Intravascular Catheter Research Articles

Using Simulation and Competency Assessment to Decrease Inappropriate Referrals to a Comprehensive Vascular Access Team.

This department column highlights translation of research into health care quality practice. Achieving the highest quality of health care requires attention to creating and sustaining process efficiencies through the development of bedside provider competencies that result in workflow improvements and positive patient outcomes. An improvement intervention aimed at decreasing unnecessary referrals to a comprehensive vascular access team (CVAT) resulted in a 21% reduction in inappropriate consults to the team in approximately 6 weeks. The purpose of this article is to describe a simulation and competency assessment intervention aimed at increasing staff nurse proficiency in the emergency department for placing ultrasound-guided intravascular catheters, thereby reducing the number of inappropriate referrals to a CVAT team.

Application of laser light scattering technique to diagnose catheter-associated infections.

The results of the bacteriological catheter investigation on the analyzer with the technology of laser light scattering and using D. Maki culture technique coincided in 91.8% of cases. Catheter-associated infections are proven in 8 cases. The following obtained from blood and intravascular catheter in 5 patients: Staphylococcus epidermidis (n=1), Staphylococcus haemolyticus (n=1), Escherichia coli (n=1), Staphylococcus aureus (n=2); Staphylococcus epidermidis (n=1) was detected in 1 child from ventricular shunt and cerebrospinal fluid and Escherichia coli lactose-negative + Staphylococcus haemolyticus were detected in 1 child from ventricular shunt, whily only Escherichia coli lactose-negative was detected from cerebrospinal fluid; Pseudomonas aeruginosa (n=1) was foud out in 1 patient from the urinary catheter and urine. Clinical significance of the isolated microorganisms from the catheter must be assessed in each particular case taking into account its quantity and type of the isolated microorganism.

P2239The association between global coronary flow reserve and coronary inflammation assessed by fat attenuation index on computed tomography in patients with acute coronary syndrome

Abstract Background Impaired global coronary flow reserve (G-CFR) is known to predict worse outcomes in patients with coronary artery disease. Phase contrast cine-magnetic resonance imaging (PC-CMR) of the coronary sinus (CS) is a promising approach for quantifying coronary sinus flow (CSF) and global coronary flow reserve (G-CFR) without the need for ionizing radiation, radioactive tracers, or intravascular catheterization. Although G-CFR impairment has been previously reported to be linked with endothelium dysfunction and subsequent atherosclerosis, the relationship between coronary inflammation and absolute coronary blood flow volume or coronary flow reserve remains elusive. Purpose We evaluated the association between G-CFR by quantifying CSF using PC-CMR and the extent of coronary inflammation in patients with ACS treated with emergent percutaneous coronary intervention (PCI). Methods The study enrolled 107 ACS patients who underwent uncomplicated emergent PCI within 48 hours of symptom onset and coronary CT angiography were performed before PCI. Proximal 40-mm segments of all three major epicardial coronary vessels were examined. Coronary inflammation was assessed by the CT fat attenuation index of perivascular adipose tissue (FAI−PVAT) defined as the mean attenuation of the perivascular adipose tissue (−190 to −30 Hounsfield units (HU)) in a layer of tissue within a radial distance from the outer coronary artery wall equal to the diameter of the vessel, as previously reported. CMR images were acquired to assess absolute CSF at rest and during maximum hyperemia within 30 days after emergent PCI and revascularization of non-culprit significant lesions. The patients were divided into 4 groups according to the number of inflamed vessels (defined as 0, 1, 2, 3 vessels with FAI ≥−70.1 HU). Results In the final analysis of 102 patients (mean age 64, Male 65 (63.7%)) including 77 patients with non-ST-segment elevation myocardial infarction (NSTEMI) (75.5%) and 25 patients with unstable angina pectoris (UAP), 25, 30, 26, 21 patients exhibited none, 1, 2, 3 inflamed vessels with FAI ≥−70.1 HU, respectively. Rest and maximal hyperemic CSF and corrected G-CFR were 1.17 [0.63, 1.71] vs 1.36 [1.05, 1.67] vs 1.21 [0.83, 1.94] vs 1.35 [0.96, 1.67] ml/min/g; P=0.61, 3.26 [2.62, 2.99] vs 3.50 [2.60, 4.03] vs 3.34 [1.78, 4.20] vs 2.48 [1.54, 3.43]; P=0.061, 2.95 [2.05, 4.30] vs 2.63 [1.80, 3.56] vs 2.15 [1.37, 2.91] vs 2.18 [1.46, 2.42]; P=0.018, respectively. G-CFR was significantly lower in group with increased number of inflamed vessels. Conclusions In ACS patients successfully revascularized within 48 hours of onset, G-CFR obtained by noninvasive PC-CMR significantly associated with the prevalence of inflamed vessels detected by coronary CT. Further large population study is warranted to test the hypothesis that the extent of coronary inflammation before coronary revascularization in patients with ACS might provide prognostic information.

