Cannulation Rate Research Articles

Implementation of trans-cystic biliary stenting during acute cholecystectomy to facilitate elective ERCP: a quality improvement initiative.

A predominantly endoscopic approach for acute admissions with choledocholithiasis with a gallbladder in situ (CGIS) resulted in prolonged hospital length of stay due to delays at investigation and treatment junctures. We initiated a quality improvement program of trans-cystic biliary stenting to facilitate efficient patient progress to acute cholecystectomy and outpatient ERCP if required. We utilized implementation frameworks with regular re-assessment for this quality improvement project. Patients who required both ERCP and cholecystectomy for management of CGIS were identified for comparison of total length of stay before and after implementation. The outcomes for stent insertion and ERCP were also collected for analysis. Twenty-three trans-cystic stents were attempted with 22 inserted successfully. The median total length of stay for all patients requiring both ERCP and cholecystectomy for management of CGIS was shorter compared to 6 months prior to implementation (5 days (range 3-18) vs. 6 days (range 5-17); P = 0.009). The median stenting time was 14 min (range 9-48). After stent insertion, more ERCPs were performed as day-only outpatient cases (20/23 (87.0%) vs. 6/44 (13.6%) P < 0.001). The rate of pancreatic duct wire cannulation at ERCP was also lower (1/23 (4.3%) vs. 18/44 (40.9%); P = 0.002). No complications of stent insertion or ERCP were recorded in the study cohort. Implementation of trans-cystic stents can lead to reductions in total hospital length of stay and improve ERCP processes. Our experience suggests that surgical initiatives can be successfully added to routine practice by establishing a project team and applying quality improvement principles.

Capturing the incidence of patient agitation amongst conscious sedation ERCPs and the impact on therapeutic outcomes.

Completing advanced endoscopic procedures such as endoscopic retrograde cholangiopancreatography (ERCP) under conscious sedation is challenging. International recommendations favor enhanced sedation (e.g. propofol) for ERCP. Conscious sedation can result in sedation-related failure (SRF) and agitation for some patients, limiting therapeutic efficacy. The aim of this study is to establish the risk of SRF and the impact on therapeutic success under conscious sedation practice in a single tertiary referral center. A retrospective review of a prospectively maintained ERCP database, analyzing sedation, procedural success, and complications. Over 19 months, 807 conscious sedation ERCPs were recorded. Median midazolam dose was 5 mg (range 1-14 mg) and median fentanyl dose was 75 µg (0-200 µg). Sedation reversal was required in 0.1% of cases (1/807). Overall ductal cannulation rate was 92%. Severe agitation was recorded in 11% (86/807) of conscious sedation ERCP reports with SRF present in 3% (22/807). Patient agitation resulted in significantly lower cannulation (81% vs 92%, P = 0.002) and successful clearance rates (49% vs 85%, P = 0.002) versus non-agitated cases. Complication and pancreatitis rates were unaffected. Highest rates of SRF and agitation were identified in female patients, patients aged <50 years old, and post-operative biliary leak indications. Over 10% of conscious sedation ERCPs are compromised by sedation issues, resulting in procedure abandonment or significantly diminished therapeutic success. General anesthetic ERCP is beneficial in facilitating biliary access, removing the risk of agitation and providing stability to aid cannulation. Female patients, patients aged <50 years, and post-operative biliary leak ERCPs appear as the priority cases for enhanced sedation support.

All-in-one sphincterotome with high rotation performance and freely bendable blade for endoscopic sphincterotomy in patients with surgically altered anatomy (a case series with video).

A new type of sphincterotome released to the market recently has high rotation performance and a freely bendable blade. It is devised to be singly capable of accommodating not only normal anatomy but also cases with surgically altered anatomy. This study was undertaken for clinical evaluation of the usefulness of this new sphincterotome. Eight cases in a reconstructed intestine for which cannulation or endoscopic sphincterotomy (EST) had been performed were extracted from 32 cases for which endoscopic retrograde cholangiopancreatography-related procedures were performed using the sphincterotome developed during November 2023 through February 2024. The cases were investigated retrospectively. Among these, EST was applied to six cases. Cannulation was performed using the developed sphincterotome in the native papilla in four cases. The primary endpoints were the success rate of cannulation in surgically altered anatomy and the success rate of EST. Secondary endpoints were complications and usability for operators. Usability for operators was evaluated by questionnaire for several items on a 5-point scale. EST was conducted successfully in all six cases subjected to EST. Mild hemorrhage was observed in one case (17%) as an adverse event after EST. Deep cannulation to the native papilla with the developed sphincterotome was conducted successfully in three cases (75.0%). Evaluation results by operators were 4.4 ± 0.55 for rotation performance, 4.00 ± 0.63 for incision performance, 4.29 ± 0.49 for deep cannulation performance, and 4.07 ± 0.19 for overall evaluation. In conclusion, this developed sphincterotome might be very useful for EST and cannulation in cases with surgically altered anatomy.

