Iijima, Katsuya; Akahoshi, Toru; Tsuji, Tetsuo

    2017-04-01

    The present study investigated the association between the structure of catheter replacement services in home medical care settings and regional characteristics. An anonymous self-administered questionnaire was carried out from August to September 2013. Participants were physicians from 5338 clinics that provided medical care services at home, and nurses from 1619 home-visit nursing stations in Tokyo and three adjoining prefectures. The questionnaire covered catheter replacement (gastrostomy tubes, nasogastric tubes, tracheal cannulas) during home medical care, and the professions of those who replaced urethral catheters for male and female patients. Regions were divided into two groups (higher- and lower-density regions) based on the number of clinics, number of home-visit nursing stations and the ratio of the population aged ≥65 years. The rates of respondents that reported catheter replacement was usually executed, and those who reported catheters were replaced by "physicians in principle" were compared between the groups. Responses were received from 842 clinics (16.3%) and 499 home-visit nursing stations (31.4%). In the higher-density regions, the rate of physicians who reported urethral catheters for male patients were replaced by "physicians in principle" was significantly higher than in the lower-density regions (P home medical care settings, urethral catheters for male patients are replaced by nurses in regions where physician resources are limited. Geriatr Gerontol Int 2017; 17: 628-636. © 2016 Japan Geriatrics Society.

  15. Catheter Ablation of Tachyarrhythmias in Small Children

    Directory of Open Access Journals (Sweden)

    Andrew D. Blaufox

    2005-01-01

    Full Text Available An estimated 80,000-100,000 radiofrequency ablation (RFA procedures are performed in the United States each year.1 Approximately 1% of these are performed on pediatric patients at centers that contribute data to the Pediatric Radiofrequency Registry.2 Previous reports from this registry have demonstrated that RFA can safely and effectively be performed in pediatric patients.3,4 However, patients weighing less than 15 kg have been identified as being at greater risk for complications.3,4 Consequently, there has been great reluctance to perform RFA in small children such that children weighing less than 15 kg only represent approximately 6% of the pediatric RFA experience2 despite the fact that this age group carries the highest incidence of tachycardia, particularly supraventricular tachycardia (SVT.5 Factors other than the risk of complications contribute to the lower incidence of RFA in this group, including the natural history of the most common tachycardias (SVT, technical issues with RFA in small hearts, and the potential unknown long-term effects of RF applications in the maturing myocardium. Conversely, there are several reasons why ablation may be desirable in small children, including greater difficulties with medical management,6,7,8 the higher risk for hemodynamic compromise during tachycardia in infants with congenital heart disease (CHD, and the inability of these small children to effectively communicate their symptoms thereby making it more likely that their symptoms may go unnoticed until the children become more seriously ill. Before ultimately deciding that catheter ablation is indicated in small children, one must consider which tachycardias are likely to be ablated, the clinical presentation of these tachycardias, alternatives to ablation, the relative potential for success or complications, and modifications of the procedure that might reduce the risk of ablation in this group.

  16. Causes and nursing countermeasures in pediatric PICC catheter complications.

    Science.gov (United States)

    Xiang, Mingli; Li, Na; Yi, Lan; Liu, Bin

    2016-01-01

    To analyze the complications and nursing countermeasures of PICC (Peripherally Inserted Central Catheter) catheters using children PICC catheter technique 40 cases, complications were observed, and analyze the original causes, in order to propose a solution. There were 10 cases of catheter blockage, 5 cases of catheter infection, 6 cases of phlebitis, 5 cases of puncture difficulties, 2 cases of poor feeding tube, 2 cases of bleeding puncture site with the continuous exploration and research of nursing intervention, the production of clinical complications from PICC has been used in children were greatly reduced.

  17. Analytical methods used at model facility

    International Nuclear Information System (INIS)

    Wing, N.S.

    1984-01-01

    A description of analytical methods used at the model LEU Fuel Fabrication Facility is presented. The methods include gravimetric uranium analysis, isotopic analysis, fluorimetric analysis, and emission spectroscopy

  18. Hybrid interventions for catheter placement in pediatric intestinal rehabilitation patients with end-stage venous access.

    Science.gov (United States)

    Sieverding, Ludger; Busch, Andreas; Gesche, Jens; Blumenstock, Gunnar; Sturm, Ekkehard; Tsiflikas, Ilias; Piersma, Femke; Hauser, Anja; Wiegand, Gesa; Hartleif, Steffen; Hofbeck, Michael; Fuchs, Jörg; Warmann, Steven W

    2018-03-01

    The purpose of this study is to analyze the combined approach of endovascular and open surgical procedures for insertion of permanent central venous catheters in children with intestinal failure and end-stage venous access. Data of 14 children (16 interventions) with intestinal failure and end-stage venous access, treated within the pediatric intestinal rehabilitation program at our institution between September 2011 and November 2016, were retrospectively reviewed. The patients underwent hybrid endovascular/open surgical approaches for insertion of central venous catheters. Access to central veins was established through endovascular intervention; catheter placement was achieved with combined interventional and surgical measures depending on the individual vascular conditions. Median age at intervention was 47months (interquartile range (IQR),29-74), median time for interventions was 66min (IQR,42-111). Catheter placement was successfully achieved in all patients. The median dose of irradiation during angiography was 0.2Gy*cm 2 (IQR, 0.2-0.6), no complications occurred during or after interventions. Hybrid endovascular/open surgical procedures can be successfully applied for restoring or maintaining permanent central venous catheters in children with intestinal failure and end-stage venous access. These approaches are a valuable contribution in intestinal rehabilitation programs contributing to a further decrease of the need for intestinal transplantation in affected patients. Treatment Study. Level IV. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Temporary hemodialysis catheter placement by nephrology fellows: implications for nephrology training.

    Science.gov (United States)

    Clark, Edward G; Schachter, Michael E; Palumbo, Andrea; Knoll, Greg; Edwards, Cedric

    2013-09-01

    The insertion of temporary hemodialysis catheters is considered to be a core competency of nephrology fellowship training. Little is known about the adequacy of training for this procedure and the extent to which evidence-based techniques to reduce complications have been adopted. We conducted a web-based survey of Canadian nephrology trainees regarding the insertion of temporary hemodialysis catheters. Responses were received from 45 of 68 (66%) eligible trainees. The median number of temporary hemodialysis catheters inserted during the prior 6 months of training was 5 (IQR, 2-11), with 9 (20%) trainees reporting they had inserted none. More than one-third of respondents indicated that they were not adequately trained to competently insert temporary hemodialysis catheters at both the femoral and internal jugular sites. These findings are relevant to a discussion of the current adequacy of procedural skills training during nephrology fellowship. With respect to temporary hemodialysis catheter placement, there is an opportunity for increased use of simulation-based teaching by training programs. Certain infection control techniques and use of real-time ultrasound should be more widely adopted. Consideration should be given to the establishment of minimum procedural training requirements at the level of both individual training programs and nationwide certification authorities. Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  20. 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.

  1. Efficacy and safety of novel multi-lumen catheter for chronic total occlusions: from preclinical study to first-in-man experience.

    Science.gov (United States)

    Mitsutake, Yoshiaki; Ebner, Adrian; Yeung, Alan C; Taber, Mark D; Davidson, Charles J; Ikeno, Fumiaki

    2015-02-15

    To report our initial animal and human experience with a new multi-lumen catheter called MultiCross™ (Roxwood Medical, Inc.) in a porcine coronary model and patients with a chronic total occlusion (CTO). Preclinical safety study was done in the coronary vasculature of a porcine model. In a clinical setting, patients with a CTO of a coronary artery (n = 5) were enrolled. After an initial unsuccessful attempt using a conventional guidewire, operators could use the MultiCross system. The primary efficacy endpoint was successful recanalization (technical success) and the primary safety endpoint was serious adverse events through 30 days post-procedure. The MultiCross catheter was used for all patients after failure of the initial attempt with a guidewire. Successful recanalization was achieved in all CTOs attempted (100%). No patients reported any adverse events at 30 days post-procedure. In this first-in-man experience, the MultiCross catheter has the potential to enhance crossing of CTOs. © 2014 Wiley Periodicals, Inc.

  2. Intravascular Cooling Catheter-Related Venous Thromboembolism After Hypothermia: A Case Report and Review of the Literature.

    Science.gov (United States)

    Wang, Xuan; Moy, Brian T; Hiendlmayr, Brett J; Krainski, Felix; Duvall, W Lane; Fernandez, Antonio B

    2018-03-23

    Fifty-four year-old man with recent history of myocardial infarction and a percutaneous coronary intervention who suffered a ventricular fibrillation arrest at home. He was resuscitated in the field. His heart rhythm was in atrial fibrillation. The cardiac catheterization showed a patent stent from his previous myocardial infarction and no new occlusions. He subsequently underwent hypothermia protocol using the Alsius CoolGard 3000 Temperature Control System and Icy Catheter. Heparin drip was started for atrial fibrillation 36 hours after catheter insertion and became therapeutic 2 hours before the end of cooling maintenance phase. Heparin drip was stopped 4 hours into the rewarming phase because of spontaneous conversion to sinus rhythm. Subcutaneous heparin was resumed for deep venous thrombosis prophylaxis. He was extubated to room air after hypothermia protocol. The cooling catheter was removed 88 hours after insertion. Within 1 minute of catheter removal, his oxygen saturation dropped to 80%. Transthoracic echocardiogram showed a mobile thrombus in the right atrium prolapsing into the right ventricle. Computer tomography angiography of the chest confirmed a large saddle embolus. Ninety minutes later, patient went into cardiac arrest with pulseless electrical activity while he was being considered for surgical embolectomy, but he could not be resuscitated. The temporal relationship of the catheter removal and his acute clinical decompensation led to believe that this was an intravascular cooling catheter (ICC)-related event. Providers should be cognizant of the complications of central venous catheters such as thrombosis formation, as it could lead to fatal pulmonary embolism. Physicians should promote frequent assessment of the access site(s) during routine physical examinations and potentially use point of care vascular ultrasound in high-risk cases to rule out a catheter-associated thrombus before catheter removal.

