Central Venous Line Placement Research Articles

Dermatological patients in the Intensive Care Unit – a hospital record based retrospective study

Background: Various dermatological conditions can be life threatening and may require admission in the intensive care unit for monitoring and management. We carried out this study to assess the profile of dermatological admissions in the intensive care unit. Materials and Methods: It was a cross sectional retrospective study in which the records of all patients of various dermatological disorders admitted in the intensive care unit over a period of three years was studied and the clinical details were assessed. Results: Over a period of three years, a total of 16 patients (M:F 10:6), aged between 16-71 years (mean 46±2.31 years) were admitted with an underlying dermatological disorder. The most common condition requiring admission was Stevens Johnsons Syndrome (n=5), followed by Pemphigus vulgaris (n=4), erythroderma(n=2), pustular psoriasis, dermatomyositis, necrotizing faciitis, dapsone hypersensitivity syndrome and cutaneous lymphoma in 1 each. Interventions like mechanical ventilation were required in 2 patients, inotropic support in 2 patients, central venous line placement, renal replacement therapy and tracheostomy in one patient each. The mean duration of ICU stay was 14.2 days and mortality was the outcome in 2 patients of pemphigus vulgaris which was attributed to septicemia and shock. Conclusions: Dermatological disorders can cause significant morbidity and may require proper care in the intensive care unit. Timely initiation of intensive care can help in reducing the morbidity and preventing mortality.

Comparison of catheterization of internal jugular vein by ultrasound guided versus landmark approach IN I.C.U. patients

Comparison of catheterization of internal jugular vein by ultrasound guided versus landmark approach IN I.C.U. patients - IJCA- Print ISSN No: - 2394-4781 Online ISSN No:- 2394-4994 Article DOI No:- 10.18231/2394-4994.2018.0082, Indian Journal of Clinical Anaesthesia-Indian J Clin Anaesth

Management of acute subdural hematoma in incarcerated patients

IntroductionIncarcerated patients have been documented to have higher rates of mental illness, substance abuse disorders, trauma, and chronic illnesses compared to non-incarcerated populations. In this study, we evaluated the incidence of subdural hematoma (SDH) in incarcerated patients and compared the outcomes of these patients to those of non-incarcerated patients. MethodsWe conducted a retrospective cohort study of incarcerated patients admitted to a hospital with acute SDH using the Nationwide Readmissions Database between 2016−2017. Nearest-neighbor propensity score matching for demographics was implemented to identify non-incarcerated control patients admitted with SDH. Analysis used chi-squared testing, Mann-Whitney U testing, and generalized binomial regression modeling. ResultsA total of 962 incarcerated and non-incarcerated patients were identified at primary admission. No significant difference was found between the two cohorts with regards to rates of neurosurgical complications or readmissions. Incarcerated patients were found to receive a significantly lower number of procedures, including respiratory ventilation, intubation, central venous line placement, and imaging, during their primary admission (NPR = 2.7 ± 4.0) compared to non-incarcerated patients (NPR = 3.9 ± 4.9) (p = 0.00050), reduced length of stay (p = 0.0052), and reduced hospital costs (p = 0.00026) compared to non-incarcerated patients. Furthermore, female incarcerated patients with SDH had significantly worse outcomes compared to male patients with SDH, including higher rates of mortality (p = 0.0017) and 30-day readmission rates (p = 0.041). DiscussionOur study suggests that incarcerated patients may receive significantly fewer diagnostic and supportive procedures while admitted for SDH and may be discharged sooner than non-incarcerated patients with SDH. In addition, outcomes following SDH within incarcerated patients may be significantly worse for females.

Compound heterozygous protein C variants undetectable by common laboratory testing causing purpura fulminans after the neonatal period.

Compound heterozygous protein C variants undetectable by common laboratory testing causing purpura fulminans after the neonatal period.

