Catheter Dislodgement Research Articles

Is continuous catheter adductor canal block better than single-shot canal adductor canal block in primary total knee arthroplasty?: A GRADE analysis of the evidence through a systematic review and meta-analysis.

The adductor canal block (ACB) has emerged as an alternative to the femoral nerve block (FNB) after total knee arthroplasty. This meta-analysis was conducted to investigate which ACB method provides better pain relief and functional recovery after total knee arthroplasty METHODS:: We conducted a meta-analysis to identify randomized controlled trials involving single-shot adductor canal block (SACB) and continuous catheter ACB (CACB) after TKA up to December 2019 by searching databases including the PubMed, Web of Science, Embase, Cochrane Controlled Trials Register, Cochrane Library, CBM, CNKI, VIP, and Wanfang databases. Finally, we included 8 randomized controlled trials involving 702 knees in our study. We used Review Manager Software and Grading of Recommendations Assessment, Development, and Evaluation profiler to perform the meta-analysis. Compared with SACB, CACB can achieve better postoperative pain relief at 24 and 48 h both at rest and after mobilization, lower amount of opioid consumption at 72 h, a shorter length of hospital stay (LOH) and larger range of motion (ROM). In addition, the Timed Up and Go (TUG) test results; quadriceps strength; and incidence of complications, including postoperative nausea and vomiting, DVT, catheter-related infections, catheter dislodgement and neurologic deficits, showed no significant difference between the two ACB methods. The results of this study demonstrate that CACB is an effective alternative to SACB and can provide better pain relief, a shorter LOH, more degrees of maximum flexion and a lower amount of opioid consumption over time, but it provides a comparable level of recovery of quadriceps strength and mobility with a similar risk of catheter-related complications. Thus, CACB may be a better analgesia strategy than SACB after TKA at present.

Lumbar drain complications in patients undergoing fenestrated or branched endovascular aortic aneurysm repair: Development of an institutional protocol for lumbar drain management

ObjectiveLumbar drain placement with cerebrospinal fluid (CSF) drainage is an effective adjunct for reducing the risk of spinal cord ischemia in patients undergoing complex aortic aneurysm repair. However, lumbar drain placement is a challenging procedure with potential for significant complications. We sought to characterize complications of lumbar drain placement in a large, single-center experience of patients who underwent fenestrated or branched endovascular aneurysm repair (F/BEVAR). MethodsAll patients who underwent F/BEVAR and attempted lumbar drain placement from 2010 to 2019 were retrospectively reviewed. All lumbar drains were placed by four cardiovascular anesthesiologists who compose the complex aortic anesthesia team. Lumbar drain placement was guided by a set protocol and used whenever the aortic stent graft coverage was planned to extend more proximal than 40 mm above the celiac artery. Details relating to lumbar drain placement, management, and frequency and type of associated complications were characterized. ResultsDuring the study period, 256 patients underwent F/BEVAR, of whom 100 (39%) were planned for lumbar drain placement. Successful placement occurred in 98 (98%) of the cases. All lumbar drains were placed before induction of general anesthesia, using fluoroscopy guidance in 28 cases (28%). The most common level of placement was L4-5 (n = 42 [42%]). The majority (n = 82 [82%]) were left in place ≤48 hours; 21% were removed during the first 24 hours, and 61% were removed between 24 and 48 hours. Nonfunctionality was the most common complication, occurring in 16 (16%) patients. Catheter dislodgment or fracture, CSF leak, and postdural puncture headache were observed in 4 (4%), 7 (7%), and 4 (4%) patients, respectively. The most common bleeding complication was the presence of asymptomatic blood in the CSF (n = 11 [11%]), whereas subarachnoid hemorrhage combined with intraventricular hemorrhage occurred in three patients (3%); none of these patients required surgical drainage or intervention. No infectious complications were observed. ConclusionsLumbar drain placement for CSF drainage is a commonly employed adjunct to prevent spinal cord ischemia in F/BEVAR. Our experience demonstrates that lumbar drain placement can be performed successfully but is associated with a significant rate of nonfunctionality and a diverse range of complications that, fortunately, do not commonly have significant long-term sequelae.