  3. Modelling Cooperative Work at a Medical Department

    DEFF Research Database (Denmark)

    Christensen, Lars Rune; Hildebrandt, Thomas

    2017-01-01

    Based on ethnographic fieldwork, and the modelling of work processes at a medical department, this paper considers some of the opportunities and challenges involved in working with models in a complex work setting. The paper introduces a flexible modelling tool to CSCW, called the DCR Portal...

  4. The incidence and risk factors of peripherally inserted central catheter-related infection among cancer patients

    Science.gov (United States)

    Gao, Yufang; Liu, Yuxiu; Ma, Xiaoyan; Wei, Lili; Chen, Weifen; Song, Lei

    2015-01-01

    Background As the use of peripherally inserted central catheters (PICCs) increased in chemotherapy, the identification of complications and risk factors became essential to prevent patient harm. But little is known about PICC-related infection and risk factors among patients with cancer. Our study was to identify the prevalence, patterns, and risk factors of catheter-related infections associated with PICCs. Methods A 3-year prospective cohort study was conducted in a university-affiliated hospital. All patients with cancer who met inclusion criteria were enrolled. The patients were followed up until catheter removal. Tip cultures were routinely performed at the time of catheter removal. The general information was recorded at the time of PICC insertion, weekly care, and removal. Univariable and multivariable logistic regression analyses were applied for identification of risk factors. Results In total, 912 cancer patients with 912 PICCs of 96,307 catheter days were enrolled. Ninety-four developed PICC-related infection; 46 were exit-site infection, 43 were catheter bacterial colonization, and five were PICC-related bloodstream infection. The median time from catheter insertion to infection was 98.26 days. Multivariate analysis showed StatLock fixing (odds ratio [OR] =0.555, 95% confidence interval [CI]: 0.326–0.945) and tip position located in the lower one-third of the superior vena cava (OR =0.340, 95% CI: 0.202–0.571) were associated with lower PICC infection rate. Catheter care delay (OR =2.612, 95% CI: 1.373–4.969) and indwelling mostly in summer (OR =4.784, 95% CI: 2.681–8.538) were associated with higher infection incidence. Conclusion StatLock fixing and tip position located in the lower one-third of the superior vena cava were protective factors against PICC-related infection, while catheter care delay and indwelling mostly in summer were risk factors. Policy and measures targeting these factors may be necessary to reduce the risk of infection

  5. Risk Factors of Catheter-related Bloodstream Infection With Percutaneously Inserted Central Venous Catheters in Very Low Birth Weight Infants: A Center's Experience in Taiwan

    Directory of Open Access Journals (Sweden)

    Jen-Fu Hsu

    2010-12-01

    Conclusion: It is important to avoid inserting a PICC at the femoral site. Strict catheter care protocol should also be applied to reduce local site bacterial colonization and removal of PICCs as soon as they are no longer essential for patient care to reduce the incidence of infection.

  6. Model of MSD Risk Assessment at Workplace

    OpenAIRE

    K. Sekulová; M. Šimon

    2015-01-01

    This article focuses on upper-extremity musculoskeletal disorders risk assessment model at workplace. In this model are used risk factors that are responsible for musculoskeletal system damage. Based on statistic calculations the model is able to define what risk of MSD threatens workers who are under risk factors. The model is also able to say how MSD risk would decrease if these risk factors are eliminated.

  7. [A case of catheter-related bacteremia of Tsukamurella pulmonis].

    Science.gov (United States)

    Shim, Hyoeun Eun; Sung, Heungsup; Baek, Seung Mi; Namgung, Seung; Kim, Mi-Na; Kim, Yong Gyun; Lee, Gyu Hyung

    2009-02-01

    Tsukamurella pulmonis is an aerobic actinomycete. We report a catheter-related bacteremia of T. pulmonis. A 39 yr-old male with ALL was hospitalized to receive bone marrow transplantation (BMT). Although the patient developed a high fever at the 7th hospital day (HD), it subsided with vancomycin treatment, and he received BMT at 9th HD. Fever resurged at 16th HD despite sustained treatment with vancomycin, meropenem, and amphotericin B, but subsided with removal of Hickman catheter (HC) at 19th HD. Three sets of blood cultures comprising one from the HC and two from venipunctures were taken at 7th, 16th, and 19th HD, and the distal tip of the HC was also cultured. The aerobic vials of all 3 HC-withdrawn blood cultures and one peripheral blood culture taken at 19HD and the HC tip culture grew long, straight, thin gram-positive rods that were positive on modified Kinyoun stain. This organism showed tiny, rough, grey colonies after 3-day incubation and grew to large flat colonies when incubation was extended. It was catalase-positive, urease-positive, and alkaline-slant/alkaline-deep on triple sugar iron agar, and hydrolyzed hypoxanthine. The sequence of 1,296 base pairs of 16S rRNA of this organism showed a 100.0% homology with the published sequence of T. pulmonis DSM 44142T. To our knowledge, this is the first report of T. pulmonis bacteremia in Korea.

  8. Development of Remote-Type Haptic Catheter Sensor System using Piezoelectric Transducer

    Science.gov (United States)

    Haruta, Mineyuki; Murayama, Yoshinobu; Omata, Sadao

    This study describes the development of Remote-Type Haptic Catheter Sensor System which enables the mechanical property evaluation of a blood vessel. This system consists of a feedback circuit and a piezoelectric ultrasound transducer, and is operated based on a phase shift method so that the entire system oscillates at its inherent resonance frequency. Ultrasound reflected by the blood vessel makes a phase shift of the resonance system depending on the acoustic impedance of the reflector. The phase shift is then measured as a change in resonance frequency of the system; therefore, the detection resolution is highly improved. The correlation between the acoustic impedance and the resonance frequency change of the sensor system was demonstrated using silicone rubbers, metals and actual blood vessels from a pig. The performance of the sensor was also examined using vessel shaped phantom model. Finally, the discussion surveys a possibility of the novel sensor system in an application for intra vascular diagnosis.

  9. The WZNW Model at Two Loops

    NARCIS (Netherlands)

    Wit, B. de; Grisaru, M. T.; Nieuwenhuizen, P. van

    1993-01-01

    We study perturbatively the (conformal) WZNW model. At one loop we compute one-particle irreducible two- and three-point current correlation functions, both in the conventional version and in the classically equivalent, chiral, nonlocal, induced version of the model. At two loops we compute the

  10. Modelling of rate effects at multiple scales

    DEFF Research Database (Denmark)

    Pedersen, R.R.; Simone, A.; Sluys, L. J.

    2008-01-01

    , the length scale in the meso-model and the macro-model can be coupled. In this fashion, a bridging of length scales can be established. A computational analysis of  a Split Hopkinson bar test at medium and high impact load is carried out at macro-scale and meso-scale including information from  the micro-scale....

  11. Backup support of the mother-child technique: technical considerations for the size of the mother guiding catheter.

    Science.gov (United States)

    Takeshita, Satoshi; Takagi, Ayumu; Saito, Shigeru

    2012-08-01

    We previously proposed a technique called the "mother-child technique" to facilitate stent delivery for complex coronary lesions. This technique is applicable when the backup support of the guiding catheter is insufficient. In this study, we used an in vitro coronary artery tree model to determine the impact of the size of the mother guiding catheter on the backup support of the mother-child guiding system. The backup support was measured for the 4-in-5, 4-in-6, 4-in-7, and 4-in-8 systems as well as for the 5-in-6, 5-in-7, and 5-in-8 systems. Advancement of the child catheter into the coronary artery tree model improved the backup support of the mother-child system. When a 4-Fr child catheter was advanced by 9 cm, the relative increase in the backup support was 174% in the 4-in-5 system; it was 203% in the 4-in-6, and 135% in the 4-in-7 system (P guiding catheter. Thus, the mother-child technique may be most useful for PCIs in which a small guiding catheter is used, such as transradial coronary interventions. Copyright © 2012 Wiley Periodicals, Inc.

  12. An unexpected journey of a suction catheter in a preterm neonate

    Directory of Open Access Journals (Sweden)

    Ling Leung

    2015-09-01

    Full Text Available Foreign bodies are extremely rare in preterm neonates. The majority are iatrogenic. We describe a neonate of 27 weeks gestation who was found to have an 18 mm long suction catheter at the right main bronchi after resuscitation in another hospital. It was first detected by chest X-ray after endotracheal intubation. Repeat X-ray revealed the catheter moved to the stomach and migrated to the lower gastrointestinal tract in a few hours. The patient was treated conservatively and the catheter was passed out on day 14. Newborn resuscitation may result in iatrogenic foreign body in neonates. Serious complications such as respiratory compromise, perforations or abscess may occur. Early referral to a specialized tertiary center with pediatric surgical service is recommended. We hope our experience demonstrated the importance of preventing iatrogenic foreign body in clinical setting. Access to endoscopic instrumentation for foreign body removal in preterm neonates should be available at all times.

  13. HDR monotherapy for prostate cancer: A simulation study to determine the effect of catheter displacement on target coverage and normal tissue irradiation

    International Nuclear Information System (INIS)

    Kolkman-Deurloo, Inger-Karine K.; Roos, Martin A.; Aluwini, Shafak

    2011-01-01

    Purpose: The aim of this study was to systematically analyse the effect of catheter displacements both on target coverage and normal tissue irradiation in fractionated high dose rate (HDR) prostate brachytherapy, using a simulation study, and to define tolerances for catheter displacement ensuring that both target coverage and normal tissue doses remain clinically acceptable. Besides the effect of total implant displacement, also displacements of catheters belonging to selected template rows only were evaluated in terms of target coverage and normal tissue dose, in order to analyse the change in dose distribution as a function of catheter dwell weight and catheter location. Material and methods: Five representative implant geometries, with 17 catheters each, were selected. The clinical treatment plan was compared to treatment plans in which an entire implant displacement in caudal direction over 3, 5, 7 and 10 mm was simulated. Besides, treatment plans were simulated considering a displacement of either the central, most ventral or most dorsal catheter rows only, over 5 mm caudally. Results: Due to displacement of the entire implant the target coverage drops below the tolerance of 93% for all displacements studied. The effect of displacement of the entire implant on organs at risk strongly depended on the patient anatomy; e.g., for 80% of the implant geometries the V 80 of the rectum exceeded its tolerance for all displacements. The effect of displacement of catheters belonging to selected template rows depended strongly on the relative weight of each catheter row when considering the target coverage and on its location when considering the dose in the organs at risk. Conclusion: This study supports the need for a check of the catheter locations before each fraction and correction of deviations of the catheter position exceeding 3 mm.

