Dual-lumen Catheter Research Articles

Insertion, Maintenance, and Removal of the Percutaneous Dual Lumen Cannula Right Ventricular Assist Device.

Right ventricular (RV) shock, classically characterized by elevated central venous pressure (CVP) withnormal to low pulmonary artery (PA) and pulmonary capillary wedge pressures (PCWP),remains a significant cause of morbidity and mortality worldwide if left untreated.Therapies for the treatment of RV shock rangefrom medical management to durable or percutaneous mechanical circulatory support (MCS). A unique MCS device, a percutaneous right ventricular assist device (pRVAD), approved for use by the Food and Drug Administration (FDA) in 2014, works by temporarily off-loading the RV through a single, dual lumen catheter with extracorporeal mechanical support and is capable of shunting blood from the right atrium (RA) to the main PA. Although initially approved as venous-venous extracorporeal membrane oxygenation (VV-ECMO) device, this work will focus on the use of RV support, as ambulatory VV-ECMO strategies have been described previously. The catheter is most commonly inserted through the right internal jugular (IJ) vein into the PA and connected to an external pump, allowing flow up to 5 L/min. This device may be an attractive choice for the treatment of RV shock due to its percutaneous, minimally invasive insertion and removal and its ability to allow patient ambulation while the device is in place. This protocol discusses in detail the equipment, hemodynamic effects, indications, contraindications, complications, currently available research in the literature, and step-by-step instructions on how to implant, manage, and extract the device, along with the guidance on use and troubleshooting complications from one of the largest, single-center experiences with the device.

Ventilation through a straw.

Transtracheal jet ventilation can be used for resuscitation of partial airway obstruction. A prerequisite for jet ventilation is that at least a minimum airway opening for gas escape must be secured. Therefore, another option should be considered in cases of complete airway obstruction. The following methods or devices has been used under cricothyrotomy using an intravenous cannula: 1) Ambu (bag valve mask) bagging, 2) Ventrain®, 3) Rapid-O2 oxygen insufflation device (Rapid-O2), and 4) jet ventilation using a dual lumen catheter. During Ambu bagging, extraordinarily high insufflation pressure is required to force oxygen through the cannula. When using a 12-G cannula, long and slow positive-pressure ventilations (10–12 breaths/min) are required, which makes it extremely difficult to compress the bag. Therefore, a 10-G or larger is recommended. Ventrain® is an expiratory assist device capable of forcibly expelling insufflated oxygen through a transtracheal cannula. It is recommended to adjust the inspiratory and expiratory times while observing the chest wall movements. Rapid-O2 is a rescue oxygenation device with adequate ventilation of less importance; therefore, the resulting hypercarbia is inevitable. A 14-G cannula is used. Lastly, jet ventilation using a dual-lumen catheter with a 16-G inflow lumen and 10-G outflow lumen was used to obtain both oxygenation and ventilation. However, the addition of the outer diameters of 16-G and 10-G results in an outer diameter of 5.1 mm, which is too large to puncture the cricothyroid membrane. In conclusion, Ventrain® is considered the most ideal device for use among the devices developed to date.

Iatrogenic pseudoaneurysm of the middle meningeal artery during embolization of bilateral chronic subdural hematomas.

Summary/AbstractMiddle meningeal artery embolization has become an important treatment option for chronic subdural hematomas. While the treatment is safe, we present a unique case of development of an iatrogenic middle meningeal artery pseudoaneurysm during endovascular embolization with use of a dual-lumen balloon catheter used for injection of a liquid embolic agent. A 62-year-old man on Coumadin for portal vein thrombosis presented to the hospital with headache and supratherapeutic INR. Imaging revealed bilateral acute on chronic subdural hematomas. Given his medical comorbidities he underwent endovascular middle meningeal artery embolization. During the embolization, angiography revealed a pseudoaneurysm of the middle meningeal artery related to use of a dual-lumen balloon catheter. This pseudoaneurysm was successfully treated with ethylene vinyl alcohol embolization. Intracranial pseudoaneurysm related to balloon catheter use is a rare cause of iatrogenic pseudoaneurysm and could lead to life-threatening intracranial bleeding. Therefore, recognition and timely treatment are important.