Contemporary postoperative imaging practices among pediatric surgeons following image-guided central venous line placement: A survey of the American Pediatric Surgical Association

Contemporary postoperative imaging practices among pediatric surgeons following image-guided central venous line placement: A survey of the American Pediatric Surgical Association

Cardiopulmonary Resuscitation in Intensive Care Unit Patients With Coronavirus Disease 2019

Cardiopulmonary resuscitation (CPR) in patients with severe acute respiratory syndrome coronavirus-2–associated disease (coronavirus disease 2019) poses a unique challenge to health- care providers due to the risk of viral aerosolization and disease transmission. This has caused some centers to modify existing CPR procedures, limit the duration of CPR, or consider avoiding CPR altogether. In this review, the authors propose a procedure for CPR in the intensive care unit that minimizes the number of personnel in the immediate vicinity of the patient and conserves the use of scarce personal protective equipment. Highlighting the low likelihood of successful resuscitation in high-risk patients may prompt patients to decline CPR. The authors recommend the preemptive placement of central venous lines in high-risk patients with intravenous tubing extensions that allow for medication delivery from outside the patients’ rooms. During CPR, this practice can be used to deliver critical medications without delay. The use of a mechanical compression system for CPR further reduces the risk of infectious exposure to health- care providers. Extracorporeal membrane oxygenation should be reserved for patients with few comorbidities and a single failing organ system. Reliable teleconferencing tools are essential to facilitate communication between providers inside and outside the patients' rooms. General principles regarding the ethics and peri-resuscitative management of coronavirus 2019 patients also are discussed.

P080: Trauma experiences of rural emergency physicians: a self assessment

Introduction: The purpose of this study was to identify, through self-assessment, how comfortable rural emergency medicine (EM) practitioners are in treating critically ill trauma patients, the resources available to treat such patients and their comfort with performing trauma procedures. Our goal is to enhance rural trauma care by identifying obstacles rural EM physicians face in Saskatchewan. Methods: This was a cross sectional survey study, emailed to family physicians practicing rural EM in Saskatchewan identified through the Saskatchewan Medical Association database. Inclusion criteria included physicians who are providing EM care currently or within the past year. Rural was assumed to be communities in Saskatchewan that were outside of Saskatoon and Regina. The survey was an anonymous self-assessment regarding demographics, training, hospital resources and comfort. Results: 113 physicians of the 479 rural physicians agreed to participate, 78 met our inclusion criteria. Most (67%) were from communities with less than 10,000 population, 70% had less than 300 ED visits per month. Most (68%) were less than 45 years of age. In terms of training, 57% had completed undergraduate training out of Canada and 63% had completed residency training in Canada. Most had been practicing for more than 2 years (76%). Most (59%) had current ATLS credentials, however only 37% had ever completed the EDE course. Regarding available resources, most centers had plain radiography (99%), POCUS (68%), PRBC (78%) and TXA (93%). However, fresh frozen plasma (41%) and platelets (26%) were not widely available. Comfort was measured on a Likert scale. The types of trauma that respondents were least comfortable with included pediatric (39%), vascular (46%), spine (56%) and genitourinary (60%). The types skills that participants were least comfortable with included pericardiocentesis (19%), and surgical airway (25%). The majority had not performed Pediatric endotracheal tube insertion (79%), surgical airways (99%), pericardiocentesis (99%), central venous line placement (80%) and needle thoracentesis (71%) within the past 12 months. Conclusion: This self-assessment helped us identify aspects of rural trauma medicine that are the most challenging for rural practitioners. Understanding the most difficult challenges in light of the critical resources available to rural trauma medicine providers will inform future professional development initiatives.

Contemporary postoperative imaging practices among pediatric surgeons for image-guided central venous line placement: A survey of the American Pediatric Surgical Association

Background/PurposeRare life-threatening complications after central venous line (CVL) placement in children may encourage the routine use of postoperative imaging, despite multiple studies demonstrating the limited utility of this practice. The aim of this study was to investigate the nature of this discordance. MethodsA 10-question survey was sent to 1,239 members of the American Pediatric Surgical Association (APSA) addressing contemporary practices regarding CVL placement and postoperative imaging. ResultsFive hundred eighteen (42%) surveys were completed. The majority of respondents routinely obtain a chest radiograph (CXR) after image-guided CVL placement (52%). Years in practice, operative volume, and practice type were not statistically associated with postoperative CXR usage (all p > 0.05). ‘Routine’ users were more likely to cite “standard of care” (p < 0.001), position verification (p < 0.001), and complication identification (p < 0.001) as indications for use than those who use CXR selectively. ConclusionRoutine use of postoperative CXR after image-guided CVL placement remains common among pediatric surgeons. Significant variation exists in the indication for this study, with considerable disagreement between ‘selective’ and ‘routine’ users. Consideration should be given for an APSA standardized guideline utilizing a clinically-driven approach to CVL placement and postoperative imaging to align with evidence-based practice. Level of evidenceN/A — descriptive analysis of survey results.