Confirmation of Epidural Catheter Location by Epidural Pressure Waveform Recordings by the Compuflo<sup>® </sup> Cath-Checker System

Background: Pulsatile waveforms originating from the spinal cord and transmitted through the dura in synchrony with heart rate have been used to confirm the epidural location of the catheter. Lumbar epidural space identification using the CompuFlo® instrument has been reported and validated. The aim of this preliminary study was to evaluate the new CompuFlo instrument which allows the identification of pulsatile waveform recordings. Methods: We tested 30 epidural catheters previously successfully used for post cesarean analgesia and about to be removed. All patients were given 5 mL 2% lidocaine to test the catheter before its removal. After priming with 5 mL saline, the catheter was connected to CompuFlo® to record the occurrence of pulsatile waveforms and/or their disappearance during its removal. Results: Pulsatile waveforms were observed in all the catheters properly located in the epidural space and disappeared when the catheter was extracted from the epidural space. No waveforms were recorded in 2 cases in which no sensory block occurred after the test dose (catheter dislodgement). The pressure waveform analysis through the epidural catheter had a sensitivity of 100%, a positive predictive value of 100%, a specificity of 100% and a negative predictive value of 100%. Conclusions: In this preliminary trial pulsatile pressure waveform recording with CompuFlo® CathCheck™ System through the epidural catheter resulted in high sensitivity and positive predictive value.

External ventricular drain related complications-whether continuous csf drainage via ommaya reservoir is the answer?

External ventricular drainage (EVD) is one of the commonest procedures in neurosurgical practice to manage acute hydrocephalus. We evaluated the infectious and non-infectious complications associated with a modified technique for EVD using an Ommaya reservoir. Ommaya reservoir was placed in all patients who required EVD placement for CSF drainage. CSF drainage was achieved using a needle placed in a non-coring fashion percutaneously into the Ommaya reservoir to achieve CSF drainage externally. CSF was monitored for signs of infection regularly using CSF biochemistry and cultures. CSF infection was defined by a positive culture or a secondary infection in patients with already infected CSF. 59 patients required continuous CSF drainage during the study period from January 2014 to June 2017. 46 (77.96%) patients had non-infected CSF at time of starting drainage and 13 (22.03%) patients required external CSF drainage for primarily infected CSF. The study period had a total of 793 CSF drainage days (Range 3-64 days) with an average of 13.4 days per patient. The cumulative rate of new infection was 5.08%. No ventricular catheter blockage or dislodgement was seen in any of the patients. External ventricular drainage through an Ommaya chamber is a safe and effective method and can be used to reduce the catheter related complications like infection, catheter blockage and dislodgement.

Perioperative outcomes after open radical cystectomy for muscle invasive bladder cancer

Introductions: Radical cystectomy with bilateral pelvic lymphadenectomy is a primary intervention for muscle invasive or refractory, high grade Ta, T1, Tis bladder cancer. Owing to its major undertaking, patient succumbs to infection and various morbidities. This study was to assess the perioperative outcomes and complications of radical cystectomy.
 Methods: This retrospective study analyzed the perioperative outcome (early mortality within 30 days, length of stay, requirement of blood transfusion) of radical cystectomy in patients with bladder cancer during four years at Patan Hospital, Patan Academy of Health Sciences, Lalitpur, Nepal. Ethical approval was obtained. Study variables included patient’s demographics, presenting symptoms, tumor types and configuration, need for blood transfusion, length of surgery, pathological stages, types of urinary diversions, hospital stay, early (<30 days) and late (31-90 days) morbidity and mortality.
 Results: Total 32 patients underwent radical cystectomy. Data analysed on 18 patients, mean age was 66.7 years and painless hematuria 17 (94.4%). All were transitional cell carcinoma, high grade lesion in 17 (94.4%). Overall 6 (33.3%) patients developed early postoperative complications, paralytic ileus and prolong lymph drainage in 5 (27.8%), wound dehiscence in 4 (22.2%) and ureteric catheter dislodgement in two. There were 2 (11.1% of 18) mortalities (the mortality audit showed total 5 (15.6%) out of 32 radical cystectomy during the study period.
 Conclusions: Perioperative complications occurred in 1/3rd following radical cystectomy for muscle invasive bladder, more complications in those with preoperative associated co-morbidities.

