Catheter Failure Research Articles

Risk Factors for Midline Catheter Failure: A Secondary Analysis of an Existing Trial.

ObjectiveWhile midline catheters (MCs) are considered to be a reliable form of vascular access, up to 25% of the placements culminate in failure. We aimed to explore risk factors for MC failure.MethodsWe performed an analysis of existing randomized controlled trial data involving a comparison of two midline catheters. The study aimed to assess risk factors related to MC failure, including patient, procedure, catheter, and vein characteristics. Cox regression was used for univariable and multivariable analyses to evaluate the association between characteristics and MC failure.ResultsAmong 191 patients that were included in this secondary analysis, more patients were female (114/191 [59.7%]) and average age was 60.2 (SD = 16.7) years. Clinical indications for MC placement included antibiotics (60.7%), difficult venous access (32.5%), or both (6.8%). In a univariable Cox regression analysis, the increase in pulse rate (HR 1.02; 95% CI, 1.00–1.04; P=0.02), temperature ≥38°C (HR 5.59; 95% CI, 1.96–15.94; P=0.001), oxygen saturation <93% (HR 2.91; 95% CI, 1.03–8.24; P=0.04), norepinephrine in dextrose infusion (HR 2.41; 95% CI, 1.17–4.97; P=0.02) and cephalic vein insertion (HR, 2.47; 95% CI, 1.09–5.57; P=0.03) were all associated with higher risk of MC failure. In a multivariable Cox model, difficult venous access (aHR 2.05; 95% CI, 1.04–4.05; P=0.04) and norepinephrine in dextrose (aHR 2.29; 95% CI, 1.09–4.82; P=0.03) was associated with catheter failure.ConclusionElevated pulse rate, decreased oxygen saturation level, temperature ≥38°C, and norepinephrine use were each associated with an increased risk of MC failure. These factors should be considered when selecting the most appropriate vascular access device for individual patients. Additionally, the cephalic vein insertion has the highest risk for MC failure and other access points could be preferentially considered.

A Polymer Prodrug Strategy to Switch from Intravenous to Subcutaneous Cancer Therapy for Irritant/Vesicant Drugs.

Chemotherapy is almost exclusively administered via the intravenous (IV) route, which has serious limitations (e.g., patient discomfort, long hospital stays, need for trained staff, high cost, catheter failures, infections). Therefore, the development of effective and less costly chemotherapy that is more comfortable for the patient would revolutionize cancer therapy. While subcutaneous (SC) administration has the potential to meet these criteria, it is extremely restrictive as it cannot be applied to most anticancer drugs, such as irritant or vesicant ones, for local toxicity reasons. Herein, we report a facile, general, and scalable approach for the SC administration of anticancer drugs through the design of well-defined hydrophilic polymer prodrugs. This was applied to the anticancer drug paclitaxel (Ptx) as a worst-case scenario due to its high hydrophobicity and vesicant properties (two factors promoting necrosis at the injection site). After a preliminary screening of well-established polymers used in nanomedicine, polyacrylamide (PAAm) was chosen as a hydrophilic polymer owing to its greater physicochemical, pharmacokinetic, and tumor accumulation properties. A small library of Ptx-based polymer prodrugs was designed by adjusting the nature of the linker (ester, diglycolate, and carbonate) and then evaluated in terms of rheological/viscosity properties in aqueous solutions, drug release kinetics in PBS and in murine plasma, cytotoxicity on two different cancer cell lines, acute local and systemic toxicity, pharmacokinetics and biodistribution, and finally their anticancer efficacy. We demonstrated that Ptx-PAAm polymer prodrugs could be safely injected subcutaneously without inducing local toxicity while outperforming Taxol, the commercial formulation of Ptx, thus opening the door to the safe transposition from IV to SC chemotherapy.

Surgical instruments and catheter damage during ventriculoperitoneal shunt assembly.