The effect of prolonged laser activation on irrigation fluid temperature: an in vitro experimental study

To investigate the effect of prolonged laser activation on irrigation fluid temperature by varying the power settings flow rate (10-30ml/min). An experimental study using a 20ml syringe, 12/14 ureteral access sheath, a dual-lumen catheter and a thermocouple was performed. The laser was fired with 12W (0.3J × 40Hz), 40W (1J × 40Hz), 60W (1.5J × 40Hz) using Quanta Ho 150W (Quanta System, Samarate, Italy). All trials were performed with fluid outflow rate of 10, 20 and 30ml/min with the fixed fluid volume at 10ml. Continuous laser activation for 10min with the outflow rate of 10ml/min using only 12W resulted to continuous temperature rise to as high as 83°C. Similar rise of temperatures were observed for 40W and 60W with 10ml/min outflow rate with intermittent laser activation. With 20 and 30ml/min outflow rates the maximum temperatures for all power settings were below the threshold (< 43°C). However, the time to reach the same total emitted energy was 60% and 40% shorter 60W and 40W, respectively. Our study found that continuous laser activation with as less as 12W using 10ml/min outflow rate increased the irrigation fluid temperature above the threshold only after 1min. In the current experimental setup, with the fluid outflow rate of 20 and 30ml/min safe laser activation with 60W and 40W (temperature < 43°C) can be achieved reaching the same total emitted energy as with 12W in significantly shorter time period.

803 Extracorporeal Filtration of Blood and Blood Breakdown Products from CSF via Spinal Catheter (PILLAR-XT) Following Aneurysmal Subarachnoid Hemorrhage

INTRODUCTION: Delayed cerebral ischemia (DCI) is a secondary injury of aneurysmal subarachnoid hemorrhage (aSAH), and is considered to be related to blood and blood breakdown products (BBPs) in the CSF. Previously, bulk drainage of CSF post-aSAH via lumbar drain appeared to result in decreased DCI. If inflammation related to BBPs plays a role in DCI, accelerating removal of BBPs following aSAH could be of significant therapeutic benefit. This study evaluated a system designed to accelerate removal by rapidly filtering BBPs from CSF while returning filtered CSF to the patient via a dual lumen catheter and extracorporeal filtration system (Neurapheresis™ System). METHODS: Patients with aSAH had a dual lumen lumbar, intrathecal catheter placed after aneurysm securement and received up to 72±4 hours Neurapheresis therapy. The catheter aspirated blood-contaminated CSF from the lumbar cistern and returned filtered CSF to the thoracic subarachnoid space, routing BBPs to a waste bag. RESULTS: Of 7 males (24.1%) and 22 females (75.9%), a catheter was successfully placed in 27 subjects out of 29 attempts (93.1% success rate. The mean duration of treatment was 34:18 hrs [3:39 – 62:17] (n=27), and the system maintained its expected, controlled, safe drainage rate, mean 6.5 ml/hr [2.1 – 12.5] (n=27). Mean paired RBC values in CSF (106/mm3) declined by 84.5±22.3% (n=21) by the end of treatment. Mean paired total protein (mg/dL) declined by 85.3±8.3% (n=21) to within normal range. Paired Hijdra Sum Scores (sum of ten cistern blood fullness scores - maximum score: 30) declined by 60.1±24.1% (n=25); the largest decline was noted between catheter placement and catheter removal. CONCLUSIONS: In this feasibility study, Neurapheresis was associated with a decline in RBC and protein concentration in CSF, and improvement in blood clearance as measured by Hijdra Sum Scores. The procedure was safe and well tolerated in this study.

Locked dual-lumen catheter technique in percutaneous coronary intervention of chronic total occlusion.

Locked dual-lumen catheter technique in percutaneous coronary intervention of chronic total occlusion.

Initial experience with the Scepter Mini catheter for the embolization of vascular malformations in the pediatric population.