Consider Heightened Awareness of Propofol Infusion Syndrome after Extracorporeal Membrane Oxygenation (ECMO) Decannulation

THE PHARMACOKINETICS of sedative drugs can be affected by multiple factors in critically ill patients. Moreover, in patients undergoing extracorporeal membrane oxygenation (ECMO), data regarding appropriate dosing of sedative drugs is limited. ECMO is an invasive management for those who have failed conservative treatment for refractory respiratory or cardiac failure. Currently there are no consensus guidelines regarding sedation strategies for these patients. However, it is understood that lipophilic agents such as propofol can be sequestered in the extracorporeal circuit (ie, tubing and oxygenators), resulting in reduced plasma drug levels and the need for higher doses to achieve the same clinical effect seen in non-ECMO patients. 1 Hammaren E. Rosenberg P. Hynynen M. Coating of extracorporeal circuit with heparin does not prevent sequestration of propofol in vitro. Br J Anaesth. 1999; 82: 38-40 Abstract Full Text PDF PubMed Scopus (25) Google Scholar Further complicating matters, the configuration of ECMO may also affect medication requirements. Patients on venovenous (VV) ECMO appear to need higher doses as compared with patients on venoarterial (VA) ECMO. 2 Shekar K. Roberts J.A. Mullany D.V. Corley A. Fisquet S. Bull T.N. et al. Increased sedation requirements in patients receiving extracorporeal membrane oxygenation for respiratory and cardiorespiratory failure. Anaesth Intens Care. 2012; 40: 648-655 Crossref PubMed Google Scholar Pharmacokinetic data related to ECMO are often derived from in vitro studies, and to the best of the authors’ knowledge there is no strong literature describing this phenomenon that could help guide care for critically ill patients on ECMO. The need for sedation in the critically ill is often unavoidable and frequently necessary to promote comfort, alleviate pain and anxiety, relieve agitation and distress from the acute illness, and facilitate ventilator synchrony. 3 Sessler C.N. Wilhelm W. Analgesia and sedation in the intensive care unit: an overview of the issues. Crit Care (London). 2008; 12: S1 Crossref PubMed Scopus (30) Google Scholar However, excessive use of sedatives can have adverse outcomes. 4 Jackson D.L. Proudfoot C.W. Cann K.F. et al. A systematic review of the impact of sedation practice in the ICU on resource use, costs and patient safety. Crit Care. 2010; 14: R59 Crossref PubMed Scopus (104) Google Scholar Sedation needs in ECMO patients are often safety related, as it reduces the risk of catheter dislodgement or malposition (an important consideration in those centrally cannulated with an open chest), reduces coughing and Valsalva (which may negatively impact venous drainage), and facilitates comfort and ventilator synchrony in those unable to be extubated. The authors describe an interesting case of propofol infusion syndrome developing in a patient who was recently decannulated from VA ECMO.

Radiologically guided percutaneous nephrostomy: A 6-year single-center experience

Aim: To retrospectively analyze the indications, underlying pathologies, technical success rate, complications and benefit of percutaneous nephrostomies in a single centre.Materials and Methods: Data of 578 patients who underwent radiologically guided percutaneous nephrostomy between January 1999 and December 2004 were retrospectively reviewed. The mean age of the patients was 42.5 years (range, 6 days–90 years). The indications were urinary obstruction without urinary infection (77.9%), urinary obstruction with urinary infection (13.1%), urinary diversion (6.9%) and diagnostic testing (2.1%). Results: The technical success rate was 99.4%. There was no procedure related mortality. Major hemorrhage or sepsis were not observed in children. Major hemorrhage occurred in 1.55% and sepsis occured in 2.65% of adult patients. Catheter dislodgement was the commonest complication with an overall rate of 11.4%. In 7.2% patients, percutaneous nephrostomy was successful in managing patients without further intervention. 36.5% of patients had surgery and 14.7% had ureteral stenting as definitive treatment. Conclusion: Radiologically guided percutaneous nephrostomy, can be used effectively, and safely in a wide variety of indications with high technical success and low complications rates.