The effect of multiple single cannulation technique on complications of arteriovenous fistulae: A meta-analysis.

To evaluate the effect of multiple single cannulation technique on the complications of arteriovenous fistula. A comprehensive literature search was conducted to investigate the impact of multiple single cannulation technique on the complications of arteriovenous fistula. The search was performed in both Chinese and English databases including Wanfang Medicine, China National Knowledge Infrastructure, Vip, Pubmed, Embase, and The Cochrane Library, with a search period up to December 20, 2023. Following literature screening and data extraction, the quality of the included studies was assessed using the Cochrane Bias Assessment Tool for Randomized Controlled Trials. Statistical analysis was performed using Review Manager version 5.3. Thirteen papers, totaling 1299 patients, were included in the analysis. The experimental group consisted of 646 patients, while the control group had 595 patients. The meta-analysis revealed that the multiple single cannulation technique was more effective than rope ladder cannulation and buttonhole cannulation in reducing the incidence of angiomas (odds ratio [OR] = 0.19; 95% confidence interval [CI] = 0.10-0.35), stenosis (OR = 0.22; 95% CI 0.13-0.39), thrombosis (OR = 0.17; 95% CI = 0.07-0.39), and blood seepage (OR = 0.13; 95% CI = 0.08-0.21) of arteriovenous fistulas (P < .05). Additionally, it was found to increase the success rate of nurses' single cannulation (OR = 4.20; 95% CI = 1.78-9.95) of arteriovenous fistulas (P < .05). Multiple single cannulation technique could effectively reduce the incidence of complications of arteriovenous fistula, improve the success rate of cannulation, prolong the life span of arteriovenous fistula, and prolong the survival cycle of hemodialysis patients.

Is endovascular arteriovenous fistula a feasible alternative for hemodialysis patients?

For hemodialysis (HD) patients, the selection of vascular access (VA) is a crucial factor that significantly affects morbidity and mortality. Historically, native Arteriovenous Fistulas (AVFs) have been established using surgical techniques. However, devices facilitating percutaneous endovascular arteriovenous fistula formation have recently been introduced in clinical practice, showing promising initial evidence. The primary objectives were technical success, efficacy, and cannulation rates. The secondary objectives included primary and cumulative patency, safety, and the number of procedures required to maintain fistula patency. A prospective, single-center, single-arm study that included all patients who underwent endovascular arteriovenous fistulas (endoAVF) creation using the WavelinQ™ EndoAVF System at a University Hospital between December 2021 and August 2023. A total of 20 patients who underwent an endoAVF were included. Technical success was 100%. 75% (15) of the endoAVFs met the criteria for physiological suitability. The cannulation rate was 66% (10/15) for endoAVFs that reached physiological suitability. At 6 months of follow-up, the primary and cumulative patency rates were 65% and 75%, respectively; at 12 months, these were 50% and 70%, respectively. Serious adverse events were not observed. The reintervention rate was 0.33 procedures/patient-year. Based on our experience, creating AVFs using the WavelinQ 4-F EndoAVF system is safe and effective, with high technical success rates and acceptable patency and reintervention rates.

Precut Over a Pancreatic Duct Stent Versus Transpancreatic Precut Sphincterotomy for Difficult Biliary Cannulation in Endoscopic Retrograde Cholangiopancreatography: A Retrospective Cohort Study

