Image-guided intracavitary/interstitial brachytherapy is standard for locally advanced cervical cancer (LACC), yet the lack of pre-implantation planning often leads to suboptimal catheter placement and dose distribution. A template-guided, multi-criteria optimization (MCO)-based pre-implantation planning system was thus proposed, which integrates dosimetric, radiobiological, and geometric objectives.&#xD;Materials and methods: The developed system employs an improved wish-list optimization strategy featuring a tighten-relax mechanism with hybrid constraints to enhance robustness and resolve conflicts from impractical wish-lists. It incorporates dose-volume indices, the generalized equivalent uniform dose (gEUD), and a novel total conformity index (TCI), while supporting oblique catheter insertions for improved dose conformation. Dosimetric performance was benchmarked against clinical approved plans in 40 LACC cases, focusing on target coverage, conformity, and organ-at-risk sparing.&#xD;Results: Compared to the catheter configurations in clinically approved plans, the proposed method resulted in catheter displacement exceeding 5 mm in 11 out of 40 LACC cases and catheter angular deviation greater than 10 degrees in 7 cases. Correspondingly, the proportion of new plans meeting the D90 >100% criterion was 100% with template guidance versus 92.5% without, both significantly higher than the 82.5% achieved by original clinical plans. The method also increased V90 and V100 by 3.4% and 4.9% (both p<0.001), improved dose conformity from 0.59 to 0.61 (p<0.001), while maintaining OAR D2cc within clinical limits.&#xD;Conclusion: The proposed pre-implantation planning method reduces reliance on operator experience and offers a robust, automated solution for high-conformity brachytherapy.

The Effect of Obesity on Outcomes of Percutaneous Peritoneal Dialysis Catheter Insertion by Interventional Radiologists.

Evaluating Performance With the Use of a Novel All-in-One Acute Central Venous Catheter Insertion System.

Outcomes and Risk Factors Following Tunneled Peritoneal Dialysis Catheter Insertion by Interventional Radiologists.

Experiences of patients with peripheral intravenous catheter insertion and care in an Australian emergency department: A CFIR-guided qualitative study.

Venous air embolism is a rare complication of central venous catheter insertion that can have devastating consequences. Delayed air entrainment may occur in the presence of fibrin sheath formation via reinforcement of a vein-to-dermis fistula, which can lead to air embolism several hours after line removal.

Neurally-adjusted ventilatory assist (NAVA) is a mode of ventilation that uses the electrical activity of the diaphragm (EAdi) to synchronize and to control delivered pressure. EAdi is measured with a naso-/orogastric feeding tube, containing an array of sensors. Proper placement of the EAdi catheter is critical for optimal synchronization and support. Positioning the catheter requires (1) predicting the insertion distance and (2) verification using a dedicated positioning window on the ventilator, based on electrocardiogram (ECG) and EAdi signals. In preterm infants, no study has shown that the ventilator method results in proper positioning of the feeding tube tip in the stomach. We aimed to evaluate the position of the EAdi sensors (by the catheter positioning window) with the feeding tube tip position (measured by radiographs). This was a multi-center (5 sites), prospective study. Eligibility: infants with weight 400-2,000 g and either had or were planning to have an EAdi catheter placed. Screenshots of the positioning window and radiographs were taken. Sixty-seven infants were included. Median study weight was 1,250 g (interquartile range 1,026-1,448 g). The ventilator's positioning window revealed that all insertions were suitable with respect to the diaphragm/sensors position. Radiographs indicated 92% of insertions had the tip of the catheter appropriately in the body of the stomach. In 5 infants, the catheter tip was either touching the greater curvature of the stomach or near the pylorus. In our cohort, EAdi catheter insertion using guidance from the ECG/EAdi signals of the electrode array provideda safe method for tube positioning, with regard to both enteral feeding and obtaining appropriate EAdi signals for optimal ventilator support.

Determination of optimal catheter insertion depth in totally implantable venous access ports via three-dimensional reconstruction of cervicothoracic veins: a cross-sectional retrospective analysis.

