Intermediate Catheter Research Articles

Complications of Long and Intermediate Term Venous Catheters in CF Patients

SESSION TITLE: Hot Topics in Pediatic Pulmonology

Flexible tip guides and intermediate catheters: two center experience and a proposed taxonomy

BackgroundStable access to target lesions is foundational to endovascular therapy, be it in hemorrhagic or ischemic disease. Continued evolution in access technology has resulted in next generation catheters that afford...

E-029 Flow Diverter Treatment of a Ruptured Anterior Cerebral Artery Blister Aneurysm

Introduction“Blister” type aneurysms (BA) are rare, atypical vascular lesions with fragile wall, broad base, difficult visualisation on imaging and high risk of rupture. Endovascular treatment of these aneurysms remains very...

6FrセルリアンカテーテルDD6を用いたtriple coaxial system

【目的】今回我々が新たに開発した6FrセルリアンカテーテルDD6の有用性について報告する．【方法】未破裂前交通動脈瘤に対するコイル塞栓術，および破裂左中大脳動脈瘤のコイル塞栓術において，8Frガイディングカテーテルのintermediate catheterとして6FrセルリアンカテーテルDD6を使用した．【結果】親血管のアクセス困難を解決し，ガイディングカテーテルのサポートを向上させると同時に，balloonあるいはstent assist techniqueを併用したコイル塞栓術が可能であった．【結論】4Frセルリアンカテーテルを用いたtriple coaxial systemではsimple techniqueによる塞栓術のみが可能であるが，新たに開発した6FrセルリアンカテーテルDD6を用いたtriple coaxial systemであればバルーン併用あるいはEnterprise VRD併用によるコイル塞栓術が可能である．

P-017 Intermediate catheters: experience, cost and complication rates at two high volume centers

IntroductionStable access to target lesions is foundational to endovascular therapy, be it in hemorrhagic or ischemic disease. Continued evolution in access technology has resulted in next generation catheters that afford...

Continuous Spinal Anesthesia with High Dose of Local Anesthetics

Better control of the level, intensity, and duration of spinal analgesia represents the greatest advantages of continuous spinal anesthesia. With the advent of intermediate catheters (over-the-needle catheter) and its low incidence of headaches and neurological symptoms, the technique has been gaining credibility. The objective of this paper is to report the possible safety of the new catheter with a large dose of hyperbaric 0.5% bupivacaine with 1.6% glucose associated with hyperbaric 2% lidocaine with 1.6% glucose. Male patient, 78 years old, 85 kg, 168 cm, physical status ASA III, with hypertension, coronary artery disease, and chronic renal failure. The patient was candidate for surgery for huge bilateral inguinal and umbilical hernias, being submitted to preoperative pneumoperitoneum for one week to stretch abdominal cavity. After venoclysis with an 18G catheter, he was monitored with cardioscope, non-invasive blood pressure, and pulse oximetry; he was sedated with 1 mg of midazolam and 100 μg of fentanyl intravenously, and placed in left lateral decubitus. He underwent continuous spinal anesthesia by a median puncture in L₃-L₄ with a set with a 27G cut-bevel needle and 22G catheter. The total dose of anesthetic used was 25mg of 0.5% bupivacaine (hyperbaric, with 1.6% glucose), 160 mg of 2% lidocaine (hyperbaric, with 1.6% glucose), and morphine (100 μg). The patient was followed-up until the 30th postoperative day without neurological complaints. Recently, the poor distribution of the local anesthetic through the microcatheter was attributed as the cause of cauda equina syndrome. This case report showed that, with the administration of high doses of hyperbaric anesthetics through the new catheter, poor distribution or risk of cauda equina syndrome were not observed.