3:54 PM Abstract No. 361 Safety and efficacy of central venous line placement via internal jugular vein in patients with total artificial hearts

3:54 PM Abstract No. 361 Safety and efficacy of central venous line placement via internal jugular vein in patients with total artificial hearts

Routine Chest Radiographs in Children After Image-Guided Central Lines Offer Little Diagnostic Value

BackgroundThe aim of this study was to investigate the utility of postoperative chest radiograph (CXR) after image-guided central venous line (CVL) placement in children. MethodsA retrospective review was conducted of all tunneled CVLs placed at two pediatric institutions from 2010 to 2017. A subgroup analysis comparing a clinically driven approach to postoperative imaging against routine imaging was performed. ResultsDuring the study period, 1080 lines were placed in 915 patients. There were 892 postoperative CXRs (82.6%). An abnormality was seen on 40 radiographs (4.5%, n = 891), with 16 false-positive (1.3%) and 5 false-negative (0.6%) CXRs. The sensitivity and specificity of CXR to identify complications requiring intervention were 50.0% (95% confidence interval [95% CI], 10.0-90.0) and 95.8% (95% CI, 94.5-97.1), respectively. Positive predictive value of CXR was 7.5% (95% CI, 0-15.7) with a negative predictive value of 99.6% (95% CI, 99.2-100). A clinically driven approach to postoperative imaging was associated with 41% decrease in CXR (P < 0.001) without increased incidence of missed complications. Only three complications requiring intervention (0.3%) were suspected on postoperative CXR alone, and all of those were symptomatic before intervention. ConclusionsRoutine postoperative CXR offers minimal value in identifying technical complications requiring intervention after image-guided CVL placement in asymptomatic children. We recommend abandoning this practice in favor of a clinical symptom-driven approach to postoperative imaging.

Incidence of venous thromboembolism in hospitalized pediatric neurosurgical patients: a retrospective 25-year institutional experience.

Venous thromboembolism (VTE) refers to both deep venous thrombosis (DVT) and pulmonary embolism (PE). The risk of VTE in adult neurosurgical patients is thoroughly studied. However, the incidence and risk of VTE in a comprehensive pediatric neurosurgical population is not well-defined. The available pediatric data consists of reviews of specific high-risk groups, such as trauma, critical care, or cancer patients. This may not be reflective of the entire spectrum of a high-volume pediatric neurosurgery practice. This study was undertaken to analyze the incidence and risk factors of VTE in all hospitalizations evaluated by a pediatric neurosurgery service over a 25-year period. A retrospective review of electronic medical records was performed for 9149 hospitalizations in 6374 unique patients evaluated by the pediatric neurosurgery service at Riley Hospital for Children (Indianapolis, IN, USA) from 1990-2014. During this time period, there was no standardized VTE prevention protocol. The study group included all patients less than 18 years of age. Patients with a known pre-existing VTE or pregnancy were excluded. VTE was diagnosed in 20 of the 9149 (0.22%) hospitalizations, in 18 unique patients. All DVTs were diagnosed via Doppler ultrasound and/or computed tomography. Anatomic clot locations included 9 in the upper extremity (0.098% of hospitalizations), 8 in the lower extremity (0.087%), and 4 (0.044%) pulmonary emboli. Ten of the 20 occurred in hospitalizations where the patient underwent surgery, although the need for surgery was not a statistically significant risk factor. Sixteen of the 20 (80%) occurred in patients with at least one form of central venous line (p < 0.00001). There was one VTE-related death (0.01%). In all pediatric neurosurgical patients, a VTE was found in 0.22% of hospitalizations over a 25-year span. Statistically significant risk factors for VTE included central venous line placement, paralysis, malignancy, intubation greater than 48 h, and hypercoagulable state.