Safety, Feasibility, and Efficacy of Early Rehabilitation in Patients Requiring Continuous Renal Replacement: A Quality Improvement Study

IntroductionEarly rehabilitation in critically ill patients is associated with improved outcomes. Recent research demonstrates that patients requiring continuous renal replacement therapy (CRRT) can safely engage in mobility. The purpose of this study was to assess safety and feasibility of early rehabilitation with focus on mobility in patients requiring CRRT.MethodsStudy design was a mixed methods analysis of a quality improvement protocol. The setting was an intensive care unit (ICU) at a tertiary medical center. Safety was prospectively recorded by incidence of major adverse events including dislodgement of CRRT catheter, accidental extubation, bleeding, and hemodynamic emergency; and minor adverse events such as transient oxygen desaturation >10% of resting. Limited efficacy testing was performed to determine if rehabilitation parameters were associated with clinical outcomes.ResultsA total of 67 patients (54.0 ± 15.6 years old, 44% women, body mass index 29.2 ± 9.3 kg/m2) received early rehabilitation under this protocol. The median days of CRRT were 6.0 (interquartile range [IQR], 2–11) and 72% of patients were on mechanical ventilation concomitantly with CRRT at the time of rehabilitation. A total of 112 rehabilitation sessions were performed of 152 attempts (74% completion rate). No major adverse events occurred. Patients achieving higher levels of mobility were more likely to be alive at discharge (P = 0.076).ConclusionsThe provision of early rehabilitation in critically ill patients requiring CRRT is safe and feasible. Further, these preliminary results suggest that early rehabilitation with focus on mobility may improve patient outcomes in this susceptible population.

The Safety of Midline Catheters for Intravenous Therapy at a Large Academic Medical Center.

Background: Midline catheters (MCs) have arisen as alternatives to peripherally inserted central catheters (PICCs) for both general intravenous therapy and extended outpatient parenteral therapy. However, there is a lack of data concerning the safety of medication therapy through midline for extended durations. Objective: The purpose of this study is to evaluate the safety of MCs for extended intravenous use. Methods: This was a retrospective cohort study evaluating patients who received intravenous therapy through an MC at a tertiary care academic medical center. The primary end point was the incidence of composite catheter-related adverse events that included local events, catheter dislodgment, infiltration, catheter occlusion, catheter-related venous thromboembolism, extravasation, and line-associated infection. Results: A total of 82 MC placements and 50 PICC placements were included; 50 MCs were for outpatient parenteral antimicrobial therapy, and 32 were for inpatient intravenous use. There were 21 complications per 1000 catheter-days in the outpatient group and 7 complications per 1000 catheter-days in the PICC group (P = 0.91). The median time to complication in both groups was 8 days. The antimicrobial classes commonly associated with complications were cephalosporins, carbapenems, and penicillins. Conclusion and Relevance: Our results suggest that intravenous therapy with MCs is generally safe for prolonged courses that do not exceed 14 days as compared with PICC lines, which can be placed for months. There is still limited evidence for the use of MCs between 14 and 28 days of therapy. This study can help guide our selection of intravenous catheters for the purpose of outpatient antimicrobial therapy.