Current surgical techniques use common surgical instruments for sterile shunt assembly. This study investigated the impact of using these techniques and surgical instruments on the mechanical integrity of the ventriculoperitoneal shunt system, specifically shunt catheters. The authors conducted failure testing on 85 rifampin-coated catheters and 85 barium-impregnated catheters using 5 different surgical instruments and 2 different surgical techniques. In technique A, the distal end of the catheter was pushed onto the shunt valve inlet connector with the surgical instrument. In technique B, the catheter was pulled over the inlet connector. One hundred sixty catheters underwent 10-repetition-maximum testing, in which the catheter either failed before completion of 10 consecutive assembly/disassembly repetitions or the catheter completed 10 consecutive repetitions. The authors also conducted 100-repetition-maximum tests on 5 barium-impregnated and 5 rifampin-coated catheters using technique A. Catheter failure rates were significantly different among the different instruments used in assembly (p ≤ 0.001). Post hoc analysis showed that using mosquito forceps with shods resulted in a significantly lower catheter failure rate than the other instruments (p < 0.0005). The catheter failure rate of technique A was significantly lower than that of technique B (5% vs 81%, p < 0.001). There was no statistical difference between the failure rates of the barium and rifampin catheters (42% vs 44%, p = 0.9), but the barium catheters outperformed the rifampin catheters in the 100-repetition-maximum trials (p = 0.02). Instrument type (p = 0.0232) and catheter type (p = 0.0096) were both significant factors in determining the number of assembly/disassembly repetitions needed to cause catheter failure. It took an average of 2.79 repetitions of assembly/disassembly to cause catheter failure. DeBakey forceps had significantly lower mean repetitions to failure (mean 1.38) than the Gerald forceps without teeth (mean 2.73, p = 0.05) and bayonet (mean 3.25, p = 0.02). This study was the first of its kind to analyze how physical manipulation affects the mechanical integrity of ventriculoperitoneal shunt components. The authors demonstrated a significantly lower shunt catheter failure rate when mosquito forceps with shods and technique A were used in assembly. Moreover, the authors established that use of DeBakey forceps resulted in failure with fewer assembly/disassembly repetitions than use of the Gerald and bayonet forceps, suggesting that DeBakey forceps are the most damaging instrument.

PARTIAL ANOMALOUS PULMONARY VENOUS CONNECTION DIAGNOSED AFTER CENTRAL VENOUS CATHETER PLACEMENT

PARTIAL ANOMALOUS PULMONARY VENOUS CONNECTION DIAGNOSED AFTER CENTRAL VENOUS CATHETER PLACEMENT

Dural Puncture Epidural for labour analgesia in Indian parturients may need dose alteration for maximal benefits!

Dear Editor, Dural puncture epidural (DPE) is a relatively new technique for labour analgesia (LA) performed by creating an intentional dural hole using a spinal needle, followed by insertion of an epidural catheter in the epidural space through which local anaesthetics with or without adjuvants are injected.[1] The dural hole acts as a passage for medications to slowly pass from epidural space into subarachnoid space, which provides improved block quality with fewer maternal and foetal side effects.[2,3] Previously, a bolus of 20 ml of 0.125% bupivacaine was found effective in DPE for LA. At our institute, a randomised controlled trial of DPE in LA comparing 0.125% of ropivacaine and 0.125% levobupivacaine was undertaken by the present authors. In the original protocol, DPE was performed in L2-L3 or L3-L4 interspace with a 16-G Tuohy epidural needle and 26-G Whitacre spinal needle with an initial bolus of epidural 20 ml of 0.125% ropivacaine with 2 μg/ml fentanyl or 20 ml of 0.125% levobupivacaine with 2 μg/ml fentanyl. The drug was fractionated into four 5 ml boluses injected over 5 minutes as previously described.[1] In seven of first ten patients, complications of hypotension, motor blockade, and foetal heart rate variability developed [Table 1]. This prompted us to look for possible overlooked causes. On minute analysis, the height of the parturient was found more than that of the present group.[1] The protocol was modified to a maximal drug injection of 20 ml with the end point specified as a decrease in numerical rating scale (NRS) labour pain to 50% of baseline. Thus, about 4 ml of the drug was injected every 2 minutes till the end point was reached. With the modified protocol, considerably less volume of DPE drug was required (about 12 ml) in the next 20 parturients with no further reported morbidity [Table 2].Table 1: Data of first ten patients of DPE with 20 ml of 0.125% ropivacaine or 20 ml of 0.125% levobupivacaineTable 2: Data of ten patients of DPE with 20 ml of 0.125% ropivacaine or 20 ml of 0.125% levobupivacaine with the modified protocol: Graded epidural of 0.125% local anaesthetics, with a maximum limit of 20 mlEpidural injection for LA is associated with slow onset, inadequate sacral spread, and epidural catheter failure, whereas a combined spinal epidural technique gives rapid onset of blockade but is associated with maternal pruritus, maternal hypotension, and foetal bradycardia.[1] To retain the advantages of both and decrease the disadvantages, DPE for LA has been studied with the most effective results seen with a bolus of 20 ml of 0.125% bupivacaine.[2-4] In all previous studies, the height or body mass index (BMI) was more than that of the present study group[2-4] [Table 3]. After reported morbidity, the present protocol was modified to slower injections of the drug with a ceiling to the injected volume targeted to till 50% reduction in labour NRS rather than a fixed volume as previously reported. This significantly decreased the morbidity.Table 3: Studies comparing DPE to Epidural for LATo conclude, DPE with 0.125% of a local anaesthetic agent for LA in Indian parturients should be given in a graded manner till labour pain NRS reduces by 50% of baseline rather than a bolus of 20 ml. The proposal of a graded local anaesthetic for DPE for LA has never been reported previously. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Risk factors of carbapenem-resistant gram-negative bacteria pneumonia and mortality.

