Complication Of Insertion Research Articles

Point-of-care ultrasound for monitoring catheter tip location during umbilical vein catheterization in neonates: a prospective study.

Point-of-care ultrasound (POCUS) can guide umbilical vein catheter placement in real time and monitor catheter tip position, allowing avoidance of severe complications due to catheter malposition. This study aims to explore the effectiveness of POCUS in guiding venous catheter insertion and monitoring complications. Sixty-eight neonates with ultrasound-guided venous catheter insertion at the Neonatal Department of Dongguan Children's Hospital between December 2020 and February 2022 were included. POCUS was applied to monitor catheter tip location daily until catheter removal. A displacement range exceeding the intersection of the inferior vena cava and right atrium by ±0.5 cm was considered misalignment. Sixty-four neonates had a displaced catheter tip (94.1%, 64/68), with a median displacement distance of 0.4 cm (minimum -0.2 cm, maximum 1.2 cm). Ten neonates had a misalignment (14.7%, 10/68) caused by displacement. Displacement usually occurs within 2-4 days after placement, with displacement rates of 94.1% (64/68), 90.6% (58/64), and 98.3% (59/60) on days 2, 3, and 4, respectively, and could still occur on day 9 post-placement. In addition, misalignment mainly occurs on the second day after placement. During the monitoring process, 58 neonates had catheter tip displacement ≥2 times, resulting in 252 displacement and 22 misalignment incidents. Among them, the catheter tip migrated outward from the inferior vena cava seven times, all of which were removed in time. Ultrasound was used for positioning 486 times, and x-ray was indirectly avoided 486 times. The catheter tip is prone to displacement and misalignment after umbilical vein catheterization, which most commonly occurs on days 2-4. POCUS is recommended for daily monitoring of the tip location during umbilical vein catheterization until catheter removal.

Distal enteral feeding can replace total parenteral feeding to support nutrition in patients with high output stoma (jejunostomy) – A case series

Ostomy/Stoma is a common entity in patients operated for small bowel perforation in developing countries. Delay in presentation, poor general condition, malnutrition and lack of health infrastructure in peripheral areas are some of the causes leading to severe sepsis at presentation. Exteriorising the perforation site as stoma/ostomy is the preferred salvage procedure. Proximal stoma/ostomy is high output and cause fluid and electrolyte imbalance. Also it is difficult to maintain nutrition with oral feeds, as partially digested food along with digestive enzymes gets lost through the stoma. Parenteral nutrition (PN) is widely used in these patients, which is expensive requires hospitalisation, also not without risks e.g. liver dysfunction and associated with complications of central line insertion. We hereby report our experience of managing three patients of high output jejunostomy with distal enteral feeding provided by feeding chyme and partially digested food into the distal stoma. After confirming the distal patency of the bowel, we started feeding through distal lumen of stoma (known as distal enteral feeding) in our 3 patients with jejunostomies immediately in postoperative period along with PN. After few days we started decreasing PN, we gradually switched to complete enteral nutrition; and increasing distal feeding and then totally stopping the PN in few days only. We kept a watch on the different parameters of the patient like calories and protein intake, weight, electrolytes, liver function, etc. RESULTS: Distal enteral feeding improved their body weight, maintained their serum electrolytes and liver function tests including serum albumin. After achieving the good nutritional status, we were able to do successful surgical closure of stomas in all the three patients. In our experience, patients with high-output stomas can be nutritionally maintained with distal enteral feeding without the need of long term PN. Use of distal enteral feeding, if used appropriately and with proper monitoring, can nutritionally build up the patient avoiding the complications of PN.