MON-132 PERCUTANEOUS TRANSHEPATIC TUNNELLED CATHETER FOR HAEMODIALYSIS: A SINGLE CENTRE EXPERIENCE

Obtaining vascular access for dialysis can be challenging in long-term haemodialysis patients who have exhausted all traditional access sites as a result of multiple catheter placements. Transhepatic dialysis catheter insertion is potentially life-saving for those with access failure. This study aims at evaluating the functionality and safety of transhepatic venous catheters in haemodialysis patients. Eight patients (3 male and 5 female, aged 59+/-17 years ) had transhepatic tunnelled dialysis catheters inserted in our haemodialysis unit in the past 3 years. The insertion method, type of catheter use, functional duration of catheters, maximum blood flow rate achieved, catheter complications and reasons for catheter removal were evaluated retrospectively. A total of eleven transhepatic catheters were placed in eight patients between January 2016 and November 2018. All the patients were on long term dialysis, with a mean dialysis vintage of 160 months. Most patients started with peritoneal dialysis, and switched to haemodialysis after peritoneal failure. The average heamodialysis duration was 85 months (range 14-144 months). Nine catheters were placed successfully (9/11, 82% technical success). Catheter insertion failed due to development of subphenic haematoma in 1 patient and the negotiation of the catheter into the proper venous position was unsuccessful in the other. One catheter was placed under general anaesthesia while the rest were done under local anaesthesia. RetrO® Long-Term Hemodialysis Catheter (BARD Access Systems) was used in 10 out of 11 of the procedures, and Permcath™ (Medtronic) was used in 1 case. Seven of the 9 functional catheters were placed in the portal vein while the remaining 2 were placed in the hepatic vein. The functional duration of transhepatic catheters ranges from 32 to 551 days, with a mean of 298 days. Of the 9 catheters, 2 were still in use at the end of the study (2/9, 22.2%). One patient died with a functional catheter. Six of the catheters were removed(6/9, 66.6%) . Arteriovenous fistular was created in 1 patient, while 3 catheters were removed due to catheter thrombosis (3/9, 33.3%). Two patients were noted to have catheter dislodgement into the pleural cavity (2/9, 22.2%), both presented with shock and haemothorax. Poor blood flow was the most common complication during the use of transhepatic catheters. Catheter revision was required in 2 cases. The maximum blood flow rate achieved for each catheter ranged from 150ml/minute to 250ml/minute, with a mean rate of 186ml/minute. The maximum blood flow rate was below 200ml/minute in 4 of the catheters (4/9,44.4%). Bleeding at the catheter site necessitating hospital admission occurred in 3 cases (3/9, 33.3%), catheter exit site infection occurred in 2 (2/9, 22.2%), but there were no catheter related sepsis. For patients who have exhausted access options for dialysis, transhepatic catheter placement is an alternative with potentially good long-term functionality. However, limitations in blood flow rate, and the high thrombosis rate with the need for high level of maintenance to preserve patency should be noted. Furthermore, physicians need to be cautious about potentially life-threatening complications such as catheter dislodgement.

Broken and retained percutaneous nephrostomy malecot catheter: A lesson of awareness

After the first description of percutaneous nephrostomy (PCN) in 1955 by Goodwin et al. it has become commonest & well-tolerated procedure. It is now well-established technique for urinary drainage, urinary diversion, and for access to the collecting system. But it is not free of complications. Significant hemorrhage, perforation of the intra-abdominal organs & septicemia are among the major complications and minor complications mostly catheter-related like catheter dislodgment, hematuria catheter site infection & catheter blockage are mentioned in literature. Although far from being life-threatening, broken and retained nephrostomy catheter is a rare complication. We report such a rare case of a broken and retained Malecot nephrostomy catheter which was retrieved by percutaneous nephrostomy surgery and by open method.

Clinical experience of a subcutaneously anchored sutureless system for securing central venous catheters.

This article reports the results of three prospective clinical studies conducted in a university hospital regarding the efficacy, safety and cost effectiveness of a subcutaneously anchored sutureless system for securing central venous catheters. The results were favourable to the adoption of such a device, and the analysis of the data allowed the authors to define those categories of patients where the device should have the most benefit: neonates, children, non-compliant older patients with cognitive difficulties, patients with skin abnormalities that may reduce the effectiveness of a skin-adhesive sutureless securement system, patients who are candidates for having a peripherally inserted central catheter (PICC) in place for more than 8 weeks, and any other category of patients with a recognised high risk of catheter dislodgement.

Incidence, severity and risk factors of peripheral intravenous cannula-induced complications: An observational prospective study.