Peripherally inserted central catheter (PICC) placement is an essential routine procedure in neonatal intensive care units and an important life-support technology. In recent years, point-of-care ultrasound-guided catheter insertion and ultrasound localization of catheter tips have been widely applied in neonatal practice and demonstrate clear advantages over traditional methods. This guideline was developed on the basis of currently available evidence and the practical experience of domestic experts, and it is tailored to the Chinese context. It provides clinical practice recommendations for ultrasound-monitored vascular selection, ultrasound-guided PICC cannulation, and ultrasound localization of the PICC tip. In total, 22 recommendations addressing 10 key clinical questions are presented, covering pre-insertion vascular selection, intra-procedural ultrasound-guided localization, post-insertion dynamic monitoring, and troubleshooting of difficult scenarios. The aim is to promote standardized application of this technology in neonatal intensive care units in China, reduce complications, and improve safety.

In patients with pleural fluid, thoracocentesis is indicated for diagnostic and/or therapeutic reasons. Pleural fluid analysis allows for the identification of infected effusions whereby fluid drainage improves patient outcome. Pleural fluid analysis is also indicated in the setting of suspected malignancy and unilateral effusions of unclear etiology. Drainage of large fluid collections reduces dyspnea. Use of ultrasound is mandatory when selecting the site of thoracocentesis. Real-time ultrasound confirms catheter placement in the pleural space and allows for its positioning in the posterocaudal recess. An 8F catheter is sufficiently large for drainage in most settings. The rate of complications from catheter insertion is very low, and coagulopathy is rarely a contraindication.

Intravascular catheters are essential in health care but remain a major source of health care-associated infections. Optimal skin antisepsis before insertion is key, yet the most effective antiseptic agent, concentration, and formulation remain uncertain. To determine the concentration and formulation of chlorhexidine gluconate (CHG) or povidone-iodine (PVI) associated with the lowest incidence of catheter-related infections (CRIs). PubMed, EMBASE, Cochrane Central, Scopus, Web of Science, and CINAHL were searched through January 7, 2025, without restrictions. Trial registries and reference lists of relevant studies and guidelines were reviewed. Randomized clinical trials (RCTs) comparing CHG- or PVI-based skin antisepsis before insertion of intravascular catheters were eligible if they reported at least 1 CRI outcome (catheter-related bloodstream infection [CRBSI], catheter tip colonization, or local infection). Two independent reviewers screened titles, abstracts, and full texts. Data were extracted independently by 2 reviewers following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed with the Cochrane risk of bias 2 tool. A random-effects network meta-analysis (NMA) was performed to estimate relative risks (RRs) with 95% CIs. The primary outcomes were incidence of CRBSIs, catheter tip colonization, and local infections associated with CHG or PVI formulations. Sixteen RCTs (7803 patients; 11 985 catheters) met inclusion criteria. When compared with aqueous formulations, alcohol-based formulations were consistently associated with lower infections rates, with isopropyl alcohol being superior to ethanol. Compared with alcoholic PVI, alcoholic CHG was associated with lower CRBSIs (RR, 0.70 [95% CI, 0.45 to 1.08]), catheter tip colonizations (RR, 0.42 [95% CI, 0.37 to 0.48]), and local infections (RR, 0.40 [95% CI, 0.23 to 0.70]). High concentration CHG (1% or higher) further lowered CRBSIs (RR, 0.31 [95% CI, 0.19 to 0.52]) and colonization (RR, 0.36 [95% CI, 0.30 to 0.42]) compared with lower concentrations. Local adverse events were uncommon, slightly more frequent with alcohol-based formulations, and similar between CHG and PVI. In this NMA of RCTs, high concentration CHG in isopropyl alcohol was associated with the lowest incidence of CRIs. These results suggest that alcoholic PVI and aqueous formulations should be reserved for situations in which CHG or alcohol cannot be used.