This experiment aimed to study the risk factors of carbapenem-resistant Gram-negative bacteria pneumonia and death. For this aim, a total of 181 patients with Gram-negative bacterial pneumonia treated from March 2020 to March 2022 were retrospectively selected and divided into the drug-resistance group (n = 96) and the non-drug resistance group (n = 85) according to the carbapenem resistance. According to the prognosis, the drug resistance group was divided into the survival group (n = 82) and the non-survival group (n = 14), respectively. The risk factors of single and multi-factor carbapenem-resistant Gram-negative bacteria pneumonia and death were studied. Results showed that univariate analysis showed that the rates of recent surgery, respiratory failure, shock, indwelling catheterization and disturbance of consciousness were significantly higher in the drug-resistant group than in the non-drug-resistant group. The univariate analysis also showed that the rates of coronary heart disease, diabetes, shock, renal insufficiency, deep venous catheterization and respiratory failure were significantly higher in the non-survival group than in the survival group. Multivariate analysis showed an increased risk of carbapenem-resistant gram-negative pneumonia in patients who had used carbapenem-resistant antibiotics, hypertension, coronary heart disease, and malignancy in the previous 90 days. Patients with carbapenem-resistant gram-negative pneumonia who had coronary heart disease, diabetes mellitus, shock, renal insufficiency, deep venous catheterization, and respiratory failure were at increased risk of death. In conclusion, recent surgery, respiratory failure, shock, indwelling catheterization, and disturbance of consciousness are risk factors for carbapenem-resistant Gram-negative bacteria pneumonia. Coronary heart disease, diabetes mellitus, shock, renal insufficiency, deep venous catheterization and respiratory failure are risk factors for death from carbapenem-resistant gram-negative bacteria pneumonia.

Predictors of ultrasound-guided peripheral intravenous catheter failure: A secondary analysis of existing trial data.