Baska mask vs ProSeal Laryngeal mask on airway seal pressure in cases undergoing general anesthesia by mechanical ventilation: A randomized controlled trial

ABSTRACT Background Supraglottic Airway Devices (SGAs) are designed to counteract the drawbacks of endotracheal intubation. They have proven to be easy to use, robust, versatile, and usable in many difficult situations. This work aims to investigate the use of the Baska Mask (BM) airway and ProSeal™ Laryngeal Mask Airway (PLMA) as SGAs for ventilation. Methods This randomized controlled trial was carried out on 74 cases aged 21–65 years old for elective surgery of a planned duration of up to 2 h during general anaesthesia with intermittent positive pressure ventilation. Cases were divided into two equal groups. Ventilation was done either by BM® Airway (group BM) or PLMA (group PLMA). Results BM had a shorter insertion time and lower leak fraction versus PLMA, while seal pressure elevated significantly with BM versus PLMA (P < 0.001). PLMA had significantly more cases than the BM mask group complaining of a sore throat at 2 h (P = 0.042). Complication after gastric tube insertion was parallel between both groups. Conclusions BM can be used successfully during anesthesia as it displays a shorter insertion time, lower leak fraction, higher seal pressure, and lower incidence of sore throat and gastric tube insertion complications than PLMA.

#4047 ULTRASOUND-GUIDED RIGHT INTERNAL JUGULAR TUNNELED CATHETER INSERTION FOR HAEMODIALYSIS: PRACTICES AND OUTCOMES FROM A SINGLE CENTRE

Abstract Background and Aims Internal jugular vein tunneled catheters are important vascular access for haemodialysis (HD). In our practice, Left-sided internal jugular (LIJ) catheter insertion is performed in radiology under direct X-ray screening. Most right-side internal jugular (RIJ) catheters are inserted under ultrasound guidance in dedicated renal procedure rooms. Vascular access can become challenging with the potential for venous stenosis and thrombosis with catheter use. The aims of this study are to evaluate our practices and outcomes of non-radiologically inserted RIJ tunneled HD catheters and to investigate the predictors of procedure failure. Method 200 successive RIJ tunnel HD catheters inserted from June 2016 under ultrasound guidance at our centre were included in this analysis. Data including demographics, co-morbidities, first or higher order insertion, outcome (success or failed attempt), and immediate complications were collated from electronic patient records. Binary logistic regression analysis was conducted to investigate the predictor for failure in catheter insertion. Results Of the 200 patients, 152 (76%) were first-time insertions and 48 (24%) were second or higher-order insertions. The median age of our cohort was 58 years, with a predominance of males (68%) and white ethnicity (82%). 36.5% were diabetic, with 37.5% having a history of cardiovascular disease. Nearly 30% of patients were on an antiplatelet agent, and 8% were on anticoagulants, which were appropriately managed before line insertion. Pre-operative median haemoglobin was 93 g/dl, with clotting screen and platelet counts in the target range. There was a statistically significant difference in the success of insertion, depending on the insertion being first or subsequent (96.1% vs 81.2%; p = 0.001). The reason for failure in insertion included on-table observation of a small calibre vein on ultrasound or failure to thread wire/dilator due to possible stenosis or thromboses. All line rewire (12/48) procedures were performed successfully. Immediate complication (&amp;lt;1 week) was recorded in 9% of patients, predominantly tunnel bleeding (n = 7) and malposition (deep or high; n = 7) (Table 1). Second or higher-order RIJ catheter insertion showed a higher risk for failure in a multivariable binary logistic regression analysis. (OR: 6.4; CI: 2.1-20.5; P = 0.002) (Figure 1). Of the higher-order insertions, the longer duration between the first and subsequent catheters showed a higher risk for failure (OR:1.19; CI-1.04-1.4; p = 0.010). Conclusion Second or higher-order catheter insertions with a longer duration between the first and the subsequent insertion carry a significant risk of failure due to vein stenosis and thrombosis. Therefore, a careful case-to-case triaging of patients based on previous access history is warranted before listing patients for routine ultrasound-guided insertion.