Introduction: Central venous catheter insertion is routinely performed in adults with high success rates under ultrasound guidance, but guidewire advancement can be difficult in patients with small-caliber veins, particularly in neonates and infants. This randomized exploratory study in adult patients evaluates whether a curved-tip needle, conceptually designed for use in smaller veins, performs at least as well as a standard needle in internal jugular vein (IJV) cannulation.Methods: In this prospective, randomized exploratory study, adult patients requiring ultrasound-guided IJV cannulation for any indication were included. Forty participants were randomized into two groups: the curved group (CG), using a curved tip needle (10°), and the standard group (SG), using a conventional straight needle. The primary outcome was the first pass success rate. Secondary objectives were overall success rate, number of attempts, needle visualization, and complications.Results: Results were similar in both the CG and SG in terms of first pass success rate (95%), overall success rate (100%), and number of attempts. Needle visualization under ultrasound was similar in both groups. No complications were noted in either group.Conclusion: Use of a curved tip needle for IJV catheterization in adults showed similar success rates and needle visualization compared with a conventional straight needle, with no added complications. Further research may explore its utility in non-operative settings, in smaller caliber veins, and at alternative central venous sites.

Abstract Introduction The cornerstone of catheter-associated urinary tract infection (CAUTI) prevention is avoiding unnecessary indwelling urinary catheter (IUC) insertion [1]. As part of a long-term project to reduce the number of catheters, the most common inserted device used across MOE wards in our hospital, we recently undertook a project to improve planning (does it need to stay, can we remove it?) and the reliability of information reconciliation around their use. Methods We designed a data collection tool, analysing key aspects of IUC care, measured our performance at least twice-yearly using data to educate and inform teams. After noting a drop off in documentation around planning, we designed an intervention for our electronic patient record: amending our multi-disciplinary team (MDT) prompt, encouraging teams each week to make a decision with regard to the necessity for ongoing catheterisation. A further two cycles of audit were performed following the intervention. Results Across the MOE footprint (up to 142 beds), the prevalence of IUC use averages around 25%. This has not changed significantly across the audit period. However, since the most recent intervention, there have been marked and sustained improvements in documentation and planning. Completion of risk assessment increased from 63 to 92%, notes of change date from 81 to 92%, MDT record of use of catheter from 56 to 83% and future plan from 6–58%. Conclusion We have increased the MDT awareness of our use of IUCs and by doing so seen sustained improvements in both planning and information reconciliation, thereby increasing safety. From this strengthened platform, we intend to link to ongoing work around CAUTI reduction. In a system where change of staff is a constant, creating a lasting message is difficult and it can leave improvers feeling like they are permanently on repeat. Encouraging measurement with local improvement ideas can lead to wins that lead to permanent change.

The effect of therapeutic play on anxiety and fear levels in 6-12-year old children undergoing central venous catheter insertion in a pediatric hematology-oncology unit: A randomized controlled trial.

The effect of arm massage on the success of peripheral intravenous catheter insertion in breast cancer patients undergoing chemotherapy: A randomized controlled study.

A 58-year-old woman with schizophrenia was transported to our hospital by ambulance due to impaired consciousness. At the time of the examination, the patient had significant abdominal distension and diabetic ketoacidosis associated with urinary retention. Although the symptoms improved with the insertion of a urinary catheter and glycemic control, the involvement of the antipsychotic olanzapine was considered the background to the pathophysiology of this case. We herein report the relationship between antipsychotic drugs, diabetic ketoacidosis, and urinary retention along with a literature review.

This article reports the case of a male patient in his 70s with middle aortic syndrome (MAS). The patient was admitted with abdominal pain, abdominal distension, vomiting, and cessation of defecation for 2 days as chief complaints and was diagnosed with intestinal obstruction. Enhanced computed tomography and vascular reconstruction revealed distal occlusion of the abdominal aorta. The celiac trunk, superior mesenteric artery, and inferior mesenteric artery were not visualized, whereas bilateral renal arteries maintained blood flow. Given the patient's history of intermittent claudication and uncontrolled hypertension, the condition was ultimately diagnosed as MAS secondary to Takayasu's arteritis, with bowel obstruction identified as a secondary manifestation of MAS. After insertion of a nasointestinal obstruction catheter, the patient's symptoms of intestinal obstruction were relieved. However, the obstruction recurred, and the patient subsequently improved following vascular reconstruction. During postoperative follow-up to date, intestinal obstruction has recurred only once due to improper diet and resolved after dietary modifications. MAS is relatively rare in clinical practice, particularly among older patients. We hope that this case study provides clinicians with an opportunity for learning and knowledge exchange, thereby contributing to improved diagnostic and therapeutic approaches for patients with similar conditions.