  14. Catheter based mid-infrared reflectance and reflectance generated absorption spectroscopy

    Science.gov (United States)

    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.

  15. In Vivo Biocompatibility and In Vitro Efficacy of Antimicrobial Gendine-Coated Central Catheters

    Science.gov (United States)

    Jamal, Mohamed A.; Hachem, Ray Y.; Rosenblatt, Joel; McArthur, Mark J.; Felix, Edd; Jiang, Ying; Tailor, Ramesh C.

    2015-01-01

    Antimicrobial peripherally inserted central catheters (PICCs) might reduce the incidence of central line-associated bloodstream infections (CLABSI). We tested the biocompatibility of a novel gendine-coated (combination of chlorhexidine [CHX] and gentian violet [GV]) PICC in a rabbit intravascular model and tested antimicrobial efficacy in comparison with commercially available minocycline/rifampin (M/R)- and CHX-treated PICCs in an in vitro biofilm colonization model. Gendine-coated and uncoated control PICCs were inserted in the jugular veins of rabbits for 4 days. Histopathological analysis was performed at the end of the 4-day period, and circulating levels of CHX and GV in the blood were measured at different time points using liquid chromatography-mass spectrometry. The antimicrobial efficacy of the PICCs was tested following simulated intravascular indwells of 24 h and 1 week against clinical isolates of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii, Enterobacter cloacae, Candida albicans, and Candida glabrata. Rabbits implanted with gendine-coated PICCs exhibited reduced levels of thrombosis and inflammation compared to those of the rabbits with uncoated controls. No GV was detected in blood samples over the entire study period, and trace concentrations of CHX were detected. The gendine-coated PICCs completely prevented the adherence of all pathogens from 24 h to 1 week (P ≤ 0.001), while M/R-treated, CHX-treated, and control PICCs did not. Gendine-coated PICCs were highly effective in preventing biofilm formation of multidrug-resistant pathogenic bacteria and fungi. Gendine-coated PICCs were biocompatible in an intravascular setting. Further, the pharmacokinetic testing established that acute systemic exposures of CHX and GV from the gendine-coated catheters were well within safe levels. PMID:26124171

  16. Ultrasound assessment of umbilical venous catheter migration in preterm infants: a prospective study.

    Science.gov (United States)

    Franta, Jan; Harabor, Andrei; Soraisham, Amuchou S

    2017-05-01

    To evaluate the umbilical venous catheter (UVC) tip position by ultrasound and compare it with standard radiograph findings and to examine the catheter tip migration rates during the first week of life. Prospective observational study of inborn preterm infants who had an UVC placed and its position radiographically confirmed. The first ultrasound was done on UVC placement at median (IQR) age of 2 hours (1-4) and follow-up scans at a median (IQR) age of 34 hours (27-44 hours), 77 hours (70-94 hours) and 6 days (5-7 days) after insertion. Catheter tip was considered in optimum position if tip was lying in the inferior vena cava up to the right atrium opening. We studied 65 infants at a mean (±SD) gestational age and birth weight of 26.4 (±2.1) weeks and 808 (±289) g, respectively. Ultrasound confirmed optimum position of UVC tip in 25/65 (38.5%) infants. Majority (38/40) of the malpositioned catheters were located inside the heart with 15 reaching the left atrium. Catheter tip migration occurred in 29 of 58 infants (50%) at any time during the first week. The proportions of UVC migration were found to be 17%, 31% and 29% on subsequent ultrasound with a trend to outward movement over time. UVC tip localisation by standard radiography is very imprecise, and catheter tip migration occurs in a significant proportion of infants during first weeks of age. We suggest ultrasound as the best modality to assist localisation and follow-up of UVC tip in preterm infants. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  17. Tensile strength decreases and perfusion pressure of 3-holed polyamide epidural catheters increases in long-term epidural infusion.

    Science.gov (United States)

    Kim, Pascal; Meyer, Urs; Schüpfer, Guido; Rukwied, Roman; Konrad, Christoph; Gerber, Helmut

    2011-01-01

    Epidural analgesia is an established method for pain management. The failure rate is 8% to 12% due to technical difficulties (catheter dislocation and/or disconnection; partial or total catheter occlusion) and management. The mechanical properties of the catheters, like tensile strength and flow rate, may also be affected by the analgesic solution and/or the tissue environment. We investigated the tensile strength and perfusion pressure of new (n=20), perioperatively (n=30), and postoperatively (n=73) used epidural catheters (20-gauge, polyamide, closed tip, 3 side holes; Perifix [B. Braun]). To prevent dislocation, epidural catheters were taped (n=5) or fixed by suture (n=68) to the skin. After removal, mechanical properties were assessed by a tensile-testing machine (INSTRON 4500), and perfusion pressure was measured at flow rates of 10, 20, and 40 mL/h. All catheters demonstrated a 2-step force transmission. Initially, a minimal increase of length could be observed at 15 N followed by an elongation of several cm at additional forces (7 N). Breakage occurred in the control group at 23.5±1.5 N compared with 22.4±1.6 N in perioperative and 22.4±1.7 N in postoperative catheters (Ptensile strength, whereas perfusion pressure at clinically used flow rates (10 mL/h) increased significantly from 19±1.3 to 44±72 mm Hg during long-term (≥7 days) epidural analgesia (Ptensile strength or perfusion pressure. Epidural catheter use significantly increases the perfusion pressure and decreases the tensile strength. Copyright © 2011 by American Society of Regional Anesthesia and Pain Medicine

  18. Treatment delivery platform for conformal catheter-based ultrasound hyperthermia

    Science.gov (United States)

    Juang, Titania; Wootton, Jeffery; Hsu, I.-Chow; Diederich, Chris

    2009-02-01

    A clinical treatment delivery platform has been developed for providing 3D controlled hyperthermia with catheter-based ultrasound applicators in conjunction with high dose rate (HDR) brachytherapy. This integrated system consists of hardware and software components required for thermal therapy delivery, treatment monitoring and control, and realtime and post-treatment analysis; and interstitial and endocavity ultrasound heating applicators. Hardware includes a 32-channel RF amplifier with independent power (0-25 W) and frequency (5-10 MHz) control for ultrasound power delivery and a 48-channel thermometry system compatible with 0.4 mm OD multi-sensor thermocouple probes. Software graphical user interfaces (GUI) are used to monitor and control both the amplifier and the thermometry system. The amplifier GUI controls, monitors, and records individual channel frequency and power values in real-time; the thermometry GUI monitors and records temperature and thermal dose values in real-time, as well as displaying and allowing dynamic control for temperature and thermal dose target thresholds. The thermometry GUI also incorporates registration of thermocouple positions relative to target anatomy and applicator transducers based on HDR planning tools (CT/MRI/US overlays) for improved treatment control and documentation. The interstitial (2.4 mm) and endocavity (6 mm) ultrasound hyperthermia applicators are composed of linear arrays of 1-4 tubular piezoceramic transducers - sectored at 90°, 180°, 270°, and 360° for single or dual directional heating patterns - that are compatible with plastic implant catheters. QA techniques specific to these catheter-based ultrasound applicators have been devised and implemented, and include rotational beam plots and dynamic force balance efficiency measurements, which are critical to establish applicator performance. A quality assurance test matrix has been devised and used to evaluate and characterize all components of this system

  19. Diffusing, side-firing, and radial delivery laser balloon catheters for creating subsurface thermal lesions in tissue

    Science.gov (United States)

    Chang, Chun-Hung; Fried, Nathaniel M.

    2016-02-01

    Infrared lasers have been used in combination with applied cooling methods to preserve superficial skin layers during cosmetic surgery. Similarly, combined laser irradiation and tissue cooling may also allow development of minimally invasive laser therapies beyond dermatology. This study compares diffusing, side-firing, and radial delivery laser balloon catheter designs for creation of subsurface lesions in tissue, ex vivo, using a near-IR laser and applied contact cooling. An Ytterbium fiber laser with 1075 nm wavelength delivered energy through custom built 18 Fr (6-mm-OD) balloon catheters incorporating either 10-mm-long diffusing fiber tip, 90 degree side-firing fiber, or radial delivery cone mirror, through a central lumen. A chilled solution was flowed through a separate lumen into 9-mm-diameter balloon to keep probe cooled at 7°C. Porcine liver tissue samples were used as preliminary tissue model for immediate observation of thermal lesion creation. The diffusing fiber produced subsurface thermal lesions measuring 49.3 +/- 10.0 mm2 and preserved 0.8 +/- 0.1 mm of surface tissue. The side-firing fiber produced subsurface thermal lesions of 2.4 +/- 0.9 mm2 diameter and preserved 0.5 +/- 0.1 mm of surface tissue. The radial delivery probe assembly failed to produce subsurface thermal lesions, presumably due to the small effective spot diameter at the tissue surface, which limited optical penetration depth. Optimal laser power and irradiation time measured 15 W and 100 s for diffusing fiber and 1.4 W and 20 s, for side-firing fiber, respectively. Diffusing and side-firing laser balloon catheter designs provided subsurface thermal lesions in tissue. However, the divergent laser beam in both designs limited the ability to preserve a thicker layer of tissue surface. Further optimization of laser and cooling parameters may be necessary to preserve thicker surface tissue layers.