Ultrasound-guided (US) peripheral intravenous catheters (PIVC) have a high failure rate with many failing prior to completion of therapy. Risk factors associated with catheter failure are poorly delineated. This study aimed to assess risk factors related to catheter failure including patient, procedure, catheter, and vein characteristics to further elucidate which variables may impact catheter longevity. This was a secondary analysis using an existing trial dataset that primarily compared survival of two catheters: a standard long (SL) and an ultra-long (UL) US PIVC. Adult emergency room patients with difficult intravenous access at a tertiary care suburban academic center were study participants. Kaplan-Meier was employed to estimate the median catheter survival time. Cox regression univariable and multivariable analyses were used to evaluate the primary outcome of catheter survival. Among 257 subjects, 63% of PIVCs survived until completion of therapy. In a multivariable Cox regression model, length of catheter in vein >2.75 cm (adjusted hazard ratio [aHR] 0.58, 95% confidence interval [CI] 0.37-0.90, p = 0.01) was associated with improved survival. First stick success decreased the risk of catheter failure (aHR 0.68, 95% CI 0.44-1.06, p = 0.09) but was not statistically significant. Factors associated with the increased risk of catheter failure included: depth of vein >1.2 cm (aHR 1.68, 95% CI 1.06-2.66, p = 0.03) and PIVC placement in right extremity (aHR 1.64, 95% CI 1.07-2.51, p = 0.02). This study demonstrated that catheter length in vein (>2.75 cm) was associated with improved US PIVC survival highlighting the value of longer catheters in US PIVC survival. Choosing targets in the non-dominant extremity with shallower depths (⩽1.2 cm) may also increase catheter survival.

Adverse Events and Modes of Failure of Thermocool and Arctic Ablation Catheter: Insights from the FDA MAUDE Database

Adverse Events and Modes of Failure of Thermocool and Arctic Ablation Catheter: Insights from the FDA MAUDE Database

A Retrospective Assessment of Midline Catheter Failures Focusing on Catheter Composition.

Vascular access specialists are responsible for assessing the patient in their unique situation and determining the correct vascular access device to complete the therapeutic goal without complication or failure. This retrospective cohort study compared the failure rates of a variety of polyurethane (PU) midline catheters and a midline catheter constructed of an emerging hydrophilic biomaterial (HBM). A total of 205 patients received a midline catheter and were situationally randomized by the facility where they received it. Patients who had received a midline catheter between March 2021 and May 2021 were assessed for catheter-related failures leading to increased staff time, delays in treatment, or replacement with a new vascular access device to complete the therapy. There were 101 patients in the PU cohort and 104 patients in the HBM cohort. Comparing overall failure rates between the groups revealed a 23.8% failure rate in the PU control group and only a 3.8% failure rate in the HBM group. This suggests that a midline catheter constructed of HBM biomaterial is associated with significantly lower rates of failure, thereby improving patient experience and health care economics.

A pilot randomized controlled trial of securement bundles to reduce peripheral intravenous catheter failure

BackgroundPeripheral intravenous catheters (PIVCs) are ubiquitous in acute care settings however failure rates are unacceptably high, with around half failing before prescribed treatment is complete. The most effective dressing and securement option to prolong PIVC longevity is unclear. ObjectivesTo determine feasibility of conducting a definitive randomized controlled trial (RCT) investigating evidence-based securement bundles (medical adhesive tapes and supplementary securement products) to reduce PIVC failure. MethodsIn this pilot non-masked 3-group RCT, adults requiring a PIVC for >24 hrs were randomized to Standard care (bordered polyurethane dressing plus non-sterile tape over extension tubing), Securement Bundle 1 (two sterile tape strips over PIVC hub plus Standard care) or Securement Bundle 2 (Bundle 1 plus tubular bandage) with allocation concealed until study entry. Exclusions: laboratory-confirmed positive blood culture, current/high-risk of skin tear, or study product allergy. Primary outcome: feasibility (eligibility, recruitment, retention, protocol fidelity, participant/staff satisfaction). Secondary outcomes: PIVC failure, PIVC dwell time, adverse skin events, PIVC colonization and cost. ResultsOf 109 randomized participants, 104 were included in final analyses. Feasibility outcomes were met, except eligibility criterion (79%). Absolute PIVC failure was 38.2% (13/34) for Bundle 2, 25% (9/36) for Bundle 1 and 23.5% (8/34) for Standard care. Incidence rate ratio for PIVC failure/1000 catheter days, compared to Standard care, was 1.1 (95% confidence interval [CI] 0.4–2.7) and 2.1 (95% CI 0.9–5.1) for Bundles 1 and 2, respectively. ConclusionsA large RCT testing securement bundles is feasible, with adjustment to screening processes. Innovative dressing and securement solutions are needed to reduce unacceptable PIVC failure rates.Trial registration ACTRN12619000026123.