Achieving distal access and flow control are of significant importance for the treatment of intracerebral arteriovenous shunting lesions. The Scepter Mini catheter is a low-profile, dual-lumen balloon catheter, designed to provide navigability in small-caliber, tortuous intracranial vessels. To describe the initial experience of the Scepter Mini catheter in the treatment of pediatric arteriovenous malformations and fistulas. A single-institution, retrospective chart review identified all consecutive uses of the Scepter Mini catheter for endovascular embolization of vascular malformations in the pediatric population. Three different arterial pedicles were embolized with the Scepter Mini catheter in two different patients. One patient was diagnosed with a vein of Galen malformation that had undergone multiple treatments and the other with a torcular dural arteriovenous fistula. All cases encompassed quite challenging tortuosity of small-caliber feeders which prevented the use of another microcatheter. The Scepter Mini catheter navigated into feeding arteries of diameters 0.65, 1.9, and 1.25 mm, and its balloon was inflated to achieve excellent blood flow control. Total obliteration (100%) of the shunting lesion was achieved in both cases. No reflux, pedicle rupture or other untoward effects were observed. Both patients had an uneventful recovery. The Scepter Mini catheter afforded fast and safe distal access, flow control, and treatment of arteriovenous malformations in this initial pediatric cohort. The catheter's low profile and easy navigability should support its use in tortuous and small arterial feeders, especially in the pediatric population.

Eleven Years of Venovenous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: From H1N1 to SARS-CoV-2. Experience and Perspectives of a National Referral Center

ObjectiveDespite growing expertise and wide application of venovenous extracorporeal membrane oxygenation (VV ECMO) treatment for acute respiratory distress syndrome (ARDS) of different origin and during pandemics (H1N1 Influenza A virus and SARS-CoV-2), large reports are few and pertain mostly to multicenter registries, and randomized trials are difficult to perform. The aim of this study was to report outcomes, trends, and innovations of VV ECMO treatment over the last 11 years.Design, Setting, and ParticipantsObservational study on 142 patients treated at the IRCCS San Raffaele Hospital in Milan from June 2009 (year of the H1N1 pandemic) to May 2020 (SARS-CoV-2 pandemic).InterventionsNone.Measurements and Main ResultsThe main causes of ARDS were H1N1 pneumonia in 36% of patients, bacterial pneumonia in 17%, and SARS-CoV-2 in 9%. Seventy-two percent of patients were centralized from remote hospitals, of whom 33% had implanted VV ECMO before transport. The most common cannulation strategy was the dual-lumen catheter cannulation system (55%), and anticoagulation was performed with bivalirudin in most patients (79%). Refractory hypoxia was treated with intravenous beta-blockers (64%), nitric oxide (20%), and pronation (8%). Almost one-third of patients (32%) were extubated while on ECMO. Forty-nine percent of patients were discharged from the intensive care unit, and hospital discharge was 46%; survival was lower in patients requiring VV ECMO for more than three weeks compared with shorter support duration (23% v 56%, p = 0.007). Anticoagulation with bivalirudin was associated with higher survival, compared with heparin (55% v 31%, p = 0.03), and lower thrombocytopenia incidence (69% v 35%, p = 0.003).ConclusionVV ECMO is the pivotal rescue treatment for refractory ARDS—timely treatment and optimal care are needed to optimize therapy, as duration of support is associated with outcome. Anticoagulation with bivalirudin may improve outcome.

Active Cerebrospinal Fluid Exchange System for Treatment of Pyogenic Ventriculitis