#4062 PERITONEAL DIALYSIS CATHETER SURVIVAL: A TEN-YEAR SINGLE CENTER STUDY

Abstract Background and aims Timely insertion and adequate management of peritoneal dialysis catheter (PDC) related complications are crucial for the success of Peritoneal Dialysis (PD). The aim of the present study was to review the peritoneal dialysis catheter outcomes at our center and evaluate variables influencing catheter survival. Methods We conducted a retrospective study including 146 patients who had their first PD catheter implanted between 1st of August 2012 and 31st of July 2022 in our institution. The primary endpoint was PD catheter failure, defined as removal of the PD catheter due to catheter-related complications. Kaplan-Meier curves were used to estimate catheter survival. Cox regression model was used to identify factors that were independently associated with catheter survival. All demographic and clinical characteristics of the patients and PD complications were included as covariates. A p value of less than 0.05 was considered statistically significant. Results The study population included 85 men and 61 women, aged 55.1 $ \pm {\rm{\ }}$ 16.7 years. Mean follow-up was 26.5 +/- 22.7 months. Diabetes was the most common etiology of the stage 5 chronic kidney disease (n = 41, 28%), followed by chronic glomerulonephritis (n = 30, 20.5%). Ninety patients (61.2%) had one or more comorbidities and seventeen (11,6%) had previous abdominal surgery. In 98 patients (60.1%), the PDC was inserted using a mini-laparotomy approach, whereas the laparoscopic method was used in 54 patients (33.1%). Only 8 patients (4.9%) had their catheter placed percutaneously using the Seldinger technique. The total number of patients with one or more PD-related infectious complications during follow-up was 99 (67%): 51 patients (31%) had a single episode and 29 (17.8%) had multiple episodes of peritonitis; 34 patients (20.9%) had a single episode of PD catheter related exit site or tunnel infection, while 47 (28.8%) had more than 1 event. Sixty-six patients (45%) had PD-related mechanical complications, mostly due to outflow failure (19 patients with catheter migration, 11 with omental wrapping). The remaining non-infectious complications were hernia (n = 20, 13.7%), hemoperitoneum (n = 8, 5,5%), leakage (n = 4, 2.7%) and pleuroperitoneal shunt (n = 4, 2.7%). Fourteen patients required intervention due to mechanical complications, namely repositioning of the catheter with fluoroscopic technique in 8 patients and surgical repositioning in 6. Removal of the catheter was required in 49 patients (33.6%). The leading cause of catheter removal was infection (n = 29, 59%): peritonitis in 28 patients and refractory tunnel infection in 1. Mechanical complications were also a significant factor, accounting for 40.8% of the removals (n = 20). Overall PD catheter survival rates over 12, 24 and 36 months were 80.2%, 72.4% and 61.6%, respectively. PD catheter-related non-infectious complications was the only independent variable significantly associated with catheter survival (Hazard ratio 2.573; 95% CI 1.426–4.645). No significant association was observed between the PD catheter survival and other risk factors including age, diabetic status, comorbidities, previous abdominal surgeries, method of catheter insertion or infectious complications. Conclusions PDC non-infectious complications were the only independent factor significantly associated with catheter survival. Despite the significant number of infectious complications, including peritonitis, it was found that these complications did not result in a significant decrease in catheter survival. These findings highlight the crucial role of proper management of peritoneal dialysis catheter-related non-infectious complications for successful and long-term usage of PDC.

Intra-prostatic gold fiducial marker insertion for image-guided radiotherapy (IGRT): five-year experience on 795 patients

IntroductionProstate cancer is the second most commonly diagnosed cancer in males. The use of intra-prostatic fiducial markers (FM) for image-guided radiotherapy (IGRT) has become widespread due to their accuracy, relatively safe use, low cost, and reproducibility. FM provides a tool to monitor prostate position and volume changes. Many studies reported low to moderate rates of complications following FM implantation. In the current study, we present our five years’ experience regarding the insertion technique, technical success, and rates of complication and migration of intraprostatic insertion of FM gold marker.MethodsFrom January 2018 to January 2023, 795 patients with prostate cancer candidate for IGRT (with or without a history of radical prostatectomy) enrolled in this study. We used three fiducial markers (3*0.6 mm) inserted through an 18-gauge Chiba needle under transrectal ultrasonography (TRUS) guidance. The patients were observed for complications up to seven days after the procedure. Besides, the rate of marker migration was recorded.ResultsAll procedures were completed successfully, and all patients tolerated the procedure well with minimal discomfort. The rate of sepsis after the procedure was 1%, and transient urinary obstruction was 1.6%. Only two patients experienced marker migration shortly after insertion, and no fiducial migration was reported throughout radiotherapy. No other major complication was recorded.DiscussionTRUS-guided intraprostatic FM implantation is technically feasible, safe, and well-tolerated in most patients. The FM migration can seldom occur, with negligible effects. This study can provide convincing evidence that TRUS-guided intra-prostatic FM insertion is an appropriate choice for IGRT.