117. Hospitalized Burn Patients with Fever and Leukocytosis: Blood Culture or Not?

BackgroundFever and leukocytosis are very common in patients with burn injury. Many patients had to do blood cultures frequently during their hospitalization given the concern of bacteremia. We opt to utilize the clinical characters of the patients to evaluate the risk for bacteremia and avoid unnecessary blood culture.MethodsThe adult patients (≥18 years) with burn injury were selected from the Nationwide Inpatient Sample database (2005–2014). Using ICD-9 codes, we further identified bacteremia, total body surface area (TBSA) of burn, inhalation injury, pneumonia, urinary tract infection, wound infection, escharotomy, placement of central venous line, indwelling urinary catheter, gastrostomy tube (G-tube), intubation, and total parenteral nutrition (TPN). The risk factors for bacteremia were evaluated by Logistic regression. A risk-adjusted model to predict the occurrence of bacteremia was developed by discriminant analysis.ResultsIn total, 241,323 hospitalized patients with burn injury were identified. The incidence of bacteremia was 1.1% (n = 2,634). Comparing with the patients without bacteremia, those with bacteremia were older (51.1 vs. 46.7 year old, P < 0.001), had more severe burn injury (50.7% vs. 12% with burn TBSA over 20%, P < 0.001) and comorbidities (22.7% vs. 14.9% with Charlson index ≥2, P < 0.001), higher in-hospital mortality (5.6% vs. 3.7%, P < 0.001), longer hospital stay (26 vs. 5 days, P < 0.001) and more hospital charges ($206,028 vs. $30,339, P < 0.001). When the age, sex, race, and Charlson index of the patients were adjusted by Logistic regression, it was found that the factors of inhalation injury (OR = 1.25, 95% CI 1.03–1.51), intubation (OR = 1.62, 95% CI 1.44–1.82), TPN (OR = 1.56, 95% CI 1.16–2.11), placement of central venous line (OR = 1.86, 95% 1.57–2.01), and G-tube (OR = 2.04, 95% CI 1.60–2.60) were associated with increased risk for bacteremia. A risk-adjusted model composed of the patient’s age, Charlson index, burn TBSA, inhalation injury, intubation, TPN, placement of central venous line, and G-tube could predict the occurrence of bacteremia with an accurate rate of 85.4% (Table 1).ConclusionThe risk factors and risk-adjusted model for bacteremia may assist to decide whether a blood culture is needed in the hospitalized burn patients. Disclosures All authors: No reported disclosures.

140 Use of GoPro to Assess Central Venous Line Placement Competency Asynchronously

Complications due to failed central venous access (CVA) attempts are associated with increased morbidity and health care costs. The Agency for Healthcare Research and Quality (AHRQ) estimates a central line associated blood stream infection (CLABSI) costs approximately $70,000. There is a high failure rate in completing ultrasound guided central venous access (UGCVA) procedures among first year resident interns. Training and assessment is important, however physician time to assess resident competency is limited. Previous research has demonstrated that a GoPro camera can be used to capture procedures. In this research, we will evaluate the use of video recordings to asynchronously evaluate resident procedural competency in ultrasound guided central venous line (USGCVL) placement. This research had several steps. First, we evaluated the ability of GoPro cameras to capture procedural competencies during USGCVL procedures. Next, we developed and validated an evaluation rubric consisting of critical competencies identified from the literature and institutional guidelines. Faculty reviewers evaluated the GoPro videos asynchronously for visual clarity, and completeness of observation while using the rubric. Results demonstrated high agreement between reviewers (80-100%) for visualization of each competency. Residents were recruited to participate in this study during a training course designed to assess procedural competency in central line placement using a cadaver. Following consent, participants donned a head-mounted GoPro camera to record their performance. During the procedure, faculty evaluated residents' performance synchronously (via Qualtrics) using the same evaluation rubric validated in the prior study. At a later date, two teams each composed of a surgeon and emergency medicine (EM) physician (different than the synchronous reviewers) asynchronously viewed and independently evaluated videos divided into groups of four using the same rubric via Qualtrics. Inter-rater reliability was calculated between pairs of asynchronous reviewers and average percent agreement was calculated for both the asynchronous and the asynchronous versus live reviews. Video recordings of twenty-eight USGCVL procedures were collected. Twenty-four met study inclusion criteria (1080p 30fps continuous video no significant glare, no gross misalignment of the video field of view) and twenty are included in the data analysis. (Four videos have not been reviewed by their assigned reviewers yet.) Results are presented in Table 1. Overall percent agreement approached 80% for both asynchronous and asynchronous versus live comparisons. This study supports the feasibility of using a head mounted GoPro camera to record video for asynchronous evaluation of resident USGCVL placement. Continued refinement of data capture, scoring practices, and the grading rubric is needed to increase both the validity and reliability of the assessment process.Table 1Average percent agreement.Average Percent Agreement (%)95% CI (%)Asynchronous Rater Comparison 12 VideosRater 2 (surgeon) vs. Rater 3 (EM)73.4744.04100Live Graders vs. Asynchronous 8 VideosRater 1, 3 (EM) vs. live graders78.1242.54100 Open table in a new tab