Continuous Spinal Block In A Patient Undergoing Partial Gastrectomy. Case Report

Due to the high incidence of technical and neurological complications, continuous spinal blocks were not performed for several years. With the advent of intermediate catheters the technique has been used more often and gaining acceptance among anesthesiologists. The objective of this report was to demonstrate the usefulness of the technique as a viable alternative for medium and major size surgeries. This is a 58 years old female patient, weighing 62 kg, physical status ASA I, with a history of migraines, low back pain, and prior surgeries under spinal block without intercurrence. The patient was scheduled for exploratory laparotomy for a probable pelvic tumor. After venoclysis with an 18G catheter, monitoring with cardioscope, non-invasive blood pressure and pulse oximetry was instituted; she was sedated with 2 mg of midazolam and 100 (1/4)g of fentanyl, and placed in left lateral decubitus. The patient underwent continuous spinal block through the median approach in L3-L4; 9 mg of 0.5% hyperbaric bupivacaine and 120 (1/4)g of morphine sulfate were administered. Inspection of the abdominal cavity revealed a gastric stromal tumor that required an increase in the incision for a partial gastrectomy. A small dose of hyperbaric solution was required for the entire procedure, which was associated with complete hemodynamic stability. Postoperative admission to the ICU was not necessary; the patient presented a good evolution without complaints and with a high degree of satisfaction. She was discharged from the hospital after 72 hours without intercurrence. Intermediate catheters used in continuous spinal blocks have shown the potential to turn it an attractive and useful technique in medium and large size surgeries and it can even be an effective alternative in the management of critical patients to whom hemodynamic repercussions can be harmful.

Bullous Lesions on a Skin Graft Donor Site

<h3>Introduction</h3> Endovascular mechanical thrombectomy (MT) has dramatically decreased the mortality and morbidity associated with acute ischemic stroke (AIS) in adults. A similar benefit is seen in pediatric patients, but a due to a lack of documentation in outcomes and lack of universal guidelines on procedures, there are need for greater elucidation of pediatric thrombectomy approach and outcomes. Unfortunately, MT is only performed on large vessel occlusion (LVO). Therefore, AIS with medium and small vessel occlusion (MSVO) with disabling neurological deficit not yet have any clear options. We are presenting a pediatric patient who presented with AIS due to the occlusion of the right anterior cerebral artery (ACA) A2-A3 junction thrombus underwent successful suction MT resulting in complete perfusion and recovery. <h3>Methods</h3> <h3>Case report</h3> <h3>Results</h3> A 17-year-old Caucasian female with a known hypercoagulable state due to 4G/5G PAI-1 activity on Xarelto and history of several previous strokes presented with NIH score of 7 and baseline mRS score of 2. CT angiography was inconclusive, and patient was taken to digital subtraction angiography, which identifying a right A2-A3 junction thrombosis. Procedure: 6 French guiding sheath was placed in the right internal carotid artery. A 3 max intermediate catheter alone with velocity microcatheter and synchro 14 soft microwire were used to reach right ACA A2-A3 junction. Direct suction through the 3 max catheter resulting in TICI 3 revascularization was achieved, and patient improved to NIH score of 4 immediate post operatively. Patient further improved with targeted physical therapy and was discharged home with NIHSS 0 and modified ranking of 2. Direct anticoagulation was switched to warfarin with INR goals of 2–3. <h3>Conclusion</h3> Endovascular aspiration mechanical thrombectomy of MSVO is feasible in pediatric patients presenting with AIS and associated with good functional outcome. Additionally, when acute ongoing neurological deficit is present and CTA is inconclusive, a digital subtraction angiography is deemed needed to identify MSVO as the yields of CTA diminishes significantly beyond LVO. Further studies are required. <h3>Disclosures</h3> <b>R. Hart:</b> None. <b>A. Singh:</b> None. <b>C. Manzanero:</b> None. <b>Y. Lodi:</b> None.

Temporary Acute Care Central Venous Access Devices

Temporary and intermediate duration central venous access catheters are presented, selected historical aspects are discussed, and catheter material properties are reviewed. Finally, clinical issues including patient preparation, placement techniques, and catheter-related complications are considered.