BackgroundPrecut over a pancreatic duct stent (PPDS) and transpancreatic precut sphincterotomy (TPS) with immediate pancreatic duct stent placement are techniques employed to promote biliary access during endoscopic retrograde cholangiopancreatography (ERCP) in cases of challenging biliary cannulation. However, limited data are available to compare the efficacy of these two pancreatic stent-assisted precut sphincterotomy techniques.AimsThe aim of this study was to compare the efficacy of PPDS versus TPS.MethodsA retrospective analysis was performed on the clinical data of consecutive patients who underwent ERCP between April 1, 2019 and May 31, 2023. According to the selected cannulation approaches, patients were assigned to two groups. In the PPDS group, a pancreatic duct stent was initially placed, followed by needle-knife precut over the stent. In the TPS group, transpancreatic precut sphincterotomy was initially performed, followed by immediate pancreatic stent placement. The success rate of biliary cannulation and the incidence of post-ERCP pancreatitis (PEP) between the two groups were analysed.ResultsAmong 864 patients who underwent ERCP, 46 patients were equally enrolled in the two groups. Selective bile duct cannulation was successfully achieved in 42 out of 46 (91.3%) cases using the PPDS and in 32 out of 46 (69.6%) cases using TPS technique alone, indicating significantly higher success rate of bile duct cannulation with PPDS compared to TPS (91.3% vs. 69.6%, P = 0.009). The overall success rates for bile duct cannulation were 93.5% and 97.8% in the PPDS and TPS groups, respectively, with no significant difference identified (P = 0.307). PEP occurred in 0 and 4 (8.7%) cases in the PPDS and TPS groups, respectively, with no significant difference between the two groups (8.7% vs. 0%, P = 0.117). There were no cases of bleeding or perforation in either group.ConclusionsBoth PPDS and TPS followed by immediate pancreatic duct stent placement are viable options. TPS stands out for its simplicity and cost-effectiveness, while PPDS is more appropriate for patients who are at a high-risk of developing PEP.

Intranasal esketamine versus esketamine-dexmedetomidine combination for premedication in pediatric patients undergoing strabismus surgery: a randomized controlled trial.

Preoperative fear and anxiety are prevalent in children undergoing surgery. The combination of esketamine and dexmedetomidine has been proposed as a promising premedication for enhancing preoperative sedation and analgesia. This study compared the premedication efficacy of intranasal esketamine alone and esketamine-dexmedetomidine combination in pediatric patients undergoing strabismus surgery. One hundred and eighty preschool children aged 2-6 years scheduled for strabismus surgery were enrolled and randomly assigned to one of the three groups: intranasal premedication with esketamine 2 mg/kg (Group K), esketamine 1 mg/kg and dexmedetomidine 1 µg/kg (Group KD1), or esketamine 0.5 mg/kg and dexmedetomidine 2 µg/kg (Group KD2). The primary outcome was the level of sedation following the intervention, as measured by the modified Yale preoperative anxiety scale (mYPAS) and sedation scale (SS). Secondary outcomes included onset time of sedation, the successful rate of peripheral intravenous cannulation, parental separation anxiety scale (PSAS), mask acceptance scale (MAS), wake-up time, duration of stay in the post-anesthesia care unit (PACU), and premedication-related adverse effects. After premedication, the mYPAS score gradually decreased in the three groups, with lower values in Group K than in Group KD1 and Group KD2 patients in 1, 5, and 10 min. SS in Group KD1 and Group KD2 steadily increased until 40 min after premedication, while SS in Group K increased in the first 5 min after premedication and maintained consistent levels during the remaining time. Sedation onset was substantially faster in Group K patients (11.4±7.8 min) than Group KD1 (18.1±7.5 min, P=0.006) and Group KD2 (18.4±6.8 min, P<0.001). PSAS, separation status, the successful rate of peripheral intravenous cannulation, and MAS were comparable among groups. There was no significant difference in terms of emergence time or duration of stay in the PACU among groups. More gastrointestinal events were observed in Group K (P<0.001). Intranasal premedication with 2 mg/kg esketamine produced a more rapid onset of sedation accompanied by more gastrointestinal reactions compared with a combination of esketamine and dexmedetomidine. ClinicalTrials.gov identifier: NCT04757675.

Outcomes of endoscopic retrograde cholangiopancreatography performed in the AM versus PM: does procedural timing matter?