P-157 Factors associated with success rates and complications of metal stent insertion for left-sided colorectal cancer obstruction

P-157 Factors associated with success rates and complications of metal stent insertion for left-sided colorectal cancer obstruction

Malposition of a pulmonary artery catheter in the left ventricle: a case report

BackgroundPlacement of pulmonary artery catheters may be associated with a variety of complications. We present a case where a pulmonary artery catheter was accidentally advanced into the left ventricle by perforating the intraventricular septum.Case presentationA 73-year-old woman underwent mitral valve dysfunction. A pulmonary artery catheter could not pass the tricuspid valve under general anesthesia, which was manually advanced via the right ventricle during surgery. After valve replacement, systolic pulmonary artery pressure was higher than radial arterial blood pressure. Transesophageal echocardiography (TEE) revealed the tip of the catheter in the left ventricle. The catheter was withdrawn and then advanced to the pulmonary artery under monitoring of TEE. Transseptal shunt flow gradually decreased and finally disappeared. The surgery was completed without additional procedures.ConclusionsAlthough ventricular septal perforation is rare, it should be recognized as a potential complication of pulmonary artery catheter insertion.

Clinical Characteristics Associated With Re-Insertion and Postoperative Complication of Ventilation Tube Insertion in Pediatric Patients

Background and Objectives Otitis media with effusion is a common disease in the pediatric population. When medical treatment fails, ventilation tube insertion (VTI) is the best treatment choice. In this article, we aimed to analyze complications following VTI and evaluate clinical characteristics that increase the possibility of reoperation.Subjects and Method This study retrospective reviewed the medical charts of 287 pediatric patients who underwent VTI in our institute from May 2015 to June 2020. Patients were classified into two groups: the single VTI group, who were operated on once, and the multiple VTI group, who were operated on at least twice. We studied the differences between the two groups regarding patient demographics, the operative method, operative-related data, treatment outcomes, and complications.Results Our study included 181 patients (308 ears), consisting of 114 males (63.0%) and 67 females (37.0%). Among the patients, 141 patients (237 ears) were included in the single VTI group, and 40 patients (71 ears) were included in the multiple VTI group. There was a higher tendency of re-operation for patients whose age was younger at the first operation than for older patients and for those who had underlying diseases such as genetic diseases, developmental delay or language delay. We also found that the retraction state of the tympanic membrane after tube extrusion and earlier extrusion or obstruction of the ventilation tube was statistically significant factors associated with reoperation.Conclusion Our study identified factors affecting the possibility of reoperation. Regular follow-ups are necessary if these factors are present.

A Case of Intrathoracic Hematoma as a Complication of Central Line Insertion in a Case of Abruption of Placenta with IUFD and Situs Invertus

A Case of Intrathoracic Hematoma as a Complication of Central Line Insertion in a Case of Abruption of Placenta with IUFD and Situs Invertus

Complications of Percutaneous Radiologic Gastrostomy Among Patients in a Tertiary Care Hospital in Riyadh, Saudi Arabia.