P2704The association between global coronary flow reserve and coronary inflammation assessed by attenuation index on computed tomography in patients with stable angina pectoris

Abstract Background Impaired global coronary flow reserve (G-CFR) is known to predict worse outcomes in patients with coronary artery disease. Phase contrast cine-magnetic resonance imaging (PC-CMR) of the coronary sinus (CS) is a promising approach for quantifying coronary sinus flow (CSF) and G-CFR without the need for ionizing radiation, radioactive tracers, or intravascular catheterization. Although G-CFR impairment is previously reported to be linked with endothelium dysfunction and progression of atherosclerosis, the association of perivascular adipose tissue inflammation with myocardial coronary flow remains to be determined. Purpose We evaluated the association between G-CFR by quantifying CSF using PC-CMR and the extent of coronary inflammation evaluated by perivascular adipose tissue inflammatory status using CT to assess if coronary inflammation is linked with G-CFR in patients with stable angina pectoris (SAP) treated with elective percutaneous coronary intervention (PCI). Methods The study enrolled 74 SAP patients with single denovo lesion who underwent coronary CT angiography and PC-CMR within 90 days before coronary intervention. Proximal 40-mm segments of all three major epicardial coronary vessels were traced and examined. Coronary inflammation was assessed by the CT fat attenuation index of perivascular adipose tissue (FAI-PVAT) defined as the mean attenuation of the perivascular adipose tissue (−190 to −30 Hounsfield units (HU)) in a layer of tissue within a radial distance from the outer coronary artery wall equal to the diameter of the vessel. CMR images were also acquired to assess absolute CSF at rest and during maximum hyperemia before elective PCI. The patients were divided into 4 groups according to the number of inflamed vessels as defined by showing FAI ≥−70.1 HU. Results In the final analysis of 69 patients (mean age 67, Male 45 (65.2%)), 18, 19, 20, 12 patients exhibited none, 1, 2, 3 inflamed vessels with FAI ≥−70.1 HU, respectively. Rest and maximal hyperemic CSF and corrected G-CFR were 1.28 [0.76,1.55] vs 1.47 [1.11, 1.81] vs 1.30 [0.94, 1.64] vs 1.27 [1.11, 2.00] ml/min/g; P=0.49, 3.50 [2.84, 5.25] vs 3.28 [2.62, 4.31] vs 3.11 [2.16, 3.63] vs 2.37 [1.40, 2.98] ml/min/g; P=0.049, 3.57 [2.17, 4.54] vs 2.25 [1.73, 3.49] vs 2.26 [1.64, 3.38] vs 1.89 [0.89, 2.32]; P=0.023, respectively. G-CFR and hyperemic CSF were both significantly lower in the group with larger number of inflamed vessels. Conclusions In SAP patients with significant coronary artery stenosis, G-CFR obtained by PC-CMR significantly associated with the prevalence of inflamed vessels detected by coronary CT. The extent of coronary inflammation may influence global coronary endothelium dysfunction, resulting in decreased G-CFR.

P3585Prognostic value of the assessment of coronary sinus flow by phase contrast cine-magnetic resonance imaging in patients with acute coronary syndrome