ABSTRACT BACKGROUND Despite recent advances in antibiotic treatment, pyogenic ventricular brain infections are still associated with adverse clinical outcome in 80% of affected patients and mortality rates approaching 60%. The limitation of antibiotic penetration into the cerebrospinal fluid (CSF) challenges the treatment. Intrathecal treatment remains an option for adjunctive therapy to intravenous (iv) antibiotics when the iv therapy fails to sterilize the CFS. Current treatment options do not allow for changing the CSF composition without adversely affecting intracranial pressure (ICP) and power of hydrogen (pH). OBJECTIVE To investigate if CSF composition exchange has impact on ventriculitis patients. METHODS We report 2 cases with pyogenic ventriculitis treated with a new intracranial active fluid exchange system that consists of a dual-lumen catheter to facilitate irrigation and drainage coupled with an intelligent digital pump. RESULTS This new technique allowed us to change the composition of CSF to an antibiotic-consisted fluid. This resulted in the ability to directly modify the concentration of the targeted antibiotics in the CSF, while simultaneously removing bacterial mass without harming brain tissue and controlling ICP and pH. CONCLUSION Our reported experience shows that drainage of purulent fluid caused by healthcare-associated ventriculitis or meningitis is now possible without harming brain tissue and ICP while also changing the composition of CSF to an antibiotic-consisted fluid. Actively removing pus and altering CSF in this manner had an impact on infection treatment and antibiotic penetration. Further cases are needed to confirm that our treatment algorithm is correctly tailored to assist clinicians in reliably treating this catastrophic condition.

Abstract No. 118 A multicenter observational study to determine the incidence of catheter-related venous thrombosis using a novel antimicrobial and anti-thrombogenic peripherally inserted central catheter

This study evaluated the impact of a novel antimicrobial and antithrombogenic peripherally inserted central catheter (PICC) and its impact on associated complications within inpatient and outpatient populations. Various strategies are used in an attempt to decrease the incidence of catheter-related complications. This IRB-approved, multicenter, prospective observational study was performed at 3 large US academic hospitals. Adults who required PICC ≥14 days were considered. Patients were monitored throughout entire catheter dwell, to a maximum of 90 days. Data was collected from hospital, outpatient and patient PICC records. Duplex venous ultrasounds were performed for thrombosis before insertion, dwell day 10-14 and upon removal. 103 patients were enrolled through interventional radiology teams; 56% were male, mean BMI was 29 ± 8.8. Majority (79%) were high-risk groups—cancer, infectious diseases, transplant, and trauma. Primary indications were antibiotics (66.99%) and chemotherapy (25.24%). Double lumen PICCs (59%) and basilic vein (71.84%) were highest selected. Fourteen (13.5%) remained inpatients, (46.6%) were discharged to home health, (20.38%) to outpatient therapy, and (19.4%) into family care. Seven (6.8%) were lost to follow-up. Mean catheter dwell was 38.74 ± 25.81 days (n = 96); Eight (7.7%) PICCs remained indwelling and functional at day 90. Three (2.9%) CRBSIs were reported at days 14, 27, and 60 and were all dual-lumen catheters (59.2%). Seven (6.8%) reported symptomatic catheter-related thromboses (CRT) and 2 (28.5%) used a standardized catheter-vessel ratio vein measurement. Several patients with asymptomatic CRT at the initial screening had complete thrombosis resolution on follow-up scanning at removal. The incidence of CRBSI was 0.81/1000 days, compared to currently reported rates of 1.8–7.7/1000 days . The overall symptomatic CRT rate was 1.87/1000 days. Evans et al (2013) reported symptomatic CRT rates of 2.7–4.3/1000 days. The focus on patient harm and safety have contributed to the implementation of infection prevention and thrombosis-reduction strategies. Antimicrobial PICCs should be considered for use in high-risk populations.

Novel Dual-Lumen Drainage Catheter to Enhance the Active Evacuation of Complex Fluid Collections