  20. Retrograde epidural catheter relieves intractable sacral pain

    Directory of Open Access Journals (Sweden)

    Ruchir Gupta

    2016-01-01

    Full Text Available Pain caused by tumor infiltration of the sacral area remains a major clinical challenge. Patients with poor pain control despite comprehensive medical management may be treated with neuraxial techniques such as continuous epidural or spinal anesthetic. We report a case in which a patient with metastatic breast cancer experienced inadequate pain relief after multiple intravenous pain management regimens as well as intrathecal (IT drug delivery. The concentration of local anesthetics delivered via the IT catheter was limited due to the patient's baseline motor weakness which would be exacerbated with higher concentrations of local anesthetics. Thus, a decision was made to insert an epidural catheter via a retrograde technique to provide the patient with a “band of anesthesia” which would provide profound sensory blockade without concomitant motor weakness. Pain refractory to other modalities of pain control was successfully treated with the epidural technique.

  1. Urgent peritoneal dialysis or hemodialysis catheter dialysis.

    Science.gov (United States)

    Lok, Charmaine E

    2016-03-01

    Worldwide, there is a steady incident rate of patients with end-stage kidney disease (ESKD) who require renal replacement therapy. Of these patients, approximately one-third have an "unplanned" or "urgent" start to dialysis. This can be a very challenging situation where patients have either not had adequate time for education and decision making regarding dialysis modality and appropriate dialysis access, or a decision was made and plans were altered due to unforeseen circumstances. Despite such unplanned starts, clinicians must still consider the patient's ESKD "life-plan", which includes the best initial dialysis modality and access to suit the patient's individual goals and their medical, social, logistic, and facility circumstances. This paper will discuss the considerations of peritoneal dialysis and a peritoneal dialysis catheter access and hemodialysis and central venous catheter access in patients who require an urgent start to dialysis.

  2. Peritoneal dialysis catheter embedment: surgical considerations, expectations, and complications.

    Science.gov (United States)

    Crabtree, John H; Burchette, Raoul J

    2013-10-01

    Peritoneal dialysis catheter embedment consists of implanting the catheter far in advance of anticipated need, with the external tubing buried under the skin. The catheter is externalized when initiation of dialysis is required. Details of the surgical procedure and management of associated complications are generally lacking. A total of 84 catheters including conventional and extended catheters were embedded and externalized during the study period. Factors influencing duration of embedment, functionality upon externalization, and long-term outcomes were analyzed. Mean duration of embedment was 13.9 months (median 9.4; range .5 to 68.5). Immediate function was exhibited in 85.7% of catheters. Employing laparoscopic revision, 98.8% of embedded catheters were successfully used for peritoneal dialysis. Extended catheters and duration of embedment were important determinants of catheter functionality. Catheters can be embedded for prolonged periods and still result in functional dialysis access when needed. Complications are few and easily managed. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Radiologic Placement of Tunneled Central Venous Catheters in Pediatric Patients

    Energy Technology Data Exchange (ETDEWEB)

    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.

  4. Diagnostic Accuracy of Central Venous Catheter Confirmation by Bedside Ultrasound Versus Chest Radiography in Critically Ill Patients: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Ablordeppey, Enyo A; Drewry, Anne M; Beyer, Alexander B; Theodoro, Daniel L; Fowler, Susan A; Fuller, Brian M; Carpenter, Christopher R

    2017-04-01

    We performed a systematic review and meta-analysis to examine the accuracy of bedside ultrasound for confirmation of central venous catheter position and exclusion of pneumothorax compared with chest radiography. PubMed, Embase, Cochrane Central Register of Controlled Trials, reference lists, conference proceedings and ClinicalTrials.gov. Articles and abstracts describing the diagnostic accuracy of bedside ultrasound compared with chest radiography for confirmation of central venous catheters in sufficient detail to reconstruct 2 × 2 contingency tables were reviewed. Primary outcomes included the accuracy of confirming catheter positioning and detecting a pneumothorax. Secondary outcomes included feasibility, interrater reliability, and efficiency to complete bedside ultrasound confirmation of central venous catheter position. Investigators abstracted study details including research design and sonographic imaging technique to detect catheter malposition and procedure-related pneumothorax. Diagnostic accuracy measures included pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. Fifteen studies with 1,553 central venous catheter placements were identified with a pooled sensitivity and specificity of catheter malposition by ultrasound of 0.82 (0.77-0.86) and 0.98 (0.97-0.99), respectively. The pooled positive and negative likelihood ratios of catheter malposition by ultrasound were 31.12 (14.72-65.78) and 0.25 (0.13-0.47). The sensitivity and specificity of ultrasound for pneumothorax detection was nearly 100% in the participating studies. Bedside ultrasound reduced mean central venous catheter confirmation time by 58.3 minutes. Risk of bias and clinical heterogeneity in the studies were high. Bedside ultrasound is faster than radiography at identifying pneumothorax after central venous catheter insertion. When a central venous catheter malposition exists, bedside ultrasound will identify four out of every five earlier than

  5. 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.

  6. 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

  7. Recommended Clinical Trial End Points for Dialysis Catheters.

    Science.gov (United States)

    Allon, Michael; Brouwer-Maier, Deborah J; Abreo, Kenneth; Baskin, Kevin M; Bregel, Kay; Chand, Deepa H; Easom, Andrea M; Mermel, Leonard; Mokrzycki, Michele H; Patel, Priti R; Roy-Chaudhury, Prabir; Shenoy, Surendra; Valentini, Rudolph P; Wasse, Haimanot

    2018-03-07

    Central venous catheters are used frequently in patients on hemodialysis as a bridge to a permanent vascular access. They are prone to frequent complications, including catheter-related bloodstream infection, catheter dysfunction, and central vein obstruction. There is a compelling need to develop new drugs or devices to prevent central venous catheter complications. We convened a multidisciplinary panel of experts to propose standardized definitions of catheter end points to guide the design of future clinical trials seeking approval from the Food and Drug Administration. Our workgroup suggests diagnosing catheter-related bloodstream infection in catheter-dependent patients on hemodialysis with a clinical suspicion of infection (fever, rigors, altered mental status, or unexplained hypotension), blood cultures growing the same organism from the catheter hub and a peripheral vein (or the dialysis bloodline), and absence of evidence for an alternative source of infection. Catheter dysfunction is defined as the inability of a central venous catheter to ( 1 ) complete a single dialysis session without triggering recurrent pressure alarms or ( 2 ) reproducibly deliver a mean dialysis blood flow of >300 ml/min (with arterial and venous pressures being within the hemodialysis unit parameters) on two consecutive dialysis sessions or provide a Kt/V≥1.2 in 4 hours or less. Catheter dysfunction is defined only if it persists, despite attempts to reposition the patient, reverse the arterial and venous lines, or forcefully flush the catheter. Central vein obstruction is suspected in patients with >70% stenosis of a central vein by contrast venography or the equivalent, ipsilateral upper extremity edema, and an existing or prior history of a central venous catheter. There is some uncertainty about the specific criteria for these diagnoses, and the workgroup has also proposed future high-priority studies to resolve these questions. Copyright © 2018 by the American Society of

  8. 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.

  9. Local Intracoronary Infusion of Glycoprotein IIb/IIIa Inhibitors via a Perfusion Catheter versus Intracoronary Guiding Catheter Injection during Primary Percutaneous Coronary Intervention: A Pilot Observational Study.

    Science.gov (United States)

    Zaki, Tarek; Labib, Salwa; El-Abbady, Maged; El-Kilany, Wael; Mortada, Ayman; Rashid, Tarek; Ragy, Hany; El-Itreby, Adel; Nammas, Wail

    2017-05-01

    Glycoprotein IIb IIIa inhibitors improved short- and long-term outcome when added to primary percutaneous coronary intervention (PPCI) in patients with ST-segment-elevation myocardial infarction (STEMI). We hypothesized that intracoronary eptifibatide infusion via a perfusion catheter improves angiographic and clinical outcome of patients with STEMI undergoing PPCI, versus conventional intracoronary bolus injection. Prospectively, we enrolled 80 patients with acute STEMI and thrombolysis in myocardial infarction (TIMI) thrombus grade ≥ 2. Patients were assigned to receive eptifibatide (180 μg) either via a dedicated coronary perfusion catheter (ClearWay TM ) during PPCI (group I), or guiding catheter (group II). Assessment of TIMI thrombus grade, TIMI flow grade, and TIMI myocardial perfusion (TMP) grade was performed both at baseline and post- procedurally. The primary 'angiographic' endpoint was final TMP grade 0/1. The primary 'clinical' endpoint was a composite of cardiac death, non-fatal re-infarction, target vessel revascularization, and recurrent ischemia at 30-day follow-up. Mean age was 52.3 ± 8.9 years (17.5% females). Clearance of visible thrombus (TIMI thrombus grade 0) at final angiogram was more frequent in group I. Additionally, both final TIMI flow grade 3 and final TMP grade 3 occurred more frequently in group I. The primary angiographic endpoint was more frequent in group II versus group I (17.5% versus 0%, respectively, p = 0.001). The primary clinical endpoint was more frequent in group II (20% versus 0%, respectively, p = 0.003). In patients with STEMI, intracoronary eptifibatide infusion via a perfusion catheter during PPCI improved immediate angiographic outcome, and reduced clinical events at 30-day follow-up, versus bolus injection via the guiding catheter.

  10. Impact of catheter reconstruction error on dose distribution in high dose rate intracavitary brachytherapy and evaluation of OAR doses

    International Nuclear Information System (INIS)

    Thaper, Deepak; Shukla, Arvind; Rathore, Narendra; Oinam, Arun S.