Abstract Background Phase contrast cine-magnetic resonance imaging (PC-CMR) of the coronary sinus (CS) is a promising approach for quantifying global coronary sinus flow (CSF) and global coronary flow reserve (G-CFR) without the need for ionizing radiation, radioactive tracers, or intravascular catheterization. Purpose We evaluated the prognostic value of G-CFR by quantifying CSF using PC-CMR in patients with ACS treated with primary or emergent percutaneous coronary intervention (PCI). Methods The study prospectively enrolled 387 ACS patients who underwent uncomplicated primary or emergent PCI within 48 hours of symptom onset. Breath-hold PC-CMR images of CS were acquired to assess absolute CSF at rest and during maximum hyperemia within 30 days after primary PCI and revascularization of functionally significant non-culprit lesions of ACS. The association of G-CFR and baseline clinical characteristics with major adverse cardiac events (cardiac death, nonfatal myocardial infarction, late revascularization, or hospitalization for congestive heart failure) was investigated. Results In the final analysis of 366 patients (Male 294 (80.3%), mean age 65) including 233 patients (63.7%) with ST-segment elevation myocardial infarction (STEMI) and 133 patients (36.3%) with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), rest and maximal hyperemic CSF and corrected G-CFR were 1.24 [0.83, 1.71] ml/min/g, 2.56 [1.87, 3.66] ml/min/g, and 2.20 [1.53, 3.17], respectively. During a median follow-up of 16 months, MACE occurred in 84 patients (cardiac death: 9, nonfatal myocardial infarction: 11, late revascularization: 59, hospitalization for congestive heart failure: 5). Cardiac event-free survival was significantly worse in patients with a corrected G-CFR <2.00 (log-rank χ2=20.2, P<0.001). Cox proportional hazards analysis showed that corrected G-CFR were independent predictors of adverse cardiac events during follow-up in patients with STEMI (hazard ratio, 0.66, 95% confidence interval, 0.51–0.85, p=0.001) and NSTE-ACS (hazard ratio, 0.64, 95% confidence interval, 0.43–0.95, p=0.026), respectively. Conclusions In ACS patients successfully revascularized within 48 hours of onset, G-CFR obtained by noninvasive PC-CMR provided significant prognostic information independent of infarction size and conventional risk scores.

A CASE OF TSUKAMURELLA PULMONIS MASQUERADING AS PLEURAL TB IN AN IMMUNOCOMPETENT PATIENT

SESSION TITLE: Interesting Presentations of Infectious Diseases SESSION TYPE: Fellow Case Reports PRESENTED ON: 10/20/2019 1:00 PM - 2:00 PM INTRODUCTION: Respiratory infections due to Tsukamurella have been described in immunodeficient patients. To our knowledge, only one other case report of respiratory infection has been described in an immunocompetent patient. We hereby present a case of Tsukamurella infection causing tuberculosis like syndrome in an immunocompetent patient. CASE PRESENTATION: A 42-year-old male with a past medical history of hyperthyroidism who recently moved to the United States from India presented to the hospital with chest pain and shortness of breath (SOB). The patient had a viral upper respiratory infection three weeks before presentation and eventually developed worsening sharp chest pain and SOB. He saw a provider in the clinic who recommended a chest X-ray which revealed a right-sided pleural effusion. He underwent an outpatient thoracentesis, a liter of fluid was drained and revealed an eosinophilic predominant exudative fluid. A Quantiferon gold test was negative during that time. At our hospital, the patient was again found to have a right-sided pleural effusion, underwent repeat thoracentesis and eventually, a chest tube was placed. Pleural fluid analysis revealed a monocyte predominant exudative fluid. He later underwent a decortication procedure due to re-accumulation of fluid. Cultures from the fluid and the tissue were negative for acid-fast bacilli. Pathology of the pleura revealed benign tissue with fibrinous pleuritis. Initially, testing for Acid Fast Bacilli (AFB) on three sputum samples and nucleic acid amplification testing (NAAT) remained negative. Throughout this, the patient remained under airborne precautions and was being empirically treated for pleural tuberculosis. Eventually one of the sputum cultures grew acid-fast bacilli within the first week, and this was deemed to be a rapid grower and not Mycobacterium tuberculosis. The culture was sent to Mayo clinic for identification and came back positive for Tsukamurella pulmonis. His antitubercular therapy was discontinued, and he was treated with levofloxacin and rifabutin for 3-6 months. He remained stable and disease free on follow up at 2 months. DISCUSSION: Tsukamurella species are obligate, aerobic, gram-positive, weakly acid-fast Actinomycetales. Infections are mostly related to immunocompromised state and use of intravascular catheters and prosthetic devices. Diagnosis remains a challenge as demonstrated in our case and the infection can mimic tuberculosis like syndrome leading to inappropriate treatment with anti-tubercular therapy. No guidelines exist regarding appropriate treatment, but levofloxacin and rifabutin have been described for treatment of pulmonary infection. CONCLUSIONS: As outlined in our case, Tsukamurella can mimic tuberculosis and diagnosis remains a challenge. A high index of suspicion is required to diagnose this infection in patients with high risk for tuberculosis as it changes management significantly. Reference #1: Inchingolo R., Nardi I., Chiappini F., Macis G., Ardito F., Sali M. First case of Tsukamurella pulmonis infection in an immunocompetent patient. Respir Med CME Reference #2: Chen C.H., Lee C.T., Chang T.C. Tsukamurella tyrosinosolvens bacteremia with coinfection of Mycobacterium bovis pneumonia: case report and literature review. SpringerPlus. 2016;5:2033. Reference #3: Safaei, S., Fatahi-Bafghi, M., & Pouresmaeil, O. (2017). Role of Tsukamurella species in human infections: first literature review. New microbes and new infections, 22, 6-12. https://doi.org/10.1016/j.nmni.2017.10.002 DISCLOSURES: Speaker/Speaker's Bureau relationship with Gilead Please note: $1-$1000 Added 03/15/2019 by Paul Anthony, source=Web Response, value=Honoraria No relevant relationships by Gaurav Manek, source=Web Response No relevant relationships by Anand Muthu Krishnan, source=Web Response No relevant relationships by Nihar Shah, source=Web Response