Epidural catheter replacement rates with dural puncture epidural labor analgesia compared with epidural analgesia without dural puncture: a retrospective cohort study

BackgroundLumbar epidural analgesia (LEA) is commonly used for labor analgesia but up to 13% of epidural catheters fail and require replacement. Combined spinal-epidural analgesia is associated with a lower catheter failure rate. Few data exist regarding catheter replacement rates after dural-puncture epidural (DPE). We conducted a retrospective analysis comparing catheter failure rates between epidural and DPE techniques. MethodsThis retrospective single-center trial reviewed all labor neuraxial analgesia procedures among 18 726 women across five years, and identified 810 DPE and 2667 LEA procedures. Catheter failure rates, consisting of replacement or requirement of general anesthesia for cesarean delivery, were compared. Propensity score matching was used to balance the groups. ResultsDural-puncture epidural was associated with significantly fewer catheter failures compared with LEA (74/759 vs. 49/759, odds ratio 0.64, 95% CI 0.44 to 0.93, P=0.02). Sensitivity analysis excluding cases of general anesthesia confirmed this relationship. Risk factors identified for catheter failure included age, body mass index, and nulliparity. Dural-puncture epidural was associated with a longer mean time to catheter replacement (918 min vs. 609 min, P=0.04). Kaplan-Meier and Cox multivariate analyses confirmed this relationship. There was no significant difference in the requirement for epidural analgesia supplementation, but DPE required supplementation significantly later than LEA. There was no difference in the rate of headache or epidural blood patch between groups. ConclusionsDural-puncture epidural is associated with fewer catheter failures and replacements than LEA, without an increase in the rate of post-dural puncture headache or epidural blood patch.

Analysis of the causes of failed placement of nasoenteric tube under DSA guidance and treatment strategies for successful re-catheterization.

For patients with advanced cancer or patients who have undergone digestive tract reconstruction, enteral nutrition is the most important nutritional support therapy, which can reduce the risk of enteral infection and improve self-immunity; while digital subtraction angiography (DSA) guided nasoenteric tube placement is suitable for nutritional support and palliative treatment of most patients with advanced cancer, many doctors because the preoperative preparation is not sufficient or the intraoperative operation is not standardized, resulting in catheter failure can not achieve the purpose of nutritional supply, and we need to summarize the lessons of failure and optimize the catheterization strategy. From February 2015 to July 2020, A total of 3,810 cases were treated with DSA guided nasoenteric feeding tube placement. According to the requirements that enteral nutrition could not be performed by the initial catheterization, 94 cases of catheterization failure were selected as the study subjects. The causes of catheterization failure were analyzed and summarized by analyzing the intraoperative image data and operation process; 42 cases of catheterization failure experienced successful catheterization after re-catheterization. By studying the relevant preoperative preparation and intraoperative operation, the treatment strategies and operation methods for successful re-catheterization were summarized. In 94 patients with primary catheterization failure, anastomotic stenosis or obstruction accounted for 20.2%, excessive dilatation of gastric lumen accounted for 17.0%, pyloric stenosis or obstruction of antrum accounted for 13.8%, efferent loop stenosis or obstruction accounted for 11.7%, and the above factors were the main causes of DSA guided feeding tube failure; of the 42 patients with successful recatheterization, 9 patients underwent adequate negative pressure drainage before surgery, 7 patients modified the projection angle by adjusting the C-arm, 5 patients applied cone-beam CT technique, 5 patients used balloon dilatation of the stenotic segment, and the above factors were the main strategy methods for successful recatheterization. The success rate of DSA guided nasoenteric feeding tube placement will be greatly improved by adequate gastrointestinal decompression and drainage and other related preoperative preparation as well as good intraoperative application of cone-beam CT technique or combined application of balloon, gastroscope, stent and other technical means.

Short- and long-term outcomes of early initiation of peritoneal dialysis following catheter insertion.