Abstract Background ERCP is a technically demanding procedure that carries a high cumulative adverse event (AE) rate of &amp;gt;10%. Identifying risk factors for adverse events is paramount. Procedure timing, as a surrogate for endoscopist fatigue, has been shown to influence key quality metrics in colonoscopy, but data on this relationship in ERCP is sparse. Methods We conducted a retrospective cohort study of ERCP procedures performed by 5 experienced staff endoscopists, with or without advanced endoscopy fellow (AEF) involvement, from January 1, 2010 to December 1, 2020 at St Michael’s Hospital, Toronto, Ontario, a regional referral center for therapeutic endoscopy. The primary outcome was the difference in rate of selective deep, duct canulation between AM and PM procedures. Results A total of 5672 ERCP procedures were eligible for inclusion. 2793 (49.2%) procedures were performed in the AM and 2879 procedures (50.8%) were performed in the PM. We found no significant difference in the rate of selective ductal cannulation between AM and PM procedures in the unadjusted (82.8% AM vs. 83.1% P-value = .79) or adjusted (OR = 0.98, 95% CI, 0.85-1.12, P-value = .72) analyses. We found no significant difference in the mean procedural duration or rate of perforation between AM and PM procedures. The rate of immediate bleeding was slightly higher in the AM cohort. Conclusion In our single-center retrospective study, ERCP quality, including selective cannulation rates and immediate adverse events were not significantly different in procedures performed in the morning compared to those performed in the afternoon.

Flow-mediated dilation facilitates radial artery cannulation in patients undergoing intravenous general anesthesia: A prospective randomized controlled trial.

Flow-mediated dilation (FMD) is commonly used as a diagnostic tool to assess endothelial function, and compared with other methods for stimulating radial artery dilation, FMD offers several advantages such as non-invasiveness, ease of execution, minimal equipment requirements, and negligible risk. The study aimed to investigate the effect of FMD in facilitating radial arterial cannulation in the context of intravenous general anesthesia. Eighty patients undergoing intravenous general anesthesia and requiring radial artery cannulation were randomized 1:1 to the FMD group and control group. Patients in the FMD group received an upper arm occlusion for 5 min after anesthesia induction, and the cuff was placed without inflation for the equivalent duration in the control group. The primary outcome was first-attempt success rate. Secondary outcomes were the diameter and percentage of dilation of radial artery, overall success rate, total number of attempts, cannulation time, and occurrence of procedure-related complications. Intravenous anesthetic agents significantly dilated the radial artery (p < 0.05), which was further increased by FMD. An increase in both the first-attempt and overall success rate of radial artery cannulation was demonstrated with the use of FMD (67.5% vs 42.5%, p < 0.05). The total number of attempts needed to cannulate the radial artery was reduced in the FMD group as compared with the control group (p < 0.05), but no differences in cannulation time and procedure-related complications were found between the two groups (p > 0.05). FMD induced by a 5-min upper arm occlusion may facilitate radial artery cannulation in patients undergoing intravenous general anesthesia.

Peripheral venous dilation using flow-mediated dilation response: A randomized crossover study.

Venodilation is crucial in enhancing the success rate of peripheral intravenous cannulation. Flow-mediated dilation (FMD) is a vasodilatory response initiated by temporary ischemia followed by reperfusion. This crossover study aimed to test the hypothesis that FMD induces dilation of the peripheral veins of the forearm. Fifteen healthy volunteers underwent the FMD and control conditions in a randomized order. FMD involved a 5-min occlusion of blood flow in the brachial artery, followed by reperfusion, achieved by inflating and deflating a cuff placed on the upper arm. The control condition involved participants remaining at rest. The primary outcome measure was a change in the cross-sectional area of the cephalic vein post-intervention. The secondary outcomes included changes in venous diameter and perfusion index (PI). FMD significantly increased the cross-sectional area of the cephalic vein compared with the control condition (relative change to baseline: 37.7% (31.4) vs 2.2% (11.7)), with a mean difference of 35.4% (95% confidence interval (CI): 16.4-54.5, p = 0.001). Both longitudinal and transverse diameters were significantly expanded with FMD compared to the control (relative change to baseline: 15.7% (15.4) vs 2.6% (3.6), p = 0.004; 18.9% (15.6) vs -0.0 (10.2), p = 0.003, respectively). Additionally, PI significantly increased with FMD compared with the control (relative change to baseline: 77.8% (56.9) vs 14.6% (36.0)), with a mean difference of 63.2% (95% CI: 31.2-95.2, p = 0.001). FMD application induced dilation of the cephalic vein of the forearm. The findings suggest that FMD is an effective technique for dilating the venous area and potentially improving the success rate of peripheral intravenous cannulation.