    2016-01-01

    In high dose rate brachytherapy (HDR-B), current catheter reconstruction protocols are relatively slow and error prone. The purpose of this study is to evaluate the impact of catheter reconstruction error on dose distribution in CT based intracavitary brachytherapy planning and evaluation of its effect on organ at risk (OAR) like bladder, rectum and sigmoid and target volume High risk clinical target volume (HR-CTV)

  11. Motion-adapted catheter navigation with real-time instantiation and improved visualisation.

    Science.gov (United States)

    Lee, Su-Lin; Kwok, Ka-Wai; Wang, Lichao; Riga, Celia; Bicknell, Colin; Cheshire, Nicholas; Yang, Guang-Zhong

    2013-09-01

    The improvements to catheter manipulation by the use of robot-assisted catheter navigation for endovascular procedures include increased precision, stability of motion and operator comfort. However, navigation through the vasculature under fluoroscopic guidance is still challenging, mostly due to physiological motion and when tortuous vessels are involved. In this paper, we propose a motion-adaptive catheter navigation scheme based on shape modelling to compensate for these dynamic effects, permitting predictive and dynamic navigations. This allows for timed manipulations synchronised with the vascular motion. The technical contribution of the paper includes the following two aspects. Firstly, a dynamic shape modelling and real-time instantiation scheme based on sparse data obtained intra-operatively is proposed for improved visualisation of the 3D vasculature during endovascular intervention. Secondly, a reconstructed frontal view from the catheter tip using the derived dynamic model is used as an interventional aid to user guidance. To demonstrate the practical value of the proposed framework, a simulated aortic branch cannulation procedure is used with detailed user validation to demonstrate the improvement in navigation quality and efficiency.

  12. Ionosphere-thermosphere models at the Community Coordinated Modeling Center

    Science.gov (United States)

    Webb, Phillip A.; Kuznetsova, Masha M.; Hesse, Michael; Rastaetter, Lutz; Chulaki, Anna

    2009-02-01

    One of the ways to address the science needs of the research community and to enable science progress is to provide community access to modern space science models. The Community Coordinated Modeling Center (CCMC) is a multiagency partnership based at the Goddard Space Flight Center that hosts a set of state-of-the-art space science models ranging from the solar atmosphere to the Earth's upper atmosphere. The CCMC provides a Web-based, no-cost, Runs on Request system, by which the interested scientist can readily request simulations for time intervals of interest. CCMC also provides a tailored Web-based visualization interface for the model output, including near-real-time results from select models. Model outputs have been specifically tailored for easy comparison with observational data to facilitate data analysis and model validation. This paper provides an overview of CCMC activities, with an emphasis on the ionosphere-thermosphere models residing there.

  13. Investment Modelling at the Euro Area Level

    Directory of Open Access Journals (Sweden)

    Alin OPREANA

    2014-12-01

    Full Text Available The aim of this research is to model the investment function at the level of the Euro zone. To achieve this main objective, we use and implement the structural equation modeling procedure for empirical analysis. Using this technique, the causal relationships established between investment and influencing factors are estimated and tested. Also, in the process of modeling structural equations, we examine empirical data sets related to the Euro area’s Member States.

  14. Taurolidine-citrate-heparin lock reduces catheter-related bloodstream infections in intestinal failure patients dependent on home parenteral support

    DEFF Research Database (Denmark)

    Tribler, Siri; Brandt, Christopher F.; Petersen, Anne H.

    2017-01-01

    , and prior CRBSI incidence. The prior CRBSI incidence in the study population was 2.4 episodes/1000 central venous catheter (CVC) days [95% Poisson confidence limits (CLs): 2.12, 2.71 episodes/1000 CVC days]. The maximum treatment period was 2 y or until occurrence of a CRBSI or right-censoring because......Background: In patients with intestinal failure who are receiving home parenteral support (HPS), catheter-related bloodstream infections (CRBSIs) inflict health impairment and high costs.Objective: This study investigates the efficacy and safety of the antimicrobial catheter lock solution.......02).Conclusions: In patients with intestinal failure who are life dependent on HPS, the taurolidine-citrate-heparin catheter lock demonstrates a clinically substantial and cost-beneficial reduction of CRBSI occurrence in a high-risk population compared with heparin. This trial was registered at clinicaltrials...

  15. A Novel Catheter-Guidance Algorithm for Localization of Atrial Fibrillation Rotor and Focal Sources

    Science.gov (United States)

    Salmin, Anthony J.; Ganesan, Prasanth; Shillieto, Kristina E.; Cherry, Elizabeth M.; Huang, David T.; Pertsov, Arkady M.; Ghoraani, Behnaz

    2018-01-01

    Locating atrial fibrillation (AF) focal and rotor sources can help improve target ablation therapy for AF. However, it remains unclear how to use the information provided by multi-polar diagnostic catheters (MPDC) to locate AF sources. Our aim was to develop a catheter-guidance algorithm to locate AF focal and rotor sources using a conventional MPDC. We simulated a 10 cm x 10 cm atrial tissue with focal and rotor sources using the Nygren et al. ionic model. We modeled a Lasso MPDC with 20-unipole electrodes placed with a spacing of 4.5-1-4.5 mm (diameter, d=15 mm) along a circle to obtain 10-bipole electrograms. Staring from an initial location, the algorithm, which was blinded to the location and type of the AF source, iteratively advanced the MPDC by moving its center to the location of the first activated bipole (FAB). The algorithm located an AF source if a stopping condition for either source was satisfied using bipole electrogram characteristics extracted from the MPDC placement. We tested the algorithm for a single rotor and focal source for all possible initial positions on the simulated tissue and repeated it for a random placement with a maximum of 20 possible placements at every trial. The algorithm located the AF source for 100% of trials and on average required 5.99 ± 1.92 placements to an AF source. This algorithm may be used to iteratively direct an MPDC towards an AF source and allow the AF source to be localized for customized AF ablation. PMID:28268380

  16. Retrograde femoral vein catheter insertion. A new approach for challenging hemodialysis vascular access.

    Science.gov (United States)

    Gouda, Zaghloul

    2014-01-01

    Venous catheters provide access for hemodialysis (HD) when patients do not have functioning access device. Obstruction of jugular, femoral or even external iliac vessels further depletes options. Subclavian approach is prohibited. Catheterization of inferior vena cava requires specialized equipment and skills. The purpose is to assess a new lifesaving HD vascular access approach for patients with nonfunctioning access device in the ordinary sites. This entails insertion of a retrograde temporary HD catheter in the superficial femoral vein, directing the catheter distally, toward the foot. We included six end-stage renal disease (ESRD) patients retrospectively who are on regular renal replacement therapy and need urgent HD with nonfunctioning access device in the ordinary sites. Successful insertion of six retrograde femoral vein catheters in the superficial femoral vein. The mean catheter days were 2.5±0.5 days with one patient having 26 catheter days. The mean blood pump speed was 230.0±44.7 mL/min. Urea reduction ratio and Kt/V at 3 hours HD session were 47% and 1.5, respectively, which increased with increasing session duration. The ultrafiltration volume was 2-3 L/session which increased up to 6 L/session in case of using slow low-efficiency dialysis. No major complications were observed during insertion or the postinsertion period except thigh pain in one patient and exit site infection in the case of long duration. This is a newly applied lifesaving HD vascular access approach for selected ESRD patients with no available HD vascular access at the ordinary sites with accepted HD adequacy. It needs more evaluation and more studies.

  17. Implementation of the updated 2015 Commission for Hospital Hygiene and Infection Prevention (KRINKO) recommendations "Prevention and control of catheter-associated urinary tract infections" in the hospitals in Frankfurt/Main, Germany.

    Science.gov (United States)

    Heudorf, Ursel; Grünewald, Miriam; Otto, Ulla

    2016-01-01

    The Commission for Hospital Hygiene and Infection Prevention (KRINKO) updated the recommendations for the prevention of catheter-associated urinary tract infections in 2015. This article will describe the implementation of these recommendations in Frankfurt's hospitals in autumn, 2015. In two non-ICU wards of each of Frankfurt's 17 hospitals, inspections were performed using a checklist based on the new KRINKO recommendations. In one large hospital, a total of 5 wards were inspected. The inspections covered the structure and process quality (operating instructions, training, indication, the placement and maintenance of catheters) and the demonstration of the preparation for insertion of a catheter using an empty bed and an imaginary patient, or insertion in a model. Operating instructions were available in all hospital wards; approximately half of the wards regularly performed training sessions. The indications were largely in line with the recommendations of the KRINKO. Alternatives to urinary tract catheters were available and were used more often than the urinary tract catheters themselves (15.9% vs. 13.5%). In accordance with the recommendations, catheters were placed without antibiotic prophylaxis or the instillation of antiseptic or antimicrobial substances or catheter flushing solutions. The demonstration of catheter placement was conscientiously performed. Need for improvement was seen in the daily documentation and the regular verification of continuing indication for a urinary catheter, as well as the omission of regular catheter change. Overall, the recommendations of the KRINKO on the prevention of catheter-associated urinary tract infections were adequately implemented. However, it cannot be ruled out that in situations with time pressure and staff shortage, the handling of urinary tract catheters may be of lower quality than that observed during the inspections, when catheter insertion was done by two nurses. Against this background, a sufficient

  18. Implementation of the updated 2015 Commission for Hospital Hygiene and Infection Prevention (KRINKO recommendations “Prevention and control of catheter-associated urinary tract infections” in the hospitals in Frankfurt/Main, Germany

    Directory of Open Access Journals (Sweden)

    Heudorf, Ursel

    2016-06-01

    Full Text Available Aim: The Commission for Hospital Hygiene and Infection Prevention (KRINKO updated the recommendations for the prevention of catheter-associated urinary tract infections in 2015. This article will describe the implementation of these recommendations in Frankfurt’s hospitals in autumn, 2015.Material and methods: In two non-ICU wards of each of Frankfurt’s , inspections were performed using a checklist based on the new KRINKO recommendations. In one large hospital, a total of were inspected. The inspections covered the structure and process quality (operating instructions, training, indication, the placement and maintenance of catheters and the demonstration of the preparation for insertion of a catheter using an empty bed and an imaginary patient, or insertion in a model.Results: Operating instructions were available in all hospital wards; approximately half of the wards regularly performed training sessions. The indications were largely in line with the recommendations of the KRINKO. Alternatives to urinary tract catheters were available and were used more often than the urinary tract catheters themselves (15.9% vs. 13.5%. In accordance with the recommendations, catheters were placed without antibiotic prophylaxis or the instillation of antiseptic or antimicrobial substances or catheter flushing solutions. The demonstration of catheter placement was conscientiously performed. Need for improvement was seen in the daily documentation and the regular verification of continuing indication for a urinary catheter, as well as the omission of regular catheter change.Conclusion: Overall, the recommendations of the KRINKO on the prevention of catheter-associated urinary tract infections were adequately implemented. However, it cannot be ruled out that in situations with time pressure and staff shortage, the handling of urinary tract catheters may be of lower quality than that observed during the inspections, when catheter insertion was done by two

  19. GRA model development at Bruce Power

    International Nuclear Information System (INIS)

    Parmar, R.; Ngo, K.; Cruchley, I.