Perioperative neutropenia is not an independent risk factor for infectious complications of central venous line placement in children: A propensity score-matched analysis

BackgroundThe infectious risk of central venous line (CVL) placement in children with neutropenia (absolute neutrophil count [ANC] <500/mm3) is not well defined. This study aims to investigate the early (≤30 days) and late (>30 days) infectious complications of CVLs placed in pediatric patients with and without neutropenia. MethodsA retrospective review was conducted of all CVLs placed by pediatric surgeons at two institutions from 2010 to 2017. Multivariable logistic regression was performed to identify risk factors for line infection. Propensity score-matched cohorts of patients with and without neutropenia were compared in a 1:1 ratio. Wilcoxon rank-sum, Chi-square, Fisher's exact, and log-rank tests were also performed. ResultsReview identified 1,102 CVLs placed in 937 patients. Fifty-four patients were neutropenic at the time of placement. Multivariable analysis demonstrated tunneled catheters and subclavian access as associated with line infection. The propensity score-matched cohort included 94 patients, 47 from each group. Demographic and preoperative data were similar between the groups (p > 0.05). Patients with neutropenia were no more likely to develop early (4.3% vs. 2.1%, p = 1.000) or late (19.1% vs. 17.0%, p = 1.000) infectious complications than patients without neutropenia, with similar median time to infection (141 vs. 222 days, p = 0.370). ConclusionA policy of selective CVL placement in neutropenic patients with standardized postoperative line maintenance is safe. Future directions include defining criteria by which neutropenic patients could be prospectively selected for safe CVL placement. Level of EvidenceII – Retrospective cohort study.

“…the frame of man's body, and coherence of his parts…”

Edward Herbert (later 1st Baron Herbert of Cherbury) (c.1582-1648) (Fig. 1) has said, “Whoever considers the study of anatomy, I believe will never be an atheist; the frame of man's body, and coherence of his parts, being so strange and paradoxical, that I hold it to be the greatest miracle of nature.” Such a profound statement still resonates some four centuries after Herbert's death. Herbert was born near Wroxeter, Shropshire and was a poet, writer, knight, philosopher, historian, diplomate, and deist. He attended University College, Oxford and was friends with such noteworthy men as Ben Jonson, John, Donne, Issac Casaubon, and the Prince of Orange. He was made sheriff of Montgomeryshire in 1605. This special issue of Clinical Anatomy is devoted to the anatomy of infants and adolescents. Dr. Ali Mirjalili from the University of Auckland has orchestrated an international team of authors who have written on topics including pediatric central venous line placement, differential growth of the abdominal aorta and vertebrae, anatomy of a tongue tie, age-related changes in the inguinal region, pediatric regional anesthesia and a predictive modeling study of the ischiopubic synchondrosis. These studies remind us of the everchanging frame of man's body.

P038: A procedural skills needs assessment targeting physicians providing emergency department coverage in rural Newfoundland and Labrador

Introduction: Maintaining competence in high-acuity low-occurrence (HALO) procedures is often difficult due to their infrequent occurrence. While simulation is a valuable tool to hone skills, providing effective simulation-based education (SBE) to learners outside academic centers can be challenging. Utilizing a mobile tele-simulation unit (MTU) with expert instruction from a geographically separated mentor could prove a valuable approach to overcoming barriers in this setting. However, to maximize benefit and buy-in, the training modules developed for this unique delivery method must align with the needs of those practicing in rural settings. Objectives: - To evaluate the procedural skills training needs of emergency medicine (EM) physicians in rural Newfoundland and Labrador (NL) - To inform the development of simulation modules designed for use in a MTU Methods: A web-based needs assessment was distributed to physicians registered with the NL Medical Association, working in rural locations, and having EM listed as their primary specialty. Participants evaluated their comfort, performance frequency and desire to have further training for 12 HALO procedures. Two EM physicians selected these from a broader list of core procedural skill competencies for CCFP-EM residents at Memorial University. Participants were also able to suggest other procedures that might benefit from SBE. Results: The data collection occurred for 8 weeks with a 68% response rate (N = 22). No respondents had formal EM training outside of exposure in family medicine residency. 60% had 10+ years practicing EM. Chest tube insertion (100%), difficult intubation (92.3%) and surgical airway (92.3%) were the procedures that most respondents felt required more SBE. In practice, they most often performed bag-valve ventilation, splint application and procedural sedation (&amp;gt;10 per year). Additional procedures felt to require SBE were central venous line placement and trauma assessment. Opportunities to participate in SBE were limited (66.7%-less than annually). Despite this, most participants agreed SBE would be a significant benefit if accessible (93.3%). The greatest barriers to SBE included lack of equipment, rural location, and time necessary for travel to larger centres. Conclusion: The provision of medical care in rural settings can be particularly challenging when HALO procedures must be performed. Unique delivery methods of SBE targeted to the needs of rural practitioners may help bridge gaps in knowledge and technical skills.