Ultrasound-Guided Versus Palpation-Guided Techniques to Achieve Vascular Access in Children Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Pediatric heart surgery is a vital therapeutic option for congenital heart disease, which is one of the most prevalent causes of death in children. Arterial cannulation (AC) and central venous catheter (CVC) are required in pediatric cardiac surgery for continuous monitoring of the central venous pressure (CVP), replacement of fluid or blood products, close hemodynamic monitoring, and frequent sampling for arterial blood gases (ABG). A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) retrieved from PubMed, Embase Cochrane, Scopus, and WOS until February 2024. Risk ratio (RR) was used to report dichotomous outcomes, and mean difference (MD) was used to report continuous outcomes, both with a 95% confidence interval (CI) using the random-effects model. Thirteen RCTs with 1060 children were included. Regarding arterial cannulation, the ultrasound-guided technique (US) was associated with a statistically significant increase in successful cannulation [RR: 1.31 with 95% CI (1.10, 1.56), P < 0.0001], and first-attempt success [RR: 1.88 with 95% CI (1.35, 2.63), P < 0.0001]. However, US was not associated with any statistically significant difference in venous cannulation in both outcomes with [RR: 1.13 with 95% CI (0.98, 1.30), P = 0.10], [RR: 1.53 with 95% CI (0.86, 2.71), P = 0.15] respectively. Moreover, US was associated with a statistically significant decrease in the number of attempts either in arterial cannulation with [MD: -0.73 with 95% CI (-1.00, -0.46), P < 0.0001] or in venous cannulation with [MD: -1.34 with 95% CI (-2.55, -0.12), P = 0.03], and the time of attempted cannulation also either in arterial cannulation with [MD: -2.27 with 95% CI (-3.38, -1.16), P < 0.0001] or in venous cannulation with [MD: -4.13 with 95% CI (-7.06, -1.19), P < 0.0001]. US guidance improves successful cannulation rates and first-attempt success in arterial access and reduces the number of attempts and procedural time for arterial and venous access. It was also associated with a lower incidence of complications and procedure failure, particularly in arterial access. However, it was associated with a higher incidence of venous puncture.

Optimizing patient selection for ECMO after pediatric hypothermic cardiac arrest

BackgroundIn 2004, our level 1 regional pediatric trauma center created a protocol to activate ECMO for children with suspected hypothermic cardiac arrest based on inclusion criteria: serum potassium ≤9, submersion <90 min, and core body temperature <30 °C. In 2017, Pasquier et al. developed a model to help predict the survival of adults after hypothermic cardiac arrest (HOPE score) that has not been validated in children. We sought to apply this score to our pediatric patient population to determine if it can optimize our patient selection. MethodsThis was a retrospective review of all patients cannulated onto VA ECMO for hypothermic cardiac arrest between 2004 and 2022. We used abstracted data points to calculate the HOPE score for our patient population, both with and without presumed asphyxia. ResultsOver 19 years, 18 patients were cannulated for suspected hypothermic arrest, with three survivors (17 %). The HOPE score survival prediction ranged from 1 to 86 % with presumed asphyxia and 6–98 % without presumed asphyxia. Survivor HOPE scores ranged from 9 to 86 % with presumed asphyxia and 42–98 % without presumed asphyxia. Non-survivors’ scores ranged 1–29 % with asphyxia and 6–57 % without asphyxia. A cutoff of >5 % predicted survival with asphyxia for ECMO could have decreased our cannulations by half without missing survivors. ConclusionECMO can be a lifesaving measure for specific children after hypothermic arrest. However, identifying the patients that will benefit from this resource-intensive intervention remains difficult. HOPE score utilization may decrease the rate of futile cannulation in children, but multi-centered research is needed in the pediatric population.

The Effectiveness of Electronic Cannulation Atlas in Patients with Arteriovenous Fistula.

This study aimed to assess the effectiveness of an electronic cannulation atlas in preventing and treating complications of arteriovenous fistula. The observation group, consisting of 92 dialysis patients from July to December 2021, was managed with an electronic cannulation atlas. After 6 months, the incidence of complications such as stenosis, hematoma, thrombus, aneurysm, and cannulation failure was compared between the groups. Nurse satisfaction with the electronic cannulation atlas system was also assessed through a questionnaire. The observation group had lower incidence rates of arteriovenous fistula stenosis, thrombus, aneurysm, and failure rate of cannulation compared to the control group, with statistically significant differences (p<0.05). The incidence rates of hematoa were similar in both groups, showing no significant difference (p>0.05). After 3 months of management, the incidence of arteriovenous fistula complications in the observation group was significantly lower than in the control group (p<0.05). Additionally, utilizing the electronic cannulation atlas system was found to increase nurses' job satisfaction. The use of electronic cannulation atlas for the treatment of patients' arteriovenous fistula could effectively reduce the incidence of complications of patients' arteriovenous fistula, reduce the failure rate of cannulation, reduce the workload of nurses, and improve the job satisfaction of nurses.