Early-start peritoneal dialysis (PD) (use of PD catheter within 48 hours of insertion) is an innovative approach for prompt initiation of PD. This study was conducted to analyze the outcomes of early-start PD. A total of 100 patients on PD were retrospectively analyzed. Patients were grouped according to the "break-in period": < 48 hours (PD1) and ≥ 14 days (PD2). PD was initiated with low dwell volumes (500 mL) in a recumbent position within 48 hours of surgery. PD prescription was gradually incremented over 10 days to minimize any complications. In our study, there were 48 patients in the PD1 group and 52 in the PD2 group. The most common cause of end-stage kidney disease (ESKD) was diabetes mellitus in both groups. Incidence of early mechanical complications (within 30 days of catheter insertion), such as catheter obstruction, early catheter leakage, catheter malposition, tip migration, and infectious complications, were not found to be higher in the PD1 group. 1- and 4-year catheter patency rates were 97.0% and 96.2% in the PD1 group, respectively. These rates were comparable with those in the PD2 group. Early-start PD was not associated with an increased incidence of catheter failure (HR = 1.0, 95% CI 0.28 - 3.47). An early break-in period of < 48 hours is a feasible option for ESKD patients without any significantly increased risk of mechanical or infectious complications. It offers a safe and efficacious option for renal replacement therapy.

Definition of catheter jamming: A mechanical analysis of catheter fracture tension and fracture strain.

BACKGROUND: Catheter jamming is an emerging and possibly underrated complication.OBJECTIVE: To find the criteria for determining if the catheter cannot be removed through the mechanical analysis of fracture tension and fracture strain (f) of Peripheral Inserted Central Catheters (PICC).METHOD: We removed 30 pieces of PICC catheters from patients and recorded the indwelling time. Those with an indwelling time shorter than 12 weeks belonged to the short-term group. Those with an indwelling time longer than 12 weeks belonged to the long-term group. The first half of the same catheter is section A, and the second half is section B. The fraction tension and fracture strain of the catheter were measured, and statistical analysis was conducted.RESULTS: The fracture tension of catheter in sections A and B were 5.8917 1.0095 and 6.0670 0.8066 Newtons respectively ( 0.393) and the fracture strain of catheter in sections A and B were 6.0611 1.0810 and 6.2543 0.7187 Newtons respectively ( 0.343). The fracture tension of catheter in short-term and long-term group were 6.0696 0.9414 and 5.9192 0.8972 Newtons respectively ( 0.535) and the fracture strain of catheter in short-term and long-term group were 6.0067 0.7227 and 6.2584 1.0212 respectively ( 0.301).CONCLUSION: It is objective and consistent to take the catheter fracture tension as the standard. This standard would be able to accurately define the concept of catheter failure and reduce the risk of catheter fracture and the misdiagnosis of catheter failure. The catheter fracture tension and fracture strain was not affected by the catheter indwelling time. It is recommended to set the tensile force as 5 Newtons and carry it out at a speed of 100 mm/min for the catheter drawing of the PICC single-lumen silicone catheter (4.0F) from Budd Company.

Keeping Patients Safer: Reviewing Predictors of Success and Failure of Short Peripheral Intravenous Catheters.

In 2014, a large urban community hospital adopted protected clinical indication practices as a quality improvement project. It then undertook a research study to examine bedside practices with short peripheral catheters, which included direct observation at the bedside once weekly for 6 months. A total of 4305 catheters were observed and remained in place for a total of 23 423 days. Fifty six percent of devices remained in place beyond 96 hours. The overall rate of peripheral bloodstream infection in patients enrolled in the study was 0.12/1000 peripheral intravenous days. Significant differences were noted based on which department placed the catheter, as well as which department cared for the patient during hospitalization. Patients admitted to step-down critical care units had the highest completion of therapy rates; however, those being cared for in medical/surgical units had the best outcomes. Devices placed in the emergency department had a higher successful dwell rate than those placed in critical care units. Twenty-gauge catheters were found to have the highest successful dwell rate, as well as insertion sites that were observed to be within normal limits during the weekly observation. Dressings that were noted to be clean, dry, and intact had a stronger association with completion of therapy than those that were not fully intact. Emphasis was placed on ensuring consistent practices with insertion, care, and maintenance, which contributed to more consistent outcomes between settings that insert, care for, and maintain devices. Nonmodifiable risk factors may remain.