TO PICC OR NOT TO PICC?

SESSION TITLE: Wednesday Electronic Posters 4 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: To study the appropriate use of peripherally inserted central catheters (PICC). PICC lines have grown in popularity over the past couple of years. Although they resemble midlines, both carry different indications. Most physicians are unaware of their respective uses which ultimately leads to a high cost of burden in the hospitals. METHODS: Retrospective chart review of all the patients who underwent PICC lines and midlines placement from 20th January, 2019 till 18th February, 2019 was conducted. Statistical software was used for analysis. We identified reasons for insertion of these lines along with appropriateness of indications mentioned. RESULTS: Over the study period of 29 days, a total of 40 PICC lines and 14 midlines were ordered in patients starting from 18 years of age. The most common indication for PICC line insertion was poor intravenous access (40%) and long-term antibiotic use (40%). 15% of the PICC lines placed for delivering antibiotics were appropriately placed while the rest 25% could have been substituted by midlines. The third most common reason for PICC insertion was administering parenteral nutrition (12.5%). Other reasons included short term vasopressors administration (5%) and for non-ionic contrast use (2.5%). Therefore, out of the 40 PICC lines ordered, only 14 (35%) were ordered appropriately. Inappropriate orders originated mostly from in-patient unit (76.9%) as compared to the emergency (7.6%) and outpatient department (15.38%). CONCLUSIONS: In a retrospective study at an academic center, midline catheters were associated with more but non-serious complications as compared to PICC lines which were associated with less but serious life-threatening complications including bacteremia. Risk of PICC related DVT is higher in the first two weeks after insertion of PICC line. Therefore, knowing the appropriateness of PICC lines and midlines will make the health care personnel more cost conscious and judicious in their use of intravenous lines, thereby, reducing the cost of PICC related deep venous thrombosis, pulmonary embolism and catheter-related infections. CLINICAL IMPLICATIONS: Our study reinforces the appropriate use of intravenous lines in order to minimize the cost of burden. A separate curriculum emphasizing the indication of intravascular catheters needs to be integrated in medical education. DISCLOSURES: No relevant relationships by Ankit Agrawal, source=Web Response No relevant relationships by Mehak Bassi, source=Web Response No relevant relationships by Balaji Yegneswaran, source=Web Response

P2763Clinical prognosis of pure right-sided infective endocarditis without association to cardiac devices or intravenous drug abuse