To determine the incidence, severity and risk factors of peripheral intravenous cannula-induced complications. Peripheral venous cannulation in hospitalised patients may cause complications such as phlebitis, infiltration, occlusion and dislodgement. A review of the literature reveals the discrepancy in their incidence and identification of a wide range of risk factors, whereas the data on the occurrence and degree of severity are insufficient. An observational prospective study. The study observed 1,428 peripheral intravenous cannula insertion among 368 adult patients hospitalised at the tertiary healthcare clinics. The data collection and analysis included patients' medical data and the data related to each cannula (including placement, monitoring and the reasons for removal), as well as the data on the type of administered medications and solutions. Reporting of this research adheres to the STROBE guidelines. Phlebitis ranked first among complications with occurrence of 44%, followed by infiltration of 16.3%, while the incidence of occlusion and catheter dislodgement was 7.6% and 5.6%, respectively. In assessing the occurrence of phlebitis, multivariate analysis highlighted the presence of comorbidity, current infection, catheter size, time in situ and the number of administrations of infusion solutions associated with risk, whereas 20-gauge catheter, two or more attempts at cannulation and administration of a high-risk solutions during the first day have been singled out with regard to infiltration. As for the severity, the most common was medium stage of phlebitis, whereas grade 2 was most commonly observed for infiltration. The incidence of infiltration, occlusion and dislodgment is almost congruent with the average incidence of previous studies. However, the incidence and degree of severity associated with the occurrence of phlebitis were significantly higher. The results of the study draw attention to vulnerable groups of patients, cannula-specific and pharmacological risk factors for the development of peripheral intravenous cannula-induced complications.

Impact and Safety Associated with Accidental Dislodgement of Vascular Access Devices: A Survey of Professions, Settings, and Devices

BackgroundDislodgement rates with intravenous catheters are reported at 1.8%-24% events per year resulting in failed access, interrupted treatment, and greater resource consumption with catheter replacement. The purpose of this study was to quantitatively evaluate the perceptions of frequency, impact, contributing factors, and safety issues from accidental dislodgement affecting intravenous (IV) devices as reported by healthcare clinicians. MethodologyA cross-sectional descriptive survey was conducted via a voluntary online web-based survey of clinicians. Subjects were divided as those actively working in a clinical healthcare setting and those no longer active. Analysis of data was performed quantifying responses of clinicians on question of dislodgement. ResultsSurvey results indicate clinicians routinely observe a significant percentage of accidental dislodgement, with 68% of the 1561 respondents reporting often, daily, or multiple times daily occurrence and 96.5% identifying peripheral intravenous catheters as most common device experiencing accidental dislodgement. Respondents prioritized 10 contributing factors, with confused patient (80%), patient physically removes catheter (74%), and IV catheter tape or securement loose (65%) as the top 3 causes. Over 95% of respondents consider IV dislodgement a safety risk to patients. ConclusionsThis study reports perceptions and impact of accidental dislodgement with IV devices. Inconsistencies exist with use, application, and management of catheter securement and dressings for IV catheters. Risk of additional complications and complete device failure are increased when dislodgement occurs. Given possible complications, along with necessitating replacement of the IV device in many cases, IV catheter dislodgement was considered a safety risk to patients by nearly all respondents.

Does a catheter over needle system reduce infusate leak in continuous peripheral nerve blockade: a randomised controlled trial.