Percutaneous radiologic gastrostomy (PRG) is the method of choice for patients incapable of ingesting nutrition orally. The complications related to PRG are classified into major and minor complications. This article presents the prevalence of major and minor complications of PRG among adult patients admitted to King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia between 2017 and 2018. This was a retrospective cross-sectional study, which included adult patients who underwent a new PRG intubation between 2017 and 2018 in KAMC in Riyadh, Saudi Arabia. The variables reviewed were the demographics, comorbidities, indications of tube insertion, major and minor complications, and mortality rates. A total of 105 patients who underwent PRG were covered in this study with a mean age of 69.2 + 20.4 years. The most common indications were neurogenic pharyngeal dysphagia (31%) and dementia (29%). Most of the complications reported were minor (40%)and major complications were found in 2%. The percentage of patients with both minor and major complications was 37%. The patients who had no complications made up 21%. Major skin complication was reported in 19 patients (18%), while leakage was the most occurring minor complication found in 49 patients (47%). The 30-day mortality was observed in five patients (5%) and one-year mortality was observed in 21 patients (20%), and none of them were related to the PRG tube. This study found that the PRG procedure had low rates of complications in KAMC. The majority wereminor complications, and the mortality rate was low with none being related to the tube itself. So PRG may be considered to be a relatively safe procedure.

Vascular access device type for systemic anti-cancer therapies: a scoping review protocol

Vascular access devices (VADs) are the most common invasive procedure performed in acute medicine and cancer patients undergo multiple invasive vascular access procedures. Our aim is to identify the type of evidence available regarding the best choice of VAD for cancer patients undergoing systemic anti-cancer therapy (SACT). In this article, the authors frame the scoping review protocol used, which will systematically report all published and unpublished literature around the use of VADs for the infusion of SACT in oncology. For studies to be included, they must focus on people or populations aged 18 years or older and report on vascular access in cancer patients. The concept is the variety of VAD use in cancer and reported insertion and post-insertion complications. The context surrounds the intravenous treatment of SACT whether in a cancer centre or non-cancer setting. The JBI scoping review methodology framework will guide the conduct of this scoping review. Electronic databases (CINAHL, Cochrane, Medline and Embase) will be searched. Grey literature sources and the reference lists of key studies will be reviewed to identify those appropriate for inclusion. No date limits will be used in the searches and studies will be limited to the English language. Two reviewers will independently screen all titles and abstracts and full-text studies for inclusion, and a third reviewer will arbitrate disagreements. All bibliographic data, study characteristics and indicators will be collected and charted using a data extraction tool.

PD35-02 RETROSPECTIVE MULTICENTER ANALYSIS OF LONG-TERM OUTCOMES AFTER ARTIFICIAL URINARY SPHINCTER FOLLOWING URETHROPLASTY