Abstract Background Pure right-sided infective endocarditis (RSIE) without association with cardiac devices or intravenous drug users (IVDUs) is an entity with unclear predisposing factors and prognosis. Purpose To evaluate predisposing factors and prognosis of pure RSIE compared tothose associated to cardiac devices or IVDUs. Methods 280 consecutive patients with endocarditis were included retrospectively in a protocol of clinical and imaging follow-up. Endocarditis-related event was defined as endocarditis mortality or open-surgery requirement. Besides, a review and meta-analysis of the literature between january 2000 and december 2018 were performed. Results Fifty-two (19%) patients presented RSIE: 20 of them (39%) were pure RSIE. Intravascular catheters carriers (25% vs 3%; p=0.026) and congenital heart diseases (20% vs 0%; p=0.018) were associated to pure RSIE. These patients demonstrated the worst clinical prognosis, with the highest in-hospital mortality (25% vs 3%; p=0.026) and endocarditis-related event rate (45% vs 6%; p=0.001), being pure RSIE independently associated with in-hospital endocarditis-related events (OR=8.40; 95% CI, 1.13–62.68; p=0.038). Four studies, including ours, with 315 participants diagnosed of RSIE were evaluated in meta-analysis: 94 individuals (30%) presented pure RSIE.This group demonstrated a higher in-hospital mortality than those with cardiac devices or IVDUs (RR=2.854; 95% CI, 1.640–4.965; P<0.001; I2=0.0%; Figure 1). Figure 1. RSIE and in-hospital mortality based on groups: cases with pure RSIE versus those with cardiac devices or IVDUs. Conclusions Pure RSIE is the worst prognosis group among RSIE with the highest endocarditis-related event rate and in-hospital mortality. This growing group should stake out the benign impression and recommendations given to RSIE among IE patients.

Impact of needle-free connectors compared with 3-way stopcocks on catheter-related bloodstream infection rates: A meta-analysis

Needle-free connectors (NFCs) were introduced to eliminate the use of needles in intravascular catheters, and their newest generations were designed to improve patient safety and reduce catheter-related bloodstream infection (CRBSI) risks. The aim of this meta-analysis was to compare NFCs with 3-way stopcocks (3WSCs) and their effects on CRBSI rates. A meta-analysis was conducted using a research protocol consistent with the PRISMA statement for reporting meta-analyses. The Cochrane Database of Systematic Reviews and MEDLINE were searched for relevant randomized studies published from January 2000 to September 2018. We identified and selected for the meta-analysis 8 studies comparing CRBSI rates (according to the Centers for Disease Control and Prevention's National Healthcare Safety Network definition) associated with NFCs utilizing negative-displacement, neutral-displacement, or positive-displacement devices with rates for 3WSCs. Relative risk was 0.53 with a 95% CI of 0.28 to 1.00, and the relative difference was -0.018 with a 95% CI of -0.039 to 0.004. CRBSI risk was statistically higher for 3WSCs compared to NFCs.

An innovative cyanoacrylate device developed to improve the current standard of care for intravascular catheter securement.

Over one billion intravascular devices are used worldwide, annually. Due to the associated complications with these devices, the development of a reliable yet cost-effective securement technique is extremely important. The purpose of this study is to demonstrate the strength of a novel catheter securement cyanoacrylate for securing peripheral venous catheters, central venous catheters, peripherally inserted central catheters, and all other intravascular catheter types. An unprecedented in vitro method was performed to quantify and compare the strength of a novel cyanoacrylate product when securing intravascular catheters inserted into prepared porcine skin. In vivo, canine subjects were used to implant various types of catheters. These catheters were secured with a novel catheter securement cyanoacrylate to test the strength and durability while undergoing simulated clinical stresses. In vitro, the catheter securement cyanoacrylate demonstrated superior strength over conventional catheter securement methods as well as other known cyanoacrylates. The catheter securement cyanoacrylate demonstrated the ability to maintain superior strength for up to 7 days. In vivo, the catheter securement cyanoacrylate demonstrated the ability to withstand five weight tugs per hour for a 3-h duration, alone, while securing three types of catheters in canine subjects. This is one of the first studies to provide quantitative data to support the use of cyanoacrylate for intravascular catheter securement. The results from this research suggest that the novel catheter securement cyanoacrylate can be a simple and cost-effective catheter securement device that can improve the current health care protocol for intravascular catheterization.

Dressings for the central venous catheter to prevent infection in patients undergoing hematopoietic stem cell transplantation: a systematic review and meta-analysis