A Randomized Study Comparing Ultrasound-Guided Internal Jugular Vein Cannulation Using Two Techniques: Short-Axis Out-of-Plane With Dynamic Needle Tip Positioning Versus Long-Axis In-Plane.

Introduction Internal jugular vein (IJV) cannulation is a routine procedure in operating rooms, critical care units, and perioperative settings. Ultrasound guidance has notably increased the success rates of IJV cannulation. A modified ultrasound technique known as the short-axis out-of-plane method with dynamic needle tip positioning (DNTP) allows for continuous visualization of the needle tip throughout the procedure. This study aims to compare the first-pass success rate of IJV cannulation using the DNTP and long-axis in-plane (LAIP) approaches. Methods One hundred patients between 18 and 70 years undergoing elective surgery requiring IJV cannulation were recruited.Patients were assigned randomly to the DNTP group (n = 50) or the LAIP group (n = 50). We recorded the first-pass success rate, time to achieve successful cannulation, number of skin punctures, overall success rate within five minutes, and potential complications such as pneumothorax and hematoma. Results The first pass success rate was higher in the DNTP group (48/50, 96%) as compared to the LAIP group (38/50, 76%, relative risk, 1.67; 95% confidence interval, 0.039-0.707; p = 0.008). The cannulation time was shorter in DNTP (116.98 ± 22.90 seconds) versus the LAIP group (213.04 ± 52.08 seconds; p < 0.001). No complications like pneumothorax or hematoma were noted in both groups. Conclusion We conclude that the ultrasound-guided DNTP technique for IJV cannulation, as compared with the LAIP technique, may significantly improve the first attempt cannulation, number of attempts, and cannulation time.

Evaluation of vascular accesses in the neonatal intensive care unit. Is the midline catheter a useful long-term alternative?

ObjectiveAnalyze the usefulness of the midline catheter in terms of efficacy and safety for treatments lasting more than 3 days in the neonatal population requiring admission to the NICU. DesignAnalytical and observational of a prospective cohort (December 2021–November 2023) compared to a historical cohort (January 2020–November 2021). Setting9-bed Neonatal Intensive Care Unit (NICU, level III hospital. Patients or participants288, 66 midline group and 222 control group. Inclusion criteria: newborns from 24 to 42 weeks of gestation who required short peripheral or midline cannulation and treatment longer than 3 days. InterventionsFollow-up during NICU stay and comparison with retrospective data from a historical cohort. Main variables of interestSociodemographics, success rate (permanence of the same vascular catheter without complications until finish the prescribed treatment), number of catheters, cannulation rate per patient, indwell time, complications. ResultsThe midline group showed a higher success rate (54.2% vs 5.6%, p < 0.001), a lower number of canalizations per patient (p < 0.001), a longer indwell time (p < 0.001) and a lower number of extravasations (p < 0.001). ConclusionsThe midline catheter has advantages over short peripheral catheters, being a useful alternative in terms of efficacy and safety for treatments lasting more than 3 days in the neonatal population that requires admission to the NICU.

Evaluación de los diferentes accesos vasculares en Unidad de Cuidados Intensivos Neonatales. ¿Es el catéter midline una alternativa útil para terapias prolongadas?

ObjectiveAnalyze the usefulness of the midline catheter in terms of efficacy and safety for treatments lasting more than 3 days in the neonatal population requiring admission to the NICU. DesignAnalytical and observational of a prospective cohort (December 2021-November 2023) compared to a historical cohort (January 2020-November 2021). Setting9-bed Neonatal Intensive Care Unit (NICU, level III hospital. Patients or participants288, 66 midline group and 222 control group. Inclusion criteria: newborns from 24 to 42 weeks of gestation who required short peripheral or midline cannulation and treatment longer than 3 days. InterventionsFollow-up during NICU stay and comparison with retrospective data from a historical cohort. Main variables of interestSociodemographics, success rate (permanence of the same vascular catheter without complications until finish the prescribed treatment), number of catheters, cannulation rate per patient, indwell time, complications. ResultsThe midline group showed a higher success rate (54.2% vs. 5.6%, P<.001), a lower number of canalizations per patient (P <.001), a longer indwell time (P<.001) and a lower number of extravasations (P<.001). ConclusionsThe midline catheter has advantages over short peripheral catheters, being a useful alternative in terms of efficacy and safety for treatments lasting more than 3 days in the neonatal population that requires admission to the NICU.