PurposeTo compare the performance of a dual-lumen flushable drainage catheter to a conventional catheter for complex fluid collection drainage. MethodsTwo prototype catheters (20- and 28-F) were created by incorporating a customized infusion lumen within the wall of a large-bore conventional drainage catheter, which facilitated simultaneous irrigation of the drainage lumen and the targeted collection via inward- and outward-facing infusion side holes. These were tested against unaltered 20- and 28-F conventional catheters to determine if the injection of a dedicated flush lumen improved rapidity and completeness of gravity drainage. In vitro models were created to simulate serous fluid, purulent/exudative fluid, particulate debris, and acute hematoma. ResultsIn the purulent model, mean drainage rate was 19.9 ± 8.0 and 9.5±1.4 mL/min for the 20-F prototype and control (P < .001) and 63.9 ± 4.3 and 35.4 ± 3.4 mL/min for the 28-F prototype and control (P = .006), respectively, with complete drainage achieved in all trials. In the particulate model, mean drainage rate was 24.5 ± 9.7 and 12.0 ± 12.5 mL/min for the 28-F prototype and control (P = .003), respectively, with 69.0% versus 41.1% total drainage achieved over 24 minutes (P = .029). In the hematoma model, mean drainage rate was 22.7 ± 4.6 and 4.8 ± 4.3 mL/min for the 28-F prototype and control (P = .022), respectively, with 80.3% versus 20.1% drainage achieved over 15 minutes (P = .003). Particulate and hematoma 20-F prototypes and conventional trials failed due to immediate occlusion. ConclusionsThe proposed dual-lumen drainage catheter with irrigation of a dedicated flush lumen improved evacuation of complex fluid collections in vitro.

A case of configuration change using dual lumen catheter during veno venous-ECMO

A case of configuration change using dual lumen catheter during veno venous-ECMO

Usefulness and pitfalls of dual lumen catheter in veno venous-ECMO treatment

Usefulness and pitfalls of dual lumen catheter in veno venous-ECMO treatment

Scepter dual\u2010lumen balloon catheter for Onyx embolization for dural arteriovenous fistula

BackgroundThis study aimed to evaluate the efficacy and safety of Scepter dual-lumen balloon catheter for transarterial Onyx embolization of dural arteriovenous fistula (DAVF).MethodsTransarterial Onyx embolization using a Scepter dual-lumen balloon catheter (Scepter-assisted Onyx embolization) for DAVF was attempted in a total of 35 patients (mean age, 52.5 years; M:F = 24:11) between October 2012 and December 2018. The results of Scepter-assisted Onyx embolization were evaluated with respect to total procedural and Onyx injection times, the types and number of feeders requiring embolization, angiographic and clinical outcomes, and treatment-related complications.ResultsInitial presentations were non-hemorrhagic neurological deficits in 10, intracranial hemorrhage in 8, seizure in 7, headache in 7, and intractable tinnitus in 3. All DAVF were aggressive type (Borden type 2, 14.3 %; type 3, 85.7 %). Scepter-assisted Onyx embolization resulted in immediately complete occlusion in 33 patients (94.3 %) and near complete occlusion in 2 patients. Middle meningeal artery (51.4 %) was the most commonly used for Scepter-assisted technique, followed by occipital artery (42.9 %), ascending pharyngeal artery (2.9 %) and superficial temporal artery (2.9 %). There was no difference in complete occlusion rate between middle meningeal artery and the other arteries (94.4 % versus 94.1 %). The median number of total feeders embolized was 1 (range, 1–3). The median total procedural time was 45 minutes (range, 21 minutes – 127 minutes) and the median Onyx injection time was 11 minutes (range, 3 minutes – 25 minutes). All patients recovered completely (n = 31) or partially (n = 4) from presenting symptoms. Treatment-related complications occurred in 2 patients, of whom one had a permanent morbidity (2.8 %, ipsilateral facial nerve palsy). No patient showed a recurrence on follow-up imaging (median, 15 months; range, 3–56 months).ConclusionsScepter-assisted transarterial Onyx embolization showed a very high complete occlusion rate with a low morbidity and no recurrence in aggressive type DAVF. Scepter dual-lumen balloon catheter seems to be a useful tool for transarterial Onyx embolization of DAVF.