Introduction: Blind insertion of Supraglottic Airway Devices (SAD) often results in suboptimal positioning in the oropharynx or hypopharynx. On the other hand, laryngoscopy-guided insertion will give a better One-Lung Ventilation (OLV) and prevention of aspiration. A limited number of studies have been done to compare this blind and videolaryngoscopic positioning of a new device, Ambu® AuraGain™, which is a single-use, anatomically curved device with intubation capabilities. Aim: To compare videolaryngoscopy-guided insertion with the blind paramedian insertion technique of Ambu® AuraGain™ for the efficacy of ventilation. Materials and Methods: This Randomised Controlled Trial (RCT) was conducted at Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, over a period of 18 months (July 2022 – December 2023) in 100 patients in a tertiary care centre of a tier one city. At the end of 5 minutes and 30 minutes after device insertion, oropharyngeal leak pressure was measured as the primary outcome of the study. Randomisation was done into two groups (B and V). Group B was taken as the control group and group V was the test group, where the videolaryngoscopic-guided insertion of the device was done. Other parameters studied were successful attempts, ease of insertion and passage of the gastric catheter. Independent t-test, Chi-Square test, Fisher‘s-exact test and Statistical Package for Social Sciences (SPSS) 25.0 were used to analyse data. For statistical significance, a p-value of less than 0.05 was considered statistically significant. Results: The demographic profile of all 100 patients was comparable in both groups, based on age, gender, American Society of Anaesthesiologists Physical Status (ASA) classification, and Body Mass Index (BMI). C-MAC® videolaryngoscopyguided technique of insertion of Ambu Aura Gain provides better efficacy of ventilation in terms of higher Oropharyngeal Leak Pressure (OLP) as compared to the blind paramedian insertion technique in adult patients undergoing elective surgery under General Anaesthesia (GA). The mean oropharyngeal leak pressure (cm of H2 O) at 5 minutes and 30 minutes post device insertion in group V and group B was 37.14±1.77 vs. 34.20±1.68 and 37.9±1.61 vs. 35.2±1.54, respectively. Time taken for effective ventilation was more in the C-MAC® group (34.64±0.98 sec vs. 27.18±1.35 sec, respectively). Conclusion: C-MAC® videolaryngoscopy-guided technique of insertion of Ambu® AuraGain™ provides better efficacy of ventilation in terms of higher oropharyngeal leak pressure as compared to the blind paramedian insertion technique in adult patients undergoing elective surgery under GA.

Antecubital fossa (ACF) placement of peripheral intravenous catheters (PIVCs) is generally not recommended due to higher infection and device failure risk. However, ACF placement is common and justified in emergency departments (EDs) if injection of contrast for computed tomography (CT) is anticipated. However, it is unknown how successful ED staff are at correctly predicting contrast-enhanced CT need. To determine the prevalence of ACF PIVC insertions in EDs, their association with contrast-enhanced CT use, and key patient and clinical predictors of contrast administration. This retrospective cohort study was conducted in a metropolitan ED in Australia. Out of 1196 patients, 447 patients were eligible and included in the data analysis. The primary outcome was the proportion of ACF PIVCs linked to subsequent contrast-enhanced CT. Secondary analyses explored demographic and clinical predictors of contrast-enhanced imaging. Overall, 80% of PIVCs were inserted in the ACF. However, only 27% of patients subsequently underwent contrast-enhanced CT, indicating that approximately 73% of ACF insertions were potentially avoidable. Multivariate analysis revealed that female patients (OR = 0.599, p = 0.044), and gastrointestinal (OR = 3.397, p = 0.002) or neurological conditions (OR = 5.101, p < 0.001) had significantly higher odds of receiving contrast-enhanced CT. This study identifies a clear discrepancy between clinical guidelines and actual practice. Many ACF insertions appear to be based on incorrect assumptions rather than confirmed clinical need. The findings highlight the need for more targeted, evidence-based decision-making in EDs.

Peri-procedural anticoagulation management for central venous catheter insertion in persons with cancer.