You have accessJournal of UrologyCME1 Apr 2023PD35-02 RETROSPECTIVE MULTICENTER ANALYSIS OF LONG-TERM OUTCOMES AFTER ARTIFICIAL URINARY SPHINCTER FOLLOWING URETHROPLASTY Meghan Davis, Erin Hays, Peter Kolyvas, Margaret Higgins, Derek Wengryn, Brian Flynn, Reynaldo Gomez, Joshua Sterling, Alexander Chartier, Dmitriy Nikolavsky, Akio Horiguchi, Matthias Hofer, Jose Bernal, Francisco Martins, Felix Campos Juanatey, Henriette Veiby Holm, Jay Simhan, Stuart Boyd, Javier Angulo, Jeffrey Loh Doyle, and Krishnan Venkatesan Meghan DavisMeghan Davis More articles by this author , Erin HaysErin Hays More articles by this author , Peter KolyvasPeter Kolyvas More articles by this author , Margaret HigginsMargaret Higgins More articles by this author , Derek WengrynDerek Wengryn More articles by this author , Brian FlynnBrian Flynn More articles by this author , Reynaldo GomezReynaldo Gomez More articles by this author , Joshua SterlingJoshua Sterling More articles by this author , Alexander ChartierAlexander Chartier More articles by this author , Dmitriy NikolavskyDmitriy Nikolavsky More articles by this author , Akio HoriguchiAkio Horiguchi More articles by this author , Matthias HoferMatthias Hofer More articles by this author , Jose BernalJose Bernal More articles by this author , Francisco MartinsFrancisco Martins More articles by this author , Felix Campos JuanateyFelix Campos Juanatey More articles by this author , Henriette Veiby HolmHenriette Veiby Holm More articles by this author , Jay SimhanJay Simhan More articles by this author , Stuart BoydStuart Boyd More articles by this author , Javier AnguloJavier Angulo More articles by this author , Jeffrey Loh DoyleJeffrey Loh Doyle More articles by this author , and Krishnan VenkatesanKrishnan Venkatesan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003333.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The artificial urinary sphincter (AUS) is generally accepted as the gold standard for male stress urinary incontinence (SUI). There is limited and conflicting evidence on outcomes when urethroplasty precedes AUS insertion, and even less scrutiny of whether and how urethroplasty technique affects these outcomes. We sought to evaluate complications of AUS insertion after urethroplasty in a multi-institutional cohort. We hypothesize that complications occur at higher rates in this population and vary between augmentation and anastomotic urethroplasty. METHODS: 108 patients were identified who underwent AUS after urethroplasty. Demographic and clinical variables were analyzed. Urethroplasties were categorized as either transecting or non-transecting. Long term complications included AUS infection, erosion, and mechanical failure. Analysis was performed using Stata/BE 17.0. For descriptive statistics, continuous variables were presented as the mean or median and categorical variables were presented as absolute numbers and percentages. Chi squared test was used for categorical variables. Tests performed were two-sided and p<0.05 was considered to indicate statistical significance. RESULTS: 108 cases were identified that were performed by 13 surgeons (range 2-26). Characteristics of the sample are included in Table 1. Long term AUS complication risk including AUS infection, erosion, and mechanical failure following transecting urethroplasty was 53% compared to 29% following non-transecting urethroplasty (p=0.01). Among 59 patients who had non-transecting urethroplasty, 10 experienced erosion, 3 infection, and 3 mechanical failure. Among 49 patients who had transecting urethroplasty, 16 experienced erosion and 10 mechanical failure. Median follow-up was 30 months following AUS insertion. CONCLUSIONS: For patients undergoing AUS insertion after urethroplasty, complications occur at higher rates than outcomes in the general population. Patients who undergo transecting urethroplasty are twice as likely to experience AUS complications compared to patients who had undergone non-transecting urethroplasty. Non-transecting urethroplasty may be advisable if a subsequent need for AUS is anticipated. Source of Funding: N/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e974 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Meghan Davis More articles by this author Erin Hays More articles by this author Peter Kolyvas More articles by this author Margaret Higgins More articles by this author Derek Wengryn More articles by this author Brian Flynn More articles by this author Reynaldo Gomez More articles by this author Joshua Sterling More articles by this author Alexander Chartier More articles by this author Dmitriy Nikolavsky More articles by this author Akio Horiguchi More articles by this author Matthias Hofer More articles by this author Jose Bernal More articles by this author Francisco Martins More articles by this author Felix Campos Juanatey More articles by this author Henriette Veiby Holm More articles by this author Jay Simhan More articles by this author Stuart Boyd More articles by this author Javier Angulo More articles by this author Jeffrey Loh Doyle More articles by this author Krishnan Venkatesan More articles by this author Expand All Advertisement PDF downloadLoading ...

Monofilament Suture Versus Braided Suture Thread to Improve Pregnancy Outcomes After Vaginal Cervical Cerclage (C-STICH): A Pragmatic Randomized, Controlled, Phase 3, Superiority Trial