Skin Transillumination Improves Peripheral Vein Cannulation by Residents in Neonates: A Randomized Controlled Trial

Introduction: Establishing peripheral vein access is challenging for pediatric residents and a painful procedure for neonates. We assessed the efficacy of a red light-emitting diode transilluminator during peripheral vein catheter insertion performed by pediatric residents. Methods: Patients were stratified by current weight (≤1,500 g, >1,500 g) and randomized to the transillumination or the control group. The first three attempts were performed by pediatric residents, followed by three attempts by a neonatologist. The primary outcome was success at first attempt. Secondary comparisons included time to successful insertion and overall success rates of residents and neonatologists. Results: A total of 559 procedures were analyzed. The success rate at resident’s first attempt was 44/93 (47%) with transillumination versus 44/90 (49%) without transillumination (p = 0.88) in the strata ≤1,500 g and 103/188 (55%) with transillumination versus 64/188 (34%) without transillumination in the strata >1,500 g (p < 0.001). The overall success rate for residents was 86% in the transillumination versus 73% in the control group in the strata >1,500 g (p = 0.003) but not different in the strata ≤1,500 g (78/93 [84%] vs. 72/90 [80%], p = 0.57). There was no effect when the experience level of residents exceeded 6 months. Neonatologists’ overall success rate and time to successful cannulation did not differ significantly in both weight strata. Conclusion: Transillumination improves the first-attempt success rate of peripheral vein cannulation performed by pediatric residents in neonates >1,500 g, while no benefit was found in infants ≤1,500 g.

Pre-procedural and intra-procedural computerized tomography: providing a roadmap for successful adrenal venous sampling procedures

Background and purposeAdrenal venous sampling (AVS) is used for the diagnosis of primary hyperaldosteronism. Technical difficulties with right adrenal vein (RAV) catheterization can lead to erroneous results. Our purpose was to delineate the location of the RAV on pre-procedural CT imaging in relation to the location identified during AVS and to report on the impact of successful RAV cannulation with and without the use of intra-procedural CT scanning.MethodsRetrospective case series including patients who underwent AVS from October 2000 to September 2022. Clinical and laboratory values were abstracted from the electronic medical record. Successful cannulation of the RAV was defined as a selectivity index > 3.Results110 patients underwent 124 AVS procedures. Pre-AVS CT imaging was available for 118 AVS procedures. The RAV was identified in 61 (51.7%) CT datasets. Biochemical confirmation of successful RAV cannulation occurred in 98 (79.0%) of 124 AVS procedures. There were 52 (85.2%) procedures in which the RAV was identified on pre-AVS CT and there was biochemical confirmation of successful RAV sampling. Among these 52 procedures, the RAV was localized during AVS at the same anatomic level or within 1 vertebral body level cranial to the level identified on pre-AVS CT in 98.1% of cases. The rate of successful RAV cannulation was higher in patients who underwent intra-procedural CT (93.8% versus 63.9%), P < 0.01.ConclusionsPre-AVS and intra-procedural CT images provide an invaluable roadmap that resulted in a higher rate of accurate identification of the RAV and successful AVS procedures; in particular, search for the RAV orifice during AVS can be limited to 1 vertebral body cranial to the level identified on pre-AVS CT imaging and successful cannulation can be confidently verified with intra-procedural CT.

Effect of passive leg raising on the cross-sectional area of the right internal jugular vein in patients with obesity: a randomised controlled trial protocol

BackgroundVenous access in patients with obesity presents significant challenges. The success of central venous catheterisation largely depends on the cross-sectional area (CSA) of the internal jugular vein (IJV). While techniques...

Successful Selective Biliary Cannulation Using Biopsy Forceps during Endoscopic Retrograde Cholangiopancreatography: A Case Report

Periampullary diverticulum is a risk factor for the occurrence and recurrence of gallstone diseases. It is controversial whether periampullary diverticulum affects the success rate of elective biliary cannulation. In some cases, periampullary diverticulum makes selective biliary cannulation difficult. We report a case in which selective biliary cannulation was possible using biopsy forceps in the presence of periampullary diverticulum.