Continuous peripheral nerve blockade is a common technique in the analgesic management for many procedures. Leakage of local anaesthetic from around the nerve catheter insertion site can increase the chance of catheter dislodgement, risks infective complications, and could divert anaesthetic away from the nerve causing the block to fail. We conducted a randomised controlled trial to assess whether the type of nerve catheter influenced local anaesthetic leak rate. One hundred and ten patients scheduled for elective unilateral total knee arthroplasty were randomised to receive a perineural catheter with either a catheter over needle (CON) system (Pajunk® E-Cath) (PAJUNK® GmbH, Medizintechnologie, Geisingen, Germany), or catheter through needle (CTN) system (Pajunk® SonoLong) (PAJUNK® GmbH, Medizintechnologie, Geisingen, Germany). There was no statistically significant difference in the rate of leaking catheters between groups (CON 1.8% versus CTN 3.7%; <i>P</i>=0.618), however, the overall leak rate was much lower than anticipated from pilot data. The CON system was on average faster to insert (CON 357 seconds versus CTN 482 seconds; <i>P</i>=0.004), but associated with poorer needle visibility under ultrasound (Likert scale 1-5, mean [SD], CON 3.31 [0.96] versus CTN 3.89 [0.84]; <i>P</i>=0.001). All seven instances of inadvertent catheter dislodgement occurred in the CTN group (<i>P</i>=0.006). There was no statistically significant difference between groups in the proportion of patients who had adequate analgesia on day one (CON 80% versus CTN 86.5%; <i>P</i>=0.294) and day two postoperatively (CON 85.5% versus CTN 91.8%; <i>P</i>=0.369). Our findings show the overall leak rate to be very low with both catheter systems; however, the CON system may have advantages in terms of speed of use and rate of inadvertent catheter dislodgement.

Effect of 2% lidocaine continuous epidural infusion for thoracic or lumbar herpes-zoster-related pain.

Few treatments are effective to manage herpes-zoster (HZ)-related pain. This retrospective study focused on the efficacy of 2% lidocaine continuous epidural infusion on pain control and quality of life in patients with thoracic or lumbar HZ.A total of 256 patients with thoracic or lumbar HZ were reviewed for this study. Patients included in the study were divided into continuous epidural infusion (70 mL 2% lidocaine + 180 mL 0.9% normal saline) and medical therapy group (group1) and only medical therapy group (group2). European Organization for Research and Treatment of Cancer and Izbicki pain score were used to evaluate the pain control and quality of life before therapy, and 6 and 9 months after therapy.For 256 patients with HZ (thoracic HZ = 162, lumbar HZ = 94), 53.1% was women. Mean ± standard deviation age was 69.4 ± 9.5 ( range, 38–85) years. Significant differences between the 2 groups in terms of quality of life and pain control were detected after 6 and 9 months follow-up (P < .001). For patients with HZ at 1 to 3 months after rash onset, the pain score was significantly lower in group 1 (P < .001). Sixteen patients with postherpetic neuralgia (PHN) underwent continuous epidural infusion therapy. Only 4 patients achieved satisfactory pain relief. Seven patients required analgesic drugs, and 6 patients still were unable to work, 10/16 (62.5%) patients had readmission. In addition, the pain score was higher in patients with HZ with diabetes (P < .001). Epidural infection occurred in 6 patients (8.8%), catheter dislodgement in 4 patients (5.8%), and catheter leakage in 3 patients (4.4%). There was no spinal epidural abscesses occurred.2% lidocaine continuous epidural infusion therapy can lead to sustained pain relief and improve the quality of life in patients with for thoracic or lumbar HZ at 1 to 3 months after rash onset. Epidural lidocaine is avoided for the treatment PHN, and the level of glucose might be associated with zoster-related pain.

Optimizing the securement of epidural catheters: an in vitro trial.

IntroductionEpidural anesthesia is frequently used to provide postoperative analgesia following major surgical procedures. Secure fixation of the epidural catheter is necessary to prevent premature dislodgment and loss of epidural analgesia. Using an in vitro model, the current prospective study evaluates different types of dressings for securement of an epidural catheter by quantifying the force in Newtons (N) required for dislodgment using a digital force gage.MethodsFour methods of epidural catheter securement were used on a simulator mannequin: 1) Suresite® Window Clear Dressing, 2) Op-Site Post-Op® Visible Dressing, 3) Steri-Strips® and Suresite Window Clear Dressing, and 4) Steri-Strips and Op-Site Post-Op Visible Dressing. Each method of securement was assessed 10 times to calculate the mean force required to dislodge the catheter. Mean force of dislodgment for each method was compared using parametric tests.ResultsThe force (mean ± SD) required for catheter dislodgment for the four methods was 14.0±2.9, 2, 10.7±1.5, 8.6±2.3, and 9.6±2.2 N, respectively. The pairwise difference showed that the Suresite Window Clear Dressing was the best securement method when compared with other methods.ConclusionOur study demonstrates the advantage of the Suresite Window Clear Dressing in securing the epidural catheter. Future clinical trials are needed to validate these findings.