Safety verification of a new peripheral intravenous catheter placed in the upper arm vein for administration of drugs with high irritant potential.

Despite the widespread use of peripheral intravenous catheters, unscheduled catheter failure before completion of treatment occurs frequently. If a large vein is selected, catheter failures may be prevented despite administering a highly irritant drug. In this study, we attempted to use a catheter that can be placed in a large upper arm vein. The new catheter was 88 mm long but had no guidewire to reduce contamination risk. This study aimed to evaluate the safety of the first-in-human trial for the new catheter with the administration of highly irritant drugs. This study was conducted at a university hospital in Tokyo, Japan. Eight Japanese adults were hospitalized adults with planned administration of non-cancer drugs with high irritant potential using a peripheral catheter. A trained nurse catheterized with the new catheter in the upper arm using ultrasonography. The catheterization site was monitored by staff and a research nurse once every 24 hours for up to 7 days. No adverse events or catheter failure occurred and the catheter placement success rate was 100%. In two patients, a temporary occlusion alarm of the infusion pump occurred, possibly due to the flexion of the catheter base. The new peripheral intravenous catheter did not interrupt medical treatments as is common after placement, but safety administered the irritant drugs. However, because this catheter may be easily affected by the contraction of the muscle at the fixation position, the position and method of catheter fixation in the upper arm need to be carefully considered.

Management of Chyluria by Laparoscopic Ligation of Renal Lymphatic Vessels

A 74-year-old male was admitted due to chyluria for 60 years without scrotal or lower extremity edema. He had received an open cystotomy and clot aspiration one week before admission for acute urine retention and failure of catheterization at another hospital. He was probably infected by filariasis because filariasis had been reported as an epidemic disease in his growing town located in the southwest of China approximately 50 years ago. The patient was underweight and diagnosed with hypoproteinemia.

Diagnostic and Therapeutic Value of ERCP in Acute Severe Cholangitis: Experience of a Moroccan Endoscopic Center

Severe cholangitis is an urgent indication for endoscopic treatment, represented by endoscopic retrograde pancreatography (ERCP) and endoscopic sphincterotomy. It ensures good bile drainage, and improves patient morbidity and mortality. Materials and methods: This is a retrospective study carried out within our department between January 2010 and April 2018. All patients with severe cholangitis who benefited from therapeutic ERCP were enrolled. We analyzed the epidemiological data of the patients, the results of the ERCP, as well as the post-sphincterotomy mortality. We also performed multivariate analysis for predictive factors for mortality. Results: 88 patients were enrolled. The average age of the patients was 60.14 years [17-102 years], with a female predominance (n = 45, 51.1%). Twelve patients (13.6%) underwent a cholecystectomy. Almost 68, 18% patients (n = 60) had obstructive choledocholithiasis, fifteen patients (17,04%) had o cyst hydatic and 13 patients (14,77%) had tumor obstruction. Successful catheterization of the main bile duct was reported in 60 patients (68.18%), and failure in 28 cases (31.81%). The use of precut was performed in 28 cases (31.81%), which enabled successful access to main bile duct in 24 patients (85.71%). Failure of catheterization after a precut concerned 4 patients (14.28%): 3 patients (75%) benefited from a resumption of ERCP with success, and only one patient (25%) was proposed for surgery. fifty-five patients (91,66%) underwent stone evacuation (Figure 1). For 5 patients (8, 33%), failure of stone extraction was followed by successful surgery. Twenty-one patients benefited from successful implementation of a biliary prosthesis were objectified in 21 patients (25%). 5 patients (23.80%) failed. Among them, percutaneous drainage was done 4 patients (80%) and 1 patient (20%) was operated. The main post-ERCP complications were represented by: 5 cases (5.7%) of papillary bleeding, and 1 case of acute pancreatitis. The overall death rate was 11,36% (n=10). The course was marked by clinical and biological remission in the other patients with successful endoscopic drainage. The main predictors of mortality in multivariate analysis were impaired of consciousness upon admission (p = 0.023, OR=4, 5678 [2,678‑10, 7890]), and the presence of renal failure (p = 0.001, OR=6, 4809 [2,089‑15,781]). Conclusion: Endoscopic treatment is the gold standard for the treatment of severe cholangitis. Its results are satisfactory, with a lower mortality compared to surgical treatment with fewer hospitalizations.