ABSTRACT Preterm birth complicates approximately 10% of pregnancies worldwide. It can lead to neonatal mortality or lifelong complications for those babies who survive. One cause of preterm birth is cervical insufficiency, which affects up to 1% of pregnant women and can be treated with the placement of vaginal cervical cerclage. There are 2 techniques for cervical cerclage: the modified Shirodkar cerclage, which involves dissecting the bladder and placing a suture around the supravaginal cervix with the suture thread buried, and the McDonald cerclage, which involves inserting the suture thread as high as possible around the upper section of the cervix. The effectiveness of either technique is dependent on perioperative decisions, such as suture thread choice. One UK survey found that 87% of clinicians prefer to use braided thread, with 13% preferring monofilament thread. The preference for braided thread was due to its easy handling and concerns that monofilament thread is difficult to remove if it becomes embedded in the cervix. However, an observational, nonrandomized systemic review suggested that monofilament thread was better than braided thread to prevent pregnancy loss (7% vs 18.9%; risk ratio [RR], 0.34; 95% confidence interval [CI], 0.18–0.63). Additional evidence suggests that monofilament thread is superior because braided thread could serve as a reservoir for bacteria, causing vaginal dysbiosis and increasing the risk of pregnancy loss. There are no randomized clinical trials to inform the choice of suture thread to prevent pregnancy loss. The aim of this study was to compare the effectiveness of monofilament suture thread to braided suture thread on pregnancy loss in women undergoing cervical cerclage. This was a superiority randomized clinical trial, conducted at 75 obstetric units in the United Kingdom between August 21, 2015, and January 28, 2021. Included were women aged 18 years and older with singleton pregnancies, who required vaginal cervical cerclage. Excluded were women who required emergency or rescue cerclage, needed immediate suture insertion, or had ruptured or visible membranes, as well as those who did not have a cerclage placed vaginally. Eligible women were randomized to receive either monofilament thread or braided thread. Women were followed up until 28 days postdelivery or hospital discharge, whichever came first. Preterm neonates were followed up until delivery or discharge, and babies born at term were followed up 28 days postdelivery or hospital discharge, whichever came first. A total of 2049 women were randomized to the monofilament suture thread group (n = 1025) or the braided suture thread group (1024). The intention-to-treat analysis included 1003 women in the monofilament group and 993 women in the braided group. No significant differences were observed in the rate of pregnancy loss between the monofilament group and braided group (8% vs 7.6%, respectively; RR, 1.05; 95% CI, 0.79–1.40; adjusted risk difference, 0.002; 95% CI, −0.02 to 0.03; P = 0.73). Insertion complications occurred in 4% of women in the monofilament group and 3% in the braided suture group. Women in the monofilament group experienced more removal complications than the braided group (RR, 1.25; 95% CI, 1.15–1.36). No significant differences were observed in maternal secondary outcomes or neonatal outcomes. In conclusion, there was no difference in the rate of pregnancy loss when using monofilament suture thread or braided suture thread in women undergoing cervical cerclage.

Use of point-of-care ultrasound and serial FAST as a monitoring tool for the removal of an ectopic chest tube in liver

Common complications of chest tube insertion are lung laceration, chest wall bleeding, improper tube positioning, and subcutaneous emphysema. However, a penetrating injury of the upper abdominal organs due to chest tube malposition is rare. A 33-year-old suffered multiple injuries in a road traffic accident. Due to the respiratory distress caused by right-sided hemothorax, an intercostal chest drain (ICD) was inserted, which drained 500 ml of venous blood, followed by hemodynamic instability. The post-procedural chest radiograph revealed a lower chest tube position within the liver shadow. As the patient was hemodynamically stable, it was decided to delay the removal of the ectopic ICD, and the patient was kept under close monitoring. After 7 days, ICD removal was done under ultrasound guidance, and a post-procedural serial-focused assessment with sonography for trauma (FAST) was done. Hepatic injury secondary to chest tube insertion is rare, and its management is not standardised. Point-of-care ultrasound has not been used before for the removal of an ectopic ICD. We managed the case conservatively because of the stable hemodynamic situation of the patient and to avoid invasive surgery as possible. Point-of-care ultrasound can be a valuable tool in these conditions where other imaging modalities such as CT are not available and help avoid surgery.

Implementation of Intravenous Catheter Treatment to Prevent Phlebitis: A Cross-Sectional Study

Peripheral vein cannulation is commonly performed for rapid and accurate administration of medications. Phlebitis is the most common complication of intravenous catheter insertion. This study aims to investigate the implementation of intravenous catheter care to prevent phlebitis that was implied on a patient's cannulation conditions. This study was a cross sectional observational study conducted on patients at a hospital in Bali. Study conducted on 35 patients who were admitted to inpatient ward of the hospital in April 2022. The factors studied were age, gender, site of insertion, precision of dressing, dressing integrity, date on dressing, administration set integrity, date on administration set, and VIP score documentation. The results show that the mean age of the patient was 45.31 years old and 60% of the patients were men. 48,6% cannula was inserted in the movement area (wrist and ankle) while only 51,4% dressing was used properly so cannulation sites can be observed. All dressing were intact, dry and clean, but only 48.6% cannulation date documented on the dressing. Majority the administration sets were in good performance (94.3%) but there were only 31,4% with the installation date. The monitoring of peripheral vein cannulation using VIP score has not been widely applied (11,4%). Further intervention is needed to improve adherence to peripheral vein cannulation care so that phlebitis can be prevented optimally.