    2011-01-01

    In 2007, Bruce Power undertook a project, in partnership with AMEC NSS Limited, to develop a Generation Risk Assessment (GRA) model for its Bruce B Nuclear Generating Station. The model is intended to be used as a decision-making tool in support of plant operations. Bruce Power has recognized the strategic importance of GRA in the plant decision-making process and is currently implementing a pilot GRA application. The objective of this paper is to present the scope of the GRA model development project, methodology employed, and the results and path forward for the model implementation at Bruce Power. The required work was split into three phases. Phase 1 involved development of GRA models for the twelve systems most important to electricity production. Ten systems were added to the model during each of the next two phases. The GRA model development process consists of developing system Failure Modes and Effects Analyses (FMEA) to identify the components critical to the plant reliability and determine their impact on electricity production. The FMEAs were then used to develop the logic for system fault tree (FT) GRA models. The models were solved and post-processed to provide model outputs to the plant staff in a user-friendly format. The outputs consisted of the ranking of components based on their production impact expressed in terms of lost megawatt hours (LMWH). Another key model output was the estimation of the predicted Forced Loss Rate (FLR). (author)

  20. [Biodegradable catheters and urinary stents. When?

    Science.gov (United States)

    Soria, F; Morcillo, E; López de Alda, A; Pastor, T; Sánchez-Margallo, F M

    2016-10-01

    One of the main wishes in the field of urinary catheters and stents is to arm them with biodegradable characteristics because we consider a failure of these devices the need for retrieval, the forgotten catheter syndrome as well as the adverse effects permanent devices cause after fulfilling their aim. The efforts focused in new designs, coatings and biomaterials aim to increase the biocompatibility of theses internal devices. Lately, there have been correct advances to answer the main challenges regarding biodegradable ureteral devices. Thus, modulation of the rate of degradation has been achieved thanks to new biomaterials and the use of copolymers that enable to choose the time of permanence as it is programmed with conventional double J catheters. Biocompatibility has improved with the use of new polymers that adapt better to the urine. Finally, one of the main problems is elimination of degraded fragments and experimentally it has be demonstrated that new designs elicit controlled degradation, from distal to proximal; using stranding and combination of copolymers degradation may be caused by dilution, reducing fragmentation to the last stages of life of the prosthesis. Moreover, it has been demonstrated that biodegradable catheters potentially may cause less urinary tract infection, less encrustation and predictably they will diminish catheter morbidity, since their degradation process reduces adverse effects. Regarding the development of biodegradable urethral stents, it is necessary to find biomaterials that enable maintaining their biomechanical properties in the long term, keeping open the urethral lumen both in patients with BPH and urethral stenosis. Modulation of the time of degradation of the prosthesis has been achieved, but the appearance of urothelial hyperplasia is still a constant in the initial phases after implantation. The development of drug eluting stents, anti-proliferative or anti-inflammatory, as well as biodegradable stents biocoated is a

  1. [Peripherally inserted central catheter antibiotic therapy for cystic fibrosis patients].

    Science.gov (United States)

    Betegnie, A-L; Cracowski, C; Bedouch, P; Segond, C; Robein-Dobremez, M-J; Pin, I; Allenet, B

    2014-11-01

    Peripherally inserted central catheters (PICC) are more and more used for intravenous antibiotic infusions in cystic fibrosis (CF) patients in the Grenoble area (France). The aim of this study was to assess the use of this technique in this indication. 1. Retrospective evaluation of 102 consecutive PICC insertions over 3years and the incidence of adverse events during the therapy. 2. Prospective evaluation of 12 patient's satisfaction and their nurses over a 3-month period. 3. Comparative analysis of single domiciliary treatment costs using PICC versus peripheral catheter (PC). 102 PICC insertions were attempted in 31 patients. Seven failures and 7 complications occurred during the treatment requiring removal of the PICC, i.e. an overall success rate of 86.2% (88/102). Pain during PICC introduction was 4.2/10 (visual analogical scale). Mean satisfaction levels during therapy were 9.3/10 for patients and 8.7/10 for nurses. Compared with PC, all the patients said that PICC was "more comfortable". Differential costs of treatment with PC and with PICC at home were estimated at 57.15€ and 590.16€ respectively. PICC is an alternative to CP for intravenous antibiotherapy in CF patients, providing better safety and comfort. PICC use should be promoted in this indication. Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  2. Double guiding catheters for complex percutaneous coronary intervention.

    Science.gov (United States)

    Chou, Shing-Hsien; Lin, Chia-Pin; Lin, Yen-Chen; Kuo, Chi-Tai; Lin, Ming-Shyan; Chang, Chi-Jen

    2012-01-01

    A large-lumen guiding catheter is often used for complex percutaneous coronary intervention-particularly when a final kissing-balloon or 2-stent technique is required. However, catheter insertion is sometimes restricted by diseased vascular access sites or a tortuous vascular route.We report 2 cases in which a unique double guiding catheter technique was used to create a lumen of sufficient size for complex percutaneous coronary intervention. In each patient, two 6F guiding catheters were used concurrently to engage the ostium of 1 target vessel. In 1 patient, these catheters were used for the delivery of 2 balloons to complete kissing-balloon dilation after single-stent placement. In the other patient, the catheters were used to deliver 2 stents sequentially to their respective target lesions. The stents were then deployed simultaneously as kissing stents, followed by high-pressure kissing-balloon postdilation.

  3. Balloon catheter versus basket catheter for endoscopic bile duct stone extraction: a multicenter randomized trial.

    Science.gov (United States)

    Ishiwatari, Hirotoshi; Kawakami, Hiroshi; Hisai, Hiroyuki; Yane, Kei; Onodera, Manabu; Eto, Kazunori; Haba, Shin; Okuda, Toshinori; Ihara, Hideyuki; Kukitsu, Takehiro; Matsumoto, Ryusuke; Kitaoka, Keisuke; Sonoda, Tomoko; Hayashi, Tsuyoshi

    2016-04-01

    Endoscopic bile duct stone (BDS) removal is a well-established treatment; however, the preference for basket or balloon catheters for extraction is operator-dependent. We therefore conducted a multicenter prospective randomized trial to compare catheter performance. We enrolled patients with a BDS diameter ≤ 10 mm and common bile duct diameter ≤ 15 mm. Participants were randomly assigned to groups that were treated with basket or balloon catheters between October 2013 and September 2014. The primary endpoint was the rate of complete clearance of the duct; the secondary endpoints were the rate and time to complete clearance in one endoscopic session. We initially enrolled 172 consecutive patients; 14 were excluded after randomization. The complete clearance rates were 92.3 % (72/78) in the balloon group and 80.0 % (64 /80) in the basket group. The difference in the rates between the two groups was 12.3 percentage points, indicating non-inferiority of the balloon method (non-inferiority limit -10 %; P < 0.001 for non-inferiority). Moreover, the balloon was superior to the basket (P = 0.037). The rate of complete clearance in one endoscopic session was 97.4 % using the balloon and 97.5 % using the basket (P = 1.00). The median times to complete clearance in one endoscopic session were 6.0 minutes (1 - 30) and 7.8 minutes (1 - 37) in the balloon and basket groups, respectively (P = 0.15). For extraction of BDSs ≤ 10 mm, complete endoscopic treatment with a single catheter is more likely when choosing a balloon catheter over a basket catheter.University Hospital Medical Information Network Trials Registry: UMIN000011887. © Georg Thieme Verlag KG Stuttgart · New York.

  4. Efficacy of two antiseptic regimens on skin colonization of insertion sites for two different catheter types: a randomized, clinical trial.

    Science.gov (United States)

    Lutz, Juergen Thomas; Diener, Isabel Victoria; Freiberg, Kerstin; Zillmann, Robert; Shah-Hosseini, Kija; Seifert, Harald; Berger-Schreck, Bettina; Wisplinghoff, Hilmar

    2016-12-01

    Catheter-related bloodstream infections affect patients in surgical and intensive care settings worldwide, causing complications, aggravation of existing symptoms and increased length of stay. The trial aimed at comparing two registered skin antiseptics with respect to their residual and therefore infection-preventing effects. In a parallel, monocentric, prospective, triple-blind, randomized trial the difference in bacterial recolonization of catheter skin sites in central venous (CVC) and epidural catheters (EC) was investigated by comparing two alcoholic-based skin disinfectants. Patients receiving planned surgeries or intensive care were eligible for the trial. Those in the trial group received skin disinfection with the additive octenidine dihydrochloride (OCT) (n = 51), those in the control group were treated with benzalkonium chloride as additive (BAC) (n = 59) prior to catheter insertion. Randomization was carried out by assigning patients to groups week-wise. Endpoints of the investigation were skin colonization of the catheter site counted in colony forming units per swab at three time points: (1) prior to catheter insertion, on untreated skin; (2) directly after catheter insertion, prior to sterile coverage; (3) 48 h after catheter insertion. The hypothesis was tested by a Wilcoxon test with a two-sided alpha = 5 %. From second to third swab, recolonization of the catheter-surrounding skin was significantly lower in the trial group for both sorts of catheters: delta 2-3 OCT group: 0.72 (95 % CI: 0.42; 1.02); delta 2-3 BAC group: 1.97 (95 % CI: 1.45; 2.50); p < 0.001. None of the patients enrolled developed a catheter-related blood stream infection (CRBSI) during follow-up. Previous studies have shown that skin colonization is strongly associated with the occurrence of CRBSI. This randomized controlled trial supports the observations made in previous trials that octenidine dihydrochloride in disinfectants is more effective than agents

  5. Comparison of extraamniotic Foley catheter and intracervical prostaglandin E gel for preinduction cervical ripening.

    Science.gov (United States)

    Dalui, Rabindranath; Suri, Vanita; Ray, Pallab; Gupta, Indu

    2005-04-01

    The success of induced labor depends on the degree of ripening of cervix. Pharmacological preparations are in widespread use for cervical ripening but are not free from side-effects and complications. Mechanical methods, i.e. the use of Foley catheter balloon, though effective have not gained much popularity because of the fear of infection. Therefore, this study has been conducted to prove the efficacy and safety of extraamniotic Foley catheter balloon and to compare it with intracervical prostaglandin E2 (PGE2) gel. The randomized prospective study was conducted in the Department of Obstetrics and Gynecology and Medical Microbiology of Nehru Hospital. Hundred women attending the labor ward for induction of labor were divided into two groups: Group A--Foley catheter, Group B--PGE2 gel. Cervical swabs before and after the insertion of ripening agents were taken for culture studies. Placental membranes were also sent for culture. Labor outcome, side-effects, and complications were compared in both the groups. The statistical methods used were Student's compared t-test, Chi-square test, and Wilcoxon-Mann-Whitney test. Foley catheter proved to be a very effective preinduction ripening agent for unfavorable cervix compared with PGE2 gel, as is evident by the mean Bishop score at 12 h (P<0.001). Preparation delivery interval was significantly shorter (P<0.05) in women who underwent cervical ripening with Foley catheter balloon than with the PGE2 gel. No clinical evidence of chorioamnionitis was present in both the groups. This study concludes that extraamniotic Foley catheter balloon is an effective, safe, simple, low-cost, reversible, non-pharmacological mechanical method of preinduction cervical ripening.