Prevalence of complications associated with central venous catheter instalation for hemodyalisis

Placing central venous lines under ultrasonographic guidance reduces the complications of the procedure. To compare prevalences of complications of central venous line placements with or without ultrasonographic guidance. Descriptive study that contemplated the comparison of two groups of patients subjected to a central venous line placement at a nephrology service for renal replacement therapy. In one group of 100 patients, the line was placed without ultrasonographic guidance between 2008 and 2012. Between 2015 and 2017 the line was placed in 138 patients using ultrasonographic guidance. The prevalences of complications with both types of procedures were recorded. The frequency of complications of procedures with and without ultrasonographic guidance was 0.7 and 18% respectively (prevalence ratio 0.04, 95% confidence interval 0-0.3). Ninety five percent of recorded complications were arterial puncture, followed by hematomas in 10% and pneumothorax in 5%. The higher prevalence of complications was observed in emergency line placement without ultrasonographic guidance. There was a direct association between the number of line placement attempts in a single procedure and the prevalence of complications. Ultrasonographic guidance is associated with a reduction in the prevalence of central venous line complications.

Right-sided infective endocarditis complicating central venous line insertion: a case report

Abstract&#x0D; Infective endocarditis is a serious and potentially fatal complication of central venous line (CVL) placement in patients with diseased hearts. A man of 59 was admitted because of fever and dyspnea of 5 days duration. He was a known case of ischemic cardiomyopathy with frequent admissions to a local hospital. Two months earlier, a CVL was placed in right subclavian vein for drug administration. On examination, he was febrile and hypotensive with a systolic murmur in tricuspid and mitral areas. CVL- guide wire was radiographically visible. White blood cells and C-reactive protein were elevated. Echocardiography showed big vegetation on tricuspid valve (TV), severe mitral and tricuspid regurgitation and dilated left ventricle whilst coronary angiography revealed 3-vessel disease. Antibiotic therapy was followed by an open heart surgery during which the guide wire and valve vegetation were removed, TV was repaired, mitral valve was replaced and coronary artery bypass grafting was performed. Culture of blood, valve tissue and guide wire grew Staphylococcus Epidermidis. Despite intensive medical and surgical therapy, the patient succumbed on the 4th postoperative day.

The role of transesophageal echocardiography in the management of renal cell carcinoma with venous tumor thrombus.

We reviewed the role of transesophageal echocardiography (TEE) in the management of renal cell carcinoma (RCC) with associated tumor thrombus. Many consider intraoperative TEE as imperative in cases of Level 4 thrombi with atrial involvement, as well as in cases that require the use of cardiopulmonary bypass (CPB). However, the role of TEE in the surgical management of RCC with associated inferior vena cava (IVC) thrombus may expand beyond this subset. When performed after induction, TEE provides updated information regarding tumor thrombus staging, which is essential for optimal surgical planning. Furthermore, TEE provides feedback regarding properties of the thrombus, such as fragility and adherence, which may alter surgical technique. TEE can also be used intraoperatively for central venous line placement, to monitor cardiovascular and fluid status, to guide vascular clamp placement, and to ensure complete removal of the tumor thrombus. In some cases, the use of TEE allows for less morbid procedures and safe avoidance of CPB. We therefore recommend the use of preoperative TEE in all cases with a known tumor thrombus with discretion as to what extent TEE is used throughout the remainder of the case. Further investigation is necessary to elucidate the effect of TEE on patient outcomes, including surgical complication rates, morbidity and mortality of procedures, and cancer control.

Central Venous Line Placement and Ultrasound Probe Damage: A Word of Caution.

Central Venous Line Placement and Ultrasound Probe Damage: A Word of Caution.