A comparison of dual-lumen balloon and simple microcatheters in the embolization of DAVFs and AVMs using onyx

Endovascular embolization of arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs) has become the mainstay in treatment for these pathologies. Traditional techniques required the formation of a proximal plug of Onyx around the microcatheter prior to embolization to avoid reflux. Recently, dual-lumen balloon catheters have been introduced as a potential solution to this issue. We sought to compare our institutional experience with dual-lumen balloons to traditional microcatheters in the endovascular embolization of AVMs and DAVFs. A retrospective analysis of consecutive patients treated with Scepter between 2016 and 2020 was obtained. A control cohort treated with Marathon between 2012 and 2020 was also obtained. Variables collected included patient demographics, procedure times, pedicles treated, operative complications, obliteration rate, and retreatment rate. A total of 44 trial (30 DAVFs and 14 AVMs) and 25 control (15 DAVFs and 10 AVMs) subjects were identified. Average Scepter procedure times were 66.0 and 68.0 min for DAVFs and AVMs, respectively. Average Scepter volume of Onyx injected was 2.2 and 1.4 mL for DAVFs and AVMs, respectively. Complete angiographic occlusion Scepter rate was 86.7% and 50.0% for DAVFs and AVMs, respectively. The Scepter retreatment rate was 13.3% and 50.0% for DAVFs and AVMs, respectively. Predictors of angiographic occlusion included the number of pedicles (OR 0.54, 95%CI 0.30–0.97, p = 0.04). Predictors of retreatment included DAVF (OR 0.16, 95%CI 0.04–0.66, p = 0.01) and Marathon (OR 3.34, 95%CI 1.00–11.56, p = 0.05). Our study shows that dual-lumen balloon catheters are a viable option in the embolization of DAVFs and AVMs.

Long-term follow-up of transarterial balloon-assisted Onyx embolization for endovascular treatment of dural arteriovenous fistulas: A single-institution case series and literature review

ObjectiveDural arteriovenous fistulas (DAVFs)—specifically, symptomatic DAVFs with cortical venous reflux—are aggressive lesions with a poor prognosis. Intra-arterial endovascular closure is considered the optional treatment for DAVFs and is currently performed at several international centers. However, long-term outcomes remain unknown. This study investigated the long-term efficacy and safety of transarterial balloon-assisted Onyx embolization in the treatment of DAVFs. MethodsA total of 14 consecutive patients who underwent endovascular treatment for DAVFs were treated by balloon-assisted Onyx embolization. Additionally, we retrospectively reviewed all cases reported in the literature and compared the outcomes of patients treated with single- vs dual-lumen microcatheters. ResultsThe patients at our institution were followed-up for 114.57 ± 33.52 months. Embolization was performed by balloon-assisted Onyx injection via a single feeding artery. Complete occlusion was achieved in 13 cases and partial occlusion in 1 case. At the final follow-up, all patients were functionally independent (Modified Rankin Scale score of 0–2), with no recurrence. In our review of 70 published cases of DAVFs that underwent endovascular treatment by balloon-assisted Onyx embolization, single- and dual-lumen balloon catheters were used in 33 and 37 patients, respectively. In the former group, there was complete or near-complete occlusion in 32 cases and partial occlusion in 1 case; and in the latter, there was complete or near-complete occlusion in 35 cases and partial occlusion in 2 cases. There were no deaths following endovascular treatment. ConclusionMeasurable and durable outcomes can be achieved by endovascular treatment of DAVFs with the transarterial balloon-assisted Onyx embolization technique, especially in cases with small, distal, and circuitous feeding arteries.

S1308 Mucolytic Treatment of Small Bowel Aspirates Improves Symptom Correlation and Identification of Small Intestinal Bacterial Overgrowth Based on Culture and 16S rRNA Gene Sequencing