  6. An Endovascular Approach to the Entrapped Central Venous Catheter After Cardiac Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Desai, Shamit S., E-mail: shamit.desai@northwestern.edu [Northwestern Memorial Hospital, Department of Radiology (United States); Konanur, Meghana [Northwestern University Feinberg School of Medicine (United States); Foltz, Gretchen [Mallinckrodt Institute of Radiology at Washington University, Interventional Radiology (United States); Malaisrie, S. Chris [Northwestern Memorial Hospital, Department of Cardiothoracic Surgery (United States); Resnick, Scott, E-mail: sresnick@northwestern.edu [Northwestern University Feinberg School of Medicine, Department of Radiology, Interventional Radiology, Northwestern Memorial Hospital (United States)

    2016-03-15

    PurposeEntrapment of central venous catheters (CVC) at the superior vena cava (SVC) cardiopulmonary bypass cannulation site by closing purse-string sutures is a rare complication of cardiac surgery. Historically, resternotomy has been required for suture release. An endovascular catheter release approach was developed.Materials and MethodsFour cases of CVC tethering against the SVC wall and associated resistance to removal, suggestive of entrapment, were encountered. In each case, catheter removal was achieved using a reverse catheter fluoroscopically guided over the suture fixation point between catheter and SVC wall, followed by the placement of a guidewire through the catheter. The guidewire was snared and externalized to create a through-and-through access with the apex of the loop around the suture. A snare placed from the femoral venous access provided concurrent downward traction on the distal CVC during suture release maneuvers.ResultsIn the initial attempt, gentle traction freed the CVC, which fractured and was removed in two sections. In the subsequent three cases, traction alone did not release the CVC. Therefore, a cutting balloon was introduced over the guidewire and inflated. Gentle back-and-forth motion of the cutting balloon atherotomes successfully incised the suture in all three attempts. No significant postprocedural complications were encountered. During all cases, a cardiovascular surgeon was present in the interventional suite and prepared for emergent resternotomy, if necessary.ConclusionAn endovascular algorithm to the “entrapped CVC” is proposed, which likely reduces risks posed by resternotomy to cardiac surgery patients in the post-operative period.

  7. Case report: bilateral tunneled epidural catheters to prevent unilateral analgesia for cancer-related pain

    Directory of Open Access Journals (Sweden)

    Padalia RB

    2017-07-01

    Full Text Available Raj B Padalia,1 Corey J Reeves,2 Neal Shah,1 Ankur A Patel,3 Devang M Padalia4 1Pain Medicine, University of South Florida, Tampa, FL, USA; 2Physical Medicine and Rehabilitation, University of South Florida, Tampa, FL, USA; 3Edward Via College of Osteopathic Medicine, Blacksburg, VA, USA; 4Interventional Pain, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA Objective: Unilateral analgesia often occurs with epidural analgesia. Traditional methods of troubleshooting this problem can be insufficient in obtaining adequate pain relief in a timely manner for terminal cancer patients. This case report demonstrates a safe and effective solution which can be utilized in these circumstances.Case report: A 55-year-old female with stage IV pancreatic cancer and life expectancy of a few weeks presented to the interventional pain clinic with intractable sacral pain. The decision to place an epidural catheter and external pump for analgesia was made. An epidural catheter placed at the L5-S1 level showed contrast spread only along the right nerve roots and a test dose produced only right-sided analgesia. Suspecting compartmentalization of the epidural space, a second left-sided epidural catheter was placed and bilateral analgesia was achieved by using both catheters. This dual catheter technique gave the patient effective bilateral analgesia until she passed away several weeks later. Conclusion: The bilateral epidural catheter technique is safe and effective in patients who present with persistent unilateral epidural analgesia despite exhausting traditional solutions. Keywords: pain management, palliative care, cancer, regional techniques

  8. Electrocardiographic-guided tip positioning technique for peripherally inserted central catheters in a Dutch teaching hospital: Feasibility and cost-effectiveness analysis in a prospective cohort study.

    Science.gov (United States)

    Bloemen, Arthur; Daniels, Anne M; Samyn, Martine G; Janssen, Roel Jl; Elshof, Jan-Willem

    2018-03-01

    Peripherally inserted central catheters are venous devices intended for short to medium periods of intravenous treatment. Positioning of the catheter tip at the cavoatrial junction is necessary for optimum performance of a peripherally inserted central catheter. In this study, safety, effectiveness and cost-effectiveness of electrocardiographic-guided peripherally inserted central catheter positioning in a Dutch teaching hospital were evaluated. All patients who received a peripherally inserted central catheter in 2016 using electrocardiographic guidance were compared to those where fluoroscopy guidance was used in a prospective non-randomized cohort study. Relevant data were extracted from electronic health records. Cost-effectiveness analysis was performed. A total of 162 patients received a peripherally inserted central catheter using fluoroscopy guidance and 103 patients using electrocardiographic guidance in 2016. No significant difference was found in malposition, infection or other complications between these groups. Due to personnel reduction and omission of fluoroscopy costs, cost reduction for each catheter insertion was €120 in the first year and, as a result of discounted acquisition costs, €190 in subsequent years. The positioning results and complication rate are comparable to the previously reported literature. The cost reduction may vary in different hospitals. Other benefits of the electrocardiographic-guided technique are omission of X-ray exposure and improved patient service. Implementation of electrocardiographic-guided tip positioning for peripherally inserted central catheter was safe and effective in this study and led to an improved high value and cost-conscious care.

  9. 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

  10. Catheter Fracture and Embolization Related to an Arm Venous Port

    Directory of Open Access Journals (Sweden)

    Brent E. Burbridge

    2011-01-01

    Full Text Available This 55-year-old female had a chest X-ray during a follow-up visit for the management of her breast cancer. The chest X-ray demonstrated an embolized venous catheter superimposed upon the mediastinum. It was determined that the catheter of the patient's arm port had fractured and embolized to the pulmonary circulation. The catheter was retrieved, in the interventional radiology suite, under fluoroscopic guidance. The patient suffered no ill effects. Subsequently, one day later, the old vein port was removed and a new arm port and associated catheter were implanted to facilitate the delivery of the patient's ongoing chemotherapy.

  11. Remote control catheter navigation: options for guidance under MRI

    Directory of Open Access Journals (Sweden)

    Muller Leah

    2012-06-01

    Full Text Available Abstract Background Image-guided endovascular interventions have gained increasing popularity in clinical practice, and magnetic resonance imaging (MRI is emerging as an attractive alternative to X-ray fluoroscopy for guiding such interventions. Steering catheters by remote control under MRI guidance offers unique challenges and opportunities. Methods In this review, the benefits and limitations of MRI-guided remote control intervention are addressed, and the tools for guiding such interventions in the magnetic environment are summarized. Designs for remote control catheter guidance include a catheter tip electromagnetic microcoil design, a ferromagnetic sphere-tipped catheter design, smart material-actuated catheters, and hydraulically actuated catheters. Remote control catheter guidance systems were compared and contrasted with respect to visualization, safety, and performance. Performance is characterized by bending angles achievable by the catheter, time to achieve bending, degree of rotation achievable, and miniaturization capacity of the design. Necessary improvements for furthering catheter design, especially for use in the MRI environment, are addressed, as are hurdles that must be overcome in order to make MRI guided endovascular procedures more accessible for regular use in clinical practice. Conclusions MR-guided endovascular interventions under remote control steering are in their infancy due to issues regarding safety and reliability. Additional experimental studies are needed prior to their use in humans.

  12. The humanization of catheter room design: its clinical practice

    International Nuclear Information System (INIS)

    Lin Hanying; Shi Fengxia; Guo Huiying

    2011-01-01

    American scholar Engeer has proposed biological, psychological and sociological medicine pattern, which has been well accepted by the society, It has manifested the medical arena humanism return and has made the profound influence on the nursing development. The idea, 'the human is a whole', has gradually become the mainstream of the nurse service concept, meanwhile, the environment has more and more become a beneficial part for diagnosing and treating in hospitalization. The improvement and more user-friendly design of the diagnosing and treating environment has already become an important ring linked with the whole nursing work. At the beginning of the fitting up design for the Catheter Lab Room of Interventional Radiology in General Hospital of PLA, the authors receive the idea 'the environment experience and admiration of the patient', put more attention to the humanization in the diagnosing and treating environmental construction. The functional compartments are separated clearly. The color, the background music as well as the video are designed to be coordinated with each other in order to produce a relaxing system. Practice for the past three years indicates that the use of humanization environment design can markedly reduce the patient intense and the anxious level in perioperative period, it can also significantly promote the patient to be restored to health. This article will describe user-friendly diagnosing and treating environmental construction practice in the Catheter Lab Room of Interventional Radiology in General Hospital of PLA. (authors)

  13. Carotid artery stenting in difficult aortic arch anatomy with or without a new dedicated guiding catheter: preliminary experience.