To identify the most effective dressing for covering long-term central venous catheter exit site to prevent catheter-related infections and skin irritation in patients undergoing hematopoietic stem cell transplantation. Systematic Review. The search was performed in the following electronic databases: CINAHL, Cochrane Library CENTRAL, EMBASE, LILACS, PubMed, Scopus, and Web of Science. Google Scholar was used for the gray literature search. Seven studies were included which tested different arrangements of dressings: sterilized gauze and adhesive tape with a transparent polyurethane film (n = 2), transparent polyurethane film with a different replacement interval frequency (n = 2), transparent polyurethane film with and without chlorhexidine released continuously by the dressing at the site of intravascular catheter insertion (n = 2), and dressings vs. no dressings (n = 1). The meta-analysis for catheter-related infection prevention showed no difference between type of dressing (RR 1.76, [95% CI 0.82; 3.75], I2 0%) and for the replacement frequency at different intervals (RR 1.04, [95% CI 0.67; 1.61], I2 0%). The meta-analysis for skin irritation evaluated the transparent polyurethane film replacement frequency and indicated that a longer dressing replacement interval (10 to 15days) reduces the risk of developing this outcome (RR 0.71, 0.52; 0.96, 95% CI, I2 24%). Regarding the type of the dressing, there is no evidence indicating the best dressing. Although there is no evidence available for the ideal replacement frequency, the risk to develop skin irritation is reduced in longer dressing replacements intervals.

Guide wire electrode versus liquid electrode for intravascular electrocardiography-guided central venous catheterization in adults: A systematic review and meta-analysis.

To assess the effectiveness and safety of guide wire electrode versus liquid electrode for intravascular electrocardiography-guided central venous catheter placement in adults. Systematic review and meta-analysis. We searched the main electronic databases (Cochrane Library, the Joanna Briggs Institute Library, Embase, PubMed, CINAHL, China National Knowledge Infrastructure, and Wanfang) with articles published from inception up to March 2018. References of important articles were also screened for relevant studies. We used a structured search strategy and did not apply any search limitations. Randomized, controlled trials, quasi-experimental studies or studies using a within-subject design, evaluating guide wire electrode versus liquid electrode for intravascular electrocardiography-guided central venous catheter placement in adults, were eligible for inclusion. Risk of bias assessment was performed using the Cochrane Collaboration's tool and meta-analysis was performed using RevMan 5.3. In total, six studies with a total of 2176 participants were included. Meta-analysis showed that there was no statistically significant difference in accuracy of tip location placement between guide wire and liquid electrodes. Use of guide wire electrode had a higher risk of complications which were transient and there were an insufficient number of studies using the same parameters to evaluate intravascular electrocardiography signal quality. Due to the small number and low quality of identified studies, it is difficult to draw definitive conclusions on the relative effectiveness and safety of guide wire versus liquid electrodes for the placement of central venous catheters in adults. More well-designed studies are needed in the future.

Incidence, retrieval methods, and outcomes of intravascular ultrasound catheter stuck within an implanted stent: Systematic literature review

BackgroundThere have been no reviews regarding intravascular ultrasound (IVUS) catheter entrapment during percutaneous coronary intervention (PCI). This study investigated the incidence, retrieval methods, and outcomes of IVUS catheter stuck within implanted stents. MethodsBetween January 2015 and July 2018, a total of 794 consecutive patients underwent PCI for coronary artery disease. Among them, 705 patients underwent stent implantation using IVUS. The patients with IVUS catheter entrapment in an implanted stent were investigated. ResultsTen patients (1.4%) suffered from an IVUS catheter stuck in an implanted stent. Among them, 7 patients had very tortuous lesions while 5 patients had severely calcified lesions. Seven patients (70%) underwent placement of the 3rd generation drug-eluting stent (DES), and the stent diameters were ≤2.5mm among 8 patients (80%). Retrieval methods were the buddy wire technique, the double guide catheter technique, covering the exit port of IVUS catheter with a balloon catheter, and covering with GuideLiner® catheter (Vascular Solutions Inc., Minneapolis, MN, USA). On multivariable analysis, the predictors of IVUS catheter entrapment were tortuous lesion [odds ratio (OR), 8.21; 95% confidence interval (CI), 2.19–30.7; p=0.002], 3rd generation DES (OR, 5.31; 95% CI, 1.08–26.1; p=0.021), and stent diameter ≤2.5mm (OR, 6.31; 95% CI, 1.29–30.8; p=0.010). Furthermore, we identified 6 cases of IVUS catheter entrapment through a systematic literature review. ConclusionsThe IVUS catheter was almost stuck in tortuous lesions and the 3rd generation DES with a small diameter. We could successfully retrieve it in all cases using various retrieval techniques.

Triboelectric charging of polytetrafluoroethylene antithrombotic catheters.