INTRODUCTION: Small intestinal bacterial overgrowth (SIBO) is defined by abnormal and excessive numbers of bacteria in the small bowel. As the viscosity of small bowel aspirates makes assessing the full microbiome profile by next generation sequencing difficult, we have used the mucolytic agent dithiothreitol (DTT) to reduce aspirate viscosity. In this study, we assessed the use of DTT in the identification and analysis of microbiome profiles in SIBO and non-SIBO subjects. METHODS: Gastrointestinal symptoms were assessed by questionnaire as part of the REIMAGINE (Revealing the Entire Intestinal Microbiota and its Associations with the Genetic, Immunologic, and Neuroendocrine Ecosystem) study. Duodenal aspirates were collected using a novel sterile dual-lumen aspiration catheter, and a subset were treated with DTT. All samples were cultured on MacConkey agar (MAC). DNA was isolated using the MagAttract PowerSoil DNA Kit. Microbiota were analyzed by 16S rRNA sequencing. Operational Taxonomic Units clustering and taxonomic analysis were performed with CLC Microbial Genomics Module v. 2.5. Statistical analysis was performed in R 3.6.0. RESULTS: Of 239 samples, 117 (79 non-SIBO and 38 SIBO, based on culture results) were treated with DTT and the remaining 122 samples (100 non-SIBO and 22 SIBO) were not treated with DTT. Overall microbiome profiles were similar in DTT (Figure 1A) and non-DTT (Figure 1B) samples. DTT-treated samples were better able to cluster subjects into SIBO and non-SIBO groups based on symptoms than non-DTT samples (P = 0.0001) (Figure 1C & D). DTT samples exhibited different relative abundances of several microbial taxa (Figure 2). Genus Klebsiella was more abundant in SIBO subjects (log fold change (LFC) = 7.167183, P < 0.0001), as was family Enterobacteriaceae (LFC = 3.631824, P < 0.0001). Using DTT-treated samples showed significant differences in bloating (P = 0.0618), diarrhea (P = 0.0065), urgency (P = 0.0274) and rectal mucous discharge (P = 0.0258) in SIBO and non-SIBO subjects. Absence of all 4 cardinal SIBO symptoms ruled out SIBO (specificity = 100%) based on culture in DTT-treated samples (sensitivity = 36.54%). CONCLUSION: While not changing the overall microbiome profile, using DTT improves the accuracy of culture results and identification of SIBO by sequencing, and better differentiates SIBO-related symptoms. Therefore, mucolytic treatment appears to be a crucial step in assessing the small bowel microbiome.Figure 1.: Overall microbiome relative abundance distribution of DTT-treated aspirate samples (A) and non-DTT-treated aspirate samples (B). Principal Coordinates Analysis of Bray Curtis distance between non-DTT (C) and non-DTT samples (D) (β-diversity analysis), colored by SIBO condition. P-value for the PERMANOVA test for the differentiation between groups in DTT data is 0.001, indicating significant separation between SIBO and non-SIBO patient.Figure 2.: Differentially expressed (significant) taxa between SIBO and non-SIBO in DTT samples.

In vivo testing of the low-flow CO2 removal application of a compact, platform respiratory device

BackgroundNon-invasive and lung-protective ventilation techniques may improve outcomes for patients with an acute exacerbation of chronic obstructive pulmonary disease or moderate acute respiratory distress syndrome by reducing airway pressures. These less invasive techniques can fail due to hypercapnia and require transitioning patients to invasive mechanical ventilation. Extracorporeal CO2 removal devices remove CO2 independent of the lungs thereby controlling the hypercapnia and permitting non-invasive or lung-protective ventilation techniques. We are developing the Modular Extracorporeal Lung Assist System as a platform technology capable of providing three levels of respiratory assist: adult and pediatric full respiratory support and adult low-flow CO2 removal. The objective of this study was to evaluate the in vivo performance of our device to achieve low-flow CO2 removal.MethodsThe Modular Extracorporeal Lung Assist System was connected to 6 healthy sheep via a 15.5 Fr dual-lumen catheter placed in the external jugular vein. The animals were recovered and tethered within a pen while supported by the device for 7 days. The pump speed was set to achieve a targeted blood flow of 500 mL/min. The extracorporeal CO2 removal rate was measured daily at a sweep gas independent regime. Hematological parameters were measured pre-operatively and regularly throughout the study. Histopathological samples of the end organs were taken at the end of each study.ResultsAll animals survived the surgery and generally tolerated the device well. One animal required early termination due to a pulmonary embolism. Intra-device thrombus formation occurred in a single animal due to improper anticoagulation. The average CO2 removal rate (normalized to an inlet pCO2 of 45 mmHg) was 75.6 ± 4.7 mL/min and did not significantly change over the course of the study (p > 0.05). No signs of consistent hemolysis or end organ damage were observed.ConclusionThese in vivo results indicate positive performance of the Modular Extracorporeal Lung Assist System as a low-flow CO2 removal device.