    Science.gov (United States)

    Barbiero, Giulio; Cognolato, Diego; Casarin, Andrea; Stramanà, Rudi; Galzignan, Elisa; Guarise, Alessandro

    2013-05-01

    To evaluate carotid artery stenting (CAS) procedures with or without a new dedicated guiding catheter in anatomically challenging aortic arches in our experience. We retrospectively reviewed 172 procedures of CAS performed from December 2006 to October 2011 in 159 consecutive patients (100 men, mean age 78 years): 15 patients had type III aortic arch, 13 had a bovine aortic arch, 6 had an acute angle at the origin of the left common carotid artery from the aortic arch, 2 had type III aortic arch with bovine aortic arch, and 1 had a bicarotid trunk with an aberrant right subclavian artery. In this group of difficult anatomy (37 cases), CAS was performed with (13 cases) or without (24 cases) a new dedicated guiding catheter. Mean time of fluoroscopy (16 min vs. 18 min, P guiding catheter group. The new dedicated guiding catheter may be more effective and less risky for CAS in anatomically challenging aortic arches. • Complex anatomy of the aortic arch is not rare • Endovascular carotid artery stenting (CAS) is more difficult when the anatomy is complex • A new dedicated guiding catheter may help CAS when the arch anatomy is complex • The new dedicated guiding catheter may be less risky in complex arches.

  14. Massive Schwinger model at finite θ

    Science.gov (United States)

    Azcoiti, Vicente; Follana, Eduardo; Royo-Amondarain, Eduardo; Di Carlo, Giuseppe; Vaquero Avilés-Casco, Alejandro

    2018-01-01

    Using the approach developed by V. Azcoiti et al. [Phys. Lett. B 563, 117 (2003), 10.1016/S0370-2693(03)00601-4], we are able to reconstruct the behavior of the massive one-flavor Schwinger model with a θ term and a quantized topological charge. We calculate the full dependence of the order parameter with θ . Our results at θ =π are compatible with Coleman's conjecture on the phase diagram of this model.

  15. Selection of peripheral intravenous catheters with 24-gauge side-holes versus those with 22-gauge end-hole for MDCT: A prospective randomized study

    Energy Technology Data Exchange (ETDEWEB)

    Tamura, Akio, E-mail: a.akahane@gmail.com [Department of Radiology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka 020-8505 (Japan); Kato, Kenichi, E-mail: kkato@iwate-med.ac.jp [Department of Radiology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka 020-8505 (Japan); Kamata, Masayoshi, E-mail: kamataaoi@yahoo.co.jp [Iwate Medical University Hospital, 19-1 Uchimaru, Morioka 020-8505 (Japan); Suzuki, Tomohiro, E-mail: suzukitomohiro123@gmail.com [Department of Radiology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka 020-8505 (Japan); Suzuki, Michiko, E-mail: mamimichiko@me.com [Department of Radiology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka 020-8505 (Japan); Nakayama, Manabu, E-mail: gakuymgt@yahoo.co.jp [Department of Radiology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka 020-8505 (Japan); Tomabechi, Makiko, E-mail: mtomabechi@mac.com [Department of Radiology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka 020-8505 (Japan); Nakasato, Tatsuhiko, E-mail: nakasato77@gmail.com [Department of Radiology, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama 963-8563 (Japan); Ehara, Shigeru, E-mail: ehara@iwate-med.ac.jp [Department of Radiology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka 020-8505 (Japan)

    2017-02-15

    Highlights: • We compared 24-gauge side-hole and conventional 22-gauge end-hole catheters in MDCT. • The 24-gauge side-hole catheter is noninferior to the 22-gauge end-hole catheter. • The 24-gauge side-hole catheter is safe and facilitates optimal enhancement quality. • The 24-gauge side-hole catheter is suitable for patients with narrow or fragile veins. - Abstract: Purpose: To compare the 24-gauge side-holes catheter and conventional 22-gauge end-hole catheter in terms of safety, injection pressure, and contrast enhancement on multi-detector computed tomography (MDCT). Materials & methods: In a randomized single-center study, 180 patients were randomized to either the 24-gauge side-holes catheter or the 22-gauge end-hole catheter groups. The primary endpoint was safety during intravenous administration of contrast material for MDCT, using a non-inferiority analysis (lower limit 95% CI greater than −10% non-inferiority margin for the group difference). The secondary endpoints were injection pressure and contrast enhancement. Results: A total of 174 patients were analyzed for safety during intravenous contrast material administration for MDCT. The overall extravasation rate was 1.1% (2/174 patients); 1 (1.2%) minor episode occurred in the 24-gauge side-holes catheter group and 1 (1.1%) in the 22-gauge end-hole catheter group (difference: 0.1%, 95% CI: −3.17% to 3.28%, non-inferiority P = 1). The mean maximum pressure was higher with the 24-gauge side-holes catheter than with the 22-gauge end-hole catheter (8.16 ± 0.95 kg/cm{sup 2} vs. 4.79 ± 0.63 kg/cm{sup 2}, P < 0.001). The mean contrast enhancement of the abdominal aorta, celiac artery, superior mesenteric artery, and pancreatic parenchyma in the two groups were not significantly different. Conclusion: In conclusion, our study showed that the 24-gauge side-holes catheter is safe and suitable for delivering iodine with a concentration of 300 mg/mL at a flow-rate of 3 mL/s, and it may contribute to

  16. Selection of peripheral intravenous catheters with 24-gauge side-holes versus those with 22-gauge end-hole for MDCT: A prospective randomized study

    International Nuclear Information System (INIS)

    Tamura, Akio; Kato, Kenichi; Kamata, Masayoshi; Suzuki, Tomohiro; Suzuki, Michiko; Nakayama, Manabu; Tomabechi, Makiko; Nakasato, Tatsuhiko; Ehara, Shigeru

    2017-01-01

    Highlights: • We compared 24-gauge side-hole and conventional 22-gauge end-hole catheters in MDCT. • The 24-gauge side-hole catheter is noninferior to the 22-gauge end-hole catheter. • The 24-gauge side-hole catheter is safe and facilitates optimal enhancement quality. • The 24-gauge side-hole catheter is suitable for patients with narrow or fragile veins. - Abstract: Purpose: To compare the 24-gauge side-holes catheter and conventional 22-gauge end-hole catheter in terms of safety, injection pressure, and contrast enhancement on multi-detector computed tomography (MDCT). Materials & methods: In a randomized single-center study, 180 patients were randomized to either the 24-gauge side-holes catheter or the 22-gauge end-hole catheter groups. The primary endpoint was safety during intravenous administration of contrast material for MDCT, using a non-inferiority analysis (lower limit 95% CI greater than −10% non-inferiority margin for the group difference). The secondary endpoints were injection pressure and contrast enhancement. Results: A total of 174 patients were analyzed for safety during intravenous contrast material administration for MDCT. The overall extravasation rate was 1.1% (2/174 patients); 1 (1.2%) minor episode occurred in the 24-gauge side-holes catheter group and 1 (1.1%) in the 22-gauge end-hole catheter group (difference: 0.1%, 95% CI: −3.17% to 3.28%, non-inferiority P = 1). The mean maximum pressure was higher with the 24-gauge side-holes catheter than with the 22-gauge end-hole catheter (8.16 ± 0.95 kg/cm 2 vs. 4.79 ± 0.63 kg/cm 2 , P < 0.001). The mean contrast enhancement of the abdominal aorta, celiac artery, superior mesenteric artery, and pancreatic parenchyma in the two groups were not significantly different. Conclusion: In conclusion, our study showed that the 24-gauge side-holes catheter is safe and suitable for delivering iodine with a concentration of 300 mg/mL at a flow-rate of 3 mL/s, and it may contribute to the care

  17. Increased resting heart rate following radiofrequency catheter ablation for atrial fibrillation

    DEFF Research Database (Denmark)

    Nilsson, Brian; Chen, Xu; Pehrson, Steen

    2005-01-01

    AIM: Sinus tachycardia has been observed following radiofrequency (RF) catheter ablation for various kinds of supraventricular tachycardia. This study is aimed at determining the occurrence of changes in sinus-rhythm heart rate (HR) after pulmonary vein (PV) isolation in patients with paroxysmal...

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

    NARCIS (Netherlands)

    Paul, Katja; Cnossen, Fokeltje; Lanzer, Peter

    2017-01-01

    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

  19. Novel technique using the Outback LTD catheter for a common iliac artery occlusion.

    Science.gov (United States)

    Mixon, Timothy A

    2009-02-15

    We present a case of an unusual arterial--arterial anastamosis that resulted from an unsuccessful attempt at crossing a total occlusion of the common iliac artery. Subsequently, we were able to successful recanalize the artery using a modified technique with the Outback reentry catheter. Copyright 2009 Wiley-Liss, Inc.

  20. Combined surgical and catheter-based treatment of extensive thoracic aortic aneurysm and aortic valve stenosis

    DEFF Research Database (Denmark)

    De Backer, Ole; Lönn, Lars; Søndergaard, Lars

    2015-01-01

    valve stenosis (AS) who are considered at high risk for surgical aortic valve replacement. In this report, we describe the combined surgical and catheter-based treatment of an extensive TAA and AS. To our knowledge, this is the first report of hybrid TAA repair combined with TAVR....

  1. Presence of air in the hepatic portal system in association with umbilical venous catheter malposition

    Directory of Open Access Journals (Sweden)

    Beatriz Regina Alvares

    2014-01-01

    Full Text Available The authors report a case of umbilical venous catheter malposition with air in the portal venous system in a preterm neonate. Initially, the hypothesis of necrotizing enterocolitis was considered, but the newborn progressed with no finding of disease and the air disappeared at follow-up radiography. The differential diagnosis of such a finding can avoid unnecessary clinical treatments.

  2. Modelling fission gas release at high burnup