Catheter insertion techniques for improving catheter function and clinical outcomes in peritoneal dialysis patients.

Catheter insertion techniques for improving catheter function and clinical outcomes in peritoneal dialysis patients.

Comparison of oropharyngeal leak pressure of I-gelTM and BlockbusterTM laryngeal mask airway in anaesthetized pediatric patients.

Supraglottic airways (SGA) are increasingly used in pediatric anesthesia.Among SGA, I-gelTM is a commonly used device in pediatric patients. The BlockbusterTM laryngeal mask airway (LMA) is latest addition in pediatric airway armamentarium. This studywas conducted to compare the clinical performance of I-gelTM and BlockbusterTM LMA in pediatric patients. A total of 140 children aged 1-5 years, who were undergoing elective surgery,were randomized into two groups either I-gelTM (Group I) or BlockbusterTM LMA (Group B). Airway was secured with appropriate-sized LMA according to group allocation under generalanesthesia. The primary objective of study was oropharyngeal leak pressures (OPLP), andsecondary objectives were number of attempts of device insertion, success rate, ease ofLMA insertion, hemodynamic parameters, and postoperative pharyngolaryngeal morbidities. The mean OPLP was significantly higher for I-gelTM compared to BlockbusterTM LMA(27.97 ± 1.65 vs. 26.04 ± 2.12; P < 0.001). The devices were successfully inserted on thefirst attempt in 97.14% and 90% of the Group I and Group B respectively. The insertion time,ease of insertion, hemodynamic parameters and postoperative complications were comparable between groups. The I-gelTM was more efficacious device in term of OPLP than BlockbusterTMLMA for positive pressure ventilation in pediatric patients undergoing short surgical procedures under general anesthesia.

Use of device-assisted enteroscopy in small bowel disease: an expert consensus statement by the Korean Association for the Study of Intestinal Diseases.

The introduction of device-assisted enteroscopy (DAE) in the beginning of 21st century has revolutionized the diagnosis and treatment of diseases of the small intestine. In contrast to capsule endoscopy, the other main diagnostic modality of the small bowel diseases, DAE has the unique advantages of observing the region of interest in detail and enabling tissue acquisition and therapeutic intervention. As DAE becomes an essential procedure in daily clinical practice, there is an increasing need for correct guidelines on when and how to perform it and what technical factors should be considered. In response to these needs, the Korean Association for the Study of Intestinal Diseases developed an expert consensus statement on the performance of DAE by reviewing the current evidence. This expert consensus statement particularly focuses on the indications, choice of insertion route, therapeutic intervention, complications, and relevant technical points.

Use of Device-Assisted Enteroscopy in Small Bowel Disease: An Expert Consensus Statement by the Korean Association for the Study of Intestinal Diseases

The introduction of device-assisted enteroscopy (DAE) in the beginning of the 21st century has revolutionized the diagnosis and treatment of diseases of the small intestine. In contrast to capsule endoscopy, the other main diagnostic modality of small bowel diseases, DAE has the unique advantages of allowing the observation of the region of interest in detail and enabling tissue acquisition and therapeutic intervention. As DAE becomes an essential procedure in daily clinical practice, there is an increasing need for correct guidelines on when and how it is to be performed and what technical factors should be taken into consideration. In response to these needs, the Korean Association for the Study of Intestinal Diseases has developed an expert consensus statement on the performance of DAE by reviewing current evidence. This expert consensus statement particularly focuses on the indications, choice of insertion route, therapeutic intervention, complications, and relevant technical points.