Stellarex drug-coated balloon: a technology evaluation

ABSTRACT The Stellarex® drug-coated balloon (DCB) is an over-the-wire dual lumen catheter with a distally premounted semi-compliant balloon, which has a low dose (2 μg/mm2 of the expanded balloon surface) paclitaxel coating. Its hybrid formulation, made of amorphous and crystalline paclitaxel combined with a polyethylene glycol excipient, provides maintenance of coating integrity and adequate drug release. This balanced combination of amorphous and crystalline paclitaxel is able to maintain drug on the surface during handling and balloon tracking, with an effective drug transfer to vessel wall in the lesion site. Clinical data associated with Stellarex balloon are growing and confirm clinical effectiveness over a long-term follow-up without any possible signal of a reduced safety for treated patients.

PD01-10 SURGICAL SITE INFLUENCES COST EFFECTIVENESS OF URETEROSCOPY IN A LARGE HEALTHCARE SYSTEM

You have accessJournal of UrologyStone Disease: Surgical Therapy I (PD01)1 Apr 2020PD01-10 SURGICAL SITE INFLUENCES COST EFFECTIVENESS OF URETEROSCOPY IN A LARGE HEALTHCARE SYSTEM Sari Khaleel*, Andrew Portis, James Anderson, and Michael Borofsky Sari Khaleel*Sari Khaleel* More articles by this author , Andrew PortisAndrew Portis More articles by this author , James AndersonJames Anderson More articles by this author , and Michael BorofskyMichael Borofsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000821.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteroscopy(URS) has become the most common surgical management for urolithiasis. Disposable instruments (DI’s) used during URS may vary, which in turn affects overall procedure cost. To date, the influence of surgeon and hospital site on the total DI cost (DIC) of URS has not been formally studied. We sought to assess whether surgeon and site were independently associated with DIC in a large multi-hospital system. METHODS: Our institutional electronic medical record (Epic Systems, Madison, WI) was retrospectively searched for procedures billed for CPT codes 52356/52353 (URS with/without stent placement), performed from 8/2018 – 08/2019. We developed a computer program in Perl programming language to analyze raw EMR data. Our outcomes of interest were mean case length, number of DI’s, and hospital-incurred total DIC. DI’s were classified as laser fiber, wires, ureteral stent, stone basket, ureteral access sheath, ureteral dilator, dual lumen catheter, or other “miscellaneous” items with DIC ≥$50. We selected for surgeons who performed at least 20 procedures at more than one site. Sites were deemed high- or low-volume (HV, LV) sites if their annual volume was above or below median site volume in the system.Multivariate regression was used identify predictive factors, and analysis of variance (ANOVA) was used to assess variation across different sites and surgeons. RESULTS: We identified 368 cases performed by 8 surgeons across 6 sites (3 HV sites, 3 LV sites). Median site volume was 100 cases. Most cases (304, 75.2%) were performed at HV sites. Mean case DIC, case length, and number DI’s used varied significantly across sites (ANOVA p = 0.000 for all three variables). Overall mean DIC was $975 ($388.8 – $1863), mean number of DI’s used was 5.48 (3-9), and mean total case length was 78.7 minutes (28 – 187.8). On multivariate regression, only surgical site was a significant predictor of DIC (p = 0.000), when adjusting for surgeon and high/low volume status (Figure 1). Site and surgeon were both significant predictors of number of DI’s used (p=0.000), and case length (p = <0.01). CONCLUSIONS: Procedural costs related to URS may vary between hospitals even when performed by the same surgeon. Further investigation into hospital practices with low DIC’s is warranted in an effort to potentially identify opportunities for cost savings. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e63-e64 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sari Khaleel* More articles by this author Andrew Portis More articles by this author James Anderson More articles by this author Michael Borofsky More articles by this author Expand All Advertisement PDF downloadLoading ...