This study proposes that a polytetrafluoroethylene (PTFE) electret tube charged by frictional electricity can prevent the solidification of the indwelling catheter in blood vessels. Coagulation in intravascular indwelling catheters may discontinue the treatment because of thrombus-derived bacteria-adhesion infections or poor blood removal. Current commercially available intravascular catheters lack complete antithrombotic measures, even with heparin or urokinase antithrombotic coatings. Herein, we tested the effectiveness of an antithrombotic treatment that prevents coagulation using a static electric charge on the interior of the PTFE tube via the triboelectric effect by rubbing the tube's inner wall with a round glass rod. The anticoagulation properties were evaluated by enclosing a sample of blood in an electret tube and observing the coagulase adhering to the inner wall using a microscope. To confirm the effectiveness of this treatment, the charge-distribution on the inner surface of the electret tube was measured, surface irregularities were observed, and the elements on the surface were analyzed. The surface potential inside the electret tube was - 366.4V, which proved effective for an antithrombotic treatment, as it discouraged coagulation, and the triboelectric charging process caused neither surface element denaturation nor significant surface irregularities. The nearly uniform negative surface charge on the inside of the tube was responsible for the antithrombotic effect because no surface irregularities or change in the surface element denaturation was observed. Triboelectrically charged PTFE electret tubes are highly useful for intravascular indwelling catheters.

A case of unfractionated heparin-induced thrombocytopenia during the treatment of a gastric stromal tumor

Intensive care unit (ICU) patients are usually at high risk of platelet activation because of a combination of conditions, such as infections, septicemia, and shock. Patients with heparin-induced thrombocytopenia (HIT) have antibodies that recognize platelet factors (PF4) when HIT is in a complex with heparin. HIT is often considered during the differential diagnosis. In this case, the patient suffered from a gastric stromal tumor and liver metastasis and received unfractioned heparin (UFH) to flush the intravascular catheter and anticoagulation in vitro to soak the pipe filter. The PF4-heparin antibody was positive (OD =1.205), and the concentration level was 19.957 U/mL (>18 U/mL) as revealed by semi-quantitative interpretations. According to the clinical information and the 4T scoring system, the 4T score was 5. The patient suffered from HIT after using UFH. Our results suggest that platelet counts of ICU patients should be monitored after the administration of heparin. The patient’s prognosis is good as a result of the early detection of HIT.

Clinico-Epidemiologic Profile and with Multi Drug Resistant Gram-Negative Healthcare AssociatedOutcome of Pediatric Patients Infections at the Philippine General Hospital

Introduction: Multi Drug Resistant Organisms (MDRO) are microorganisms that are resistant to one or more classes of antimicrobial agents, and these have become significant pathogens to contend with in the treatment of Healthcare Associated Infections. Objectives: This study aimed to determine the clinico-epidemiologic profile and outcome of pediatric patients with healthcare-associated multi-drug resistant gram-negative infections, and its antimicrobial susceptibility patterns. Methodology: This was a retrospective study done on pediatric patients with gram negative healthcare associated MDRO sepsis compared to non-MDRO sepsis admitted at the ICU and pediatric wards of a tertiary government hospital from July 2015 to June 2016. Descriptive statistics was used to summarize the clinical characteristics of patients. Odds ratio and the corresponding 95% confidence interval from binary logistic regression was computed to determine significant predictors for the development of multi drug resistance. Outcome of patients with MDRO gram-negative infection was noted, as well as its antimicrobial susceptibility patterns. Results: A total of 199 patients developed HAI, and 41% were identified to be gram negative MDR cases. Pediatric patients with healthcare associated infections due to MDR gram negative organisms had shorter hospital stay and a higher mortality rate of 78% compared to 41% among non MDR patients.The most commonly isolated gram negative organisms were Burkholderia cepacia, 38%; Klebsiella pneumoniae, 31%; and Acinetobacter baumanii, 18%; while the most common MDR gram negative isolates were Klebsiella pneumoniae, 65%; Acinetobacter aumanii, 22%; and Pseudomonas aeruginosa, 7%. Significant predictors for MDRO were age (0-28 days old), ICU admission, intravascular catheterization and use of total parenteral nutrition. Conclusion: Profile of pediatric patients with healthcare-associated multidrug resistant gram-negative infections were neonates admitted in the ICU with a shorter hospital stay and a high mortality rate. The identified risk factors for developing Multi Drug Resistant Gram Negative sepsis were age of 0-28 days, admission to ICU, intravascular catheterization and parenteral nutrition. Patients with gram-negative MDR infections have a high mortality rate and isolates are susceptible mostly to Colistin.