Pelvic abscess drainage: outcome with factors affecting the clinical success.

We aimed to evaluate the success and complication rates of image-guided pelvic abscess drainage with emphasis on factors affecting the clinical success. During a 7-year period, 185 pelvic abscesses were treated in 163 patients under ultrasonography and fluoroscopy (n=140) or computed tomography (n=45) guidance with transabdominal (n=107), transvaginal (n=39), transrectal (n=21) and transgluteal (n=18) approaches. Abscess characteristics (etiology, number, size, intrastructure, microbiological content, presence of fistula), patient demographics (age, sex, presence of malignancy, primary disease, antibiotic treatments), procedure-related factors (guidance method, access route, catheter size) and their effects on clinical success, complications, and duration of catheterization were statistically analyzed. Technical and clinical success rates were 100% and 93.9%, respectively. Procedure-related mortality or major complications were not observed. Minor complications such as catheter dislodgement, obstruction, or kinking were detected in 6.7% of the patients. Clinical failure was observed in 10 patients (6.1%). Fistulization was observed in 14 abscesses. Fistulization extended the duration of catheter use (P < 0.001) and decreased the clinical success rate (P < 0.001). The presence of postoperative malignant, complex-multilocular abscesses, and fungus infection in the cavity extended catheter duration (P < 0.001, P = 0.018, and P = 0.007, respectively), whereas the presence of sterile abscess and endocavitary catheterization reduced the catheter duration (P = 0.009 and P = 0.011, respectively). Image-guided pelvic abscess drainage has high clinical success and low complication rates. The only factor affecting the clinical success rate is the presence of fistula.

Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit.

Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit.

Abstract No. 512 Intraarterial computed tomography–enhancement mapping for response assessment of hepatocellular carcinoma to transarterial chemoembolization: a preliminary analysis

To evaluate the feasibility and accuracy of utilizing intra-arterial computed tomography (IACT)–based enhancement mapping (EM) in predicting response of hepatocellular carcinoma (HCC) to transarterial chemoembolization (TACE). This single-institution retrospective study included 16 patients (mean age, 66 years, range, 50-77). IACT protocol consisted of two sets of CT scans (non-contrast and intra-arterial contrast-enhanced acquisitions) performed before and after chemoembolic delivery on a hybrid Angio-CT System. After procedure completion, IACT data were processed offline with dedicated EM software (Hepacare, Siemens Healthineers, Germany) which utilizes high-resolution deformable registration and subtraction for residual arterial tumor enhancement assessment. Analysis was done on the full resolution data with an isotropic voxel size of 0.6 mm3. Areas of residual enhancement above the post-chemoembolization background noise level were considered as residual disease. Quantification of these areas within the treated HCC was used to assess individual tumor response according to mRECIST. Study objectives were technical feasibility and accuracy of EM in predicting HCC response by mRECIST on the first routine cross-sectional contrast-enhanced CT or MR imaging (FUI-1) after TACE. EM was successfully performed in 14 (87.5%) patients (2 patients: suboptimal contrast-enhanced IACT due to catheter dislodgment). Mean time from TACE to FUI-1 was 9.5 weeks. Among the 14 patients successfully analyzed with EM, 21 HCCs were treated with TACE (mean diameter, 2.5 cm [range 1-6.3]; mean number of HCCs per patient, 1.5 [range 1-3]). Tumor response prediction based on EM showed complete response in 19 (86%) and partial response in 3 (14%) of HCCs, respectively. Response assessment by FUI-1 fully agreed with EM response assessment for all 21 HCCs treated with TACE. Dedicated EM using the proposed IACT imaging protocol was feasible and highly accurate in predicting response after TACE. Further studies are warranted to validate and investigate the role of this method for intraprocedural immediate response assessment and subsequent decision making.