Impact of Different Flushing Frequencies on Peripheral Intravenous Catheter Failure, Coagulation, and Tissue Injury—A Counterbalanced Preclinical Human Trial

Highlights Abstract Background: Peripheral intravenous venous catheters (PIVCs) are associated with a postinsertion failure incidence of 40%, yet the common maintenance and preventive strategy of saline flushing is poorly understood at a physiological level. Methods: We developed a human model of bilateral cephalic vein cannulation to study the impact of varied PIVC flushing frequency (high frequency, HF; low frequency, LF) over 5 hours on catheter failure (primary outcome), coagulation, platelet aggregation, and local tissue injury. Ultrasound was used in a subset to assess vascular diameter/catheter to vein, blood flow velocity, and thrombus formation. Results: Out of 34 catheters in 17 adult participants, 1/17 (6%) LF catheters failed, which was not significantly different from HF catheters (0/17). Platelet function, activated partial thromboplastin time, and tissue factor were also not different (P &amp;gt; 0.05). However, prothrombin time (PT) increased with HF versus LF after 5 hours (P &amp;lt; 0.05). Ultrasound demonstrated luminal thromboses in veins experiencing both HF (6/7) versus LF (5/7) conditions after 5 hours with nonsignificant changes in vascular diameter and blood flow velocity over time. Conclusions: Although no difference in PIVC failure was observed between HF and LF flushing conditions over 5 hours, greater flushing frequency increased PT time, suggesting delayed activation or consumption of extrinsic coagulation factors. This study also demonstrated feasibility in assessment of luminal thromboses, which were remarkably prevalent after PIVC placement, and changes in vascular diameter and blood flow. This manuscript illustrates that the development of a sensitive human model will be of great use for exploring the impact of interventions on reducing PIVC failure in the future.

Investigative study of hemodilution ratio: 4Vs for vein diameter, valve, velocity, and volumetric blood flow as factors for optimal forearm vein selection for intravenous infusion.

Multimodal research and guidelines recognize veins in the forearm used for peripheral intravenous catheter (PIVC) insertion can optimize dwell time. Yet, many PIVCs are still placed in areas of flexion or suboptimal locations such as the back of the hand causing premature failure of >50%. This study identified characteristics of the forearm cephalic vein that make the anatomical location highly successful for PIVC insertion. The goal was to increase the understanding of the human vasculature in association with fluid mechanics in veins above the wrist and below the antecubital fossa. A prospective in-vivo study with 10 consented healthy human volunteers (HHVs) was performed with Color Pulse Wave Doppler Ultrasound that captured high-resolution video and images of vein diameter, velocity of blood flow, and location of venous valves in the forearm. Forearm vein diameter was not directly correlated with higher or lower Velocity of Blood Flow (0.58 cm = 3.0 cm/s). However, Volumetric Blood Flow rates tended to be lower (2.51-8.28 mL/min) with Vein Diameters smaller than 0.29 cm. Ultrasound assessments and Volumetric Blood Flow calculations confirmed natural turbulence in blood and retrograde blood reflux correlated with venous valves opening and closing. Areas of turbulence, with pulse flushing, created backflow with retrograde blood flow around and into the catheter. Placement of long PIVCs in the cephalic veins of the upper forearm yield adequate flow and hemodilution capacity for veins with at least a 3 to 1 hemodilution ratio. The data from this study, along with previous research, suggest that PIVC placement in the cephalic vein, based on selection criteria, may help to reduce or eliminate intravenous complications such as chemical or mechanical thrombophlebitis causing premature catheter failure. Application of these investigational principles may result in better outcomes and catheter longevity for patients who require intravenous infusions.