High-resolution photoacoustic endoscope through beam self-cleaning in a graded index fiber.

Intravascular photoacoustic imaging can potentially improve the identification of lipid-laden atherosclerotic plaque. Most intravascular photoacoustic endoscopes use multimode fibers, which do not allow tight focusing of photons. Recent experiments on pulse propagation in multimode graded-index fibers have shown a nonlinear improvement in beam quality. Here, we harness this nonlinear phenomenon for fiber-delivery of nanosecond laser pulses. We built a photoacoustic catheter 1.4mm outer diameter, offering a lateral resolution as fine as 30μm within a depth range of 2.5mm. Such resolution is one order of magnitude better than current multimode fiber-based intravascular photoacoustic catheters. At the same time, the delivered pulse energy can reach as high as 20μJ, which is two orders of magnitude higher than that of an optical resolution photoacoustic endoscope built with a single mode fiber. These improvements are expected to promote the biomedical application of photoacoustic endoscopes which require both high resolution and high pulse energy.

Lubrizol acquires catheter company

Lubrizol has acquired the German medical device firm Bavaria Medizin Technologie for an undisclosed sum. BMT specializes in research and manufacturing of intravascular and nonvascular catheters; it developed the first drug-coated balloon. Lubrizol says the BMT buy adds to its own expertise in precision thermoplastic extrusion and product development. The acquisition includes BMT’s 100 employees and a production facility in Romania.

Microbial colonization of intravascular catheter connectors in hospitalized patients

Central line-associated bloodstream infections may be due to catheter connector colonization and intraluminal migration of pathogens. We assessed the colonization of the split septum catheter connector system, and subsequently the luer lock catheter connector system. This was a prospective, 2 phase, quality improvement study at a tertiary referral center. Each phase of the study was performed over 3 consecutive days in hospitalized patients receiving an active infusion; first with a split septum lever lock connector and second with a luer lock connector and alcohol port protector. The connectors were inoculated onto blood agar plates and incubated. Plates were assessed for microbial growth after 48-72 hours. In phase I, 98 (41.9%) of 234 split septum connectors yielded microbial growth. In phase II, 56 (23.1%) of 243 luer lock connectors yielded microbial growth. In phase II only, there was a significant increased rate of contamination in peripheral catheters compared with all other catheters, and the rate of contamination on the acute care wards was significantly higher when compared with the intensive care units. Bacterial colonization of the lever lock system was unacceptably high among all catheter types and hospital locations. Transition to luer lock catheter connectors and alcohol port protectors decreased the colonization; however, colonization still remained substantial. Causation of colonization cannot be determined with these results.

Comparison of complications with a 1.25-mm versus a 1.5-mm burr for severely calcified lesions that could not be crossed by an intravascular ultrasound catheter

Since intravascular imaging such as intravascular ultrasound (IVUS) can provide useful information for rotational atherectomy (RA), intravascular imaging should be attempted before RA. However, some calcified lesions do not allow imaging catheters to cross before RA. Although small burrs (1.25 mm or 1.5 mm) should be selected for such tight lesions, it is unknown whether a 1.25-mm burr or 1.5-mm burr is safer as the initial burr. The aim of this study was to compare the incidence of complications with a 1.25-mm versus a 1.5-mm burr as the initial burr for IVUS-uncrossable lesions. This was a retrospective, single-center study. A total of 109 IVUS-uncrossable lesions were included, and were divided into a 1.25-mm group (n =52) and a 1.5-mm group (n =57). The incidence of slow flow just after RA was not different between the 2 groups (1.25-mm group: 25%, 1.5-mm group: 31.6%, P =0.45). The incidence of peri-procedural MI with slow flow was not different and equally low in the 2 groups (1.25-mm group: 1.9%, 1.5-mm group: 3.5%, P =0.61). The use of the 1.5-mm burr as the initial burr was not significantly associated with slow flow after controlling for chronic renal failure on hemodialysis and reference diameter (vs. 1.25-mm: OR 2.34, 95% CI 0.89–6.19, P =0.09). In conclusion, the incidence of complications following RA was comparable between the 1.25-mm and the 1.5-mm burrs as the initial burr for IVUS-uncrossable lesions. The present study provides insights into the selection of an appropriate burr for IVUS-uncrossable lesions.