Introducer Needle Research Articles

Percutaneous Lung Biopsy with Pleural and Parenchymal Blood Patching: Results and Complications from 1,112 Core Biopsies

PurposeTo evaluate the outcomes of computed tomography (CT) fluoroscopy-guided core lung biopsies with emphasis on diagnostic yield, complications, and efficacy of parenchymal and pleural blood patching to avoid chest tube placement. MethodsThis is a single-center retrospective analysis of CT fluoroscopy-guided percutaneous core lung biopsies between 2006 and 2020. Parenchymal blood patching during introducer needle withdrawal was performed in 74% of cases as a preventive measure, and pleural blood patching was the primary salvage maneuver for symptomatic or growing pneumothorax in 60 of 83 (72.2%) applicable cases. ResultsA total of 1,029 patients underwent 1,112 biopsies (532 men; mean age, 66 years; 38.6%, history of emphysema; lesion size, 16.7 mm). The diagnostic yield was 93.6% (1,032/1,103). Fewer complications requiring intervention were observed in patients who underwent parenchymal blood patching (5.7% vs 14.2%, P < .001). Further intervention was required in 83 of 182 pneumothorax cases, which included the following: (a) pleural blood patch (5.4%, 60/1,112), (b) chest tube placement without a pleural blood patch attempt (1.5%, 17/1,112), and (c) simple aspiration (0.5%, 6/1,112). Pleural blood patch as monotherapy was successful in 83.3% (50/60) of cases without need for further intervention. The overall chest tube rate was 2.6% (29/1,112). Emphysema was the only significant risk factor for complications requiring intervention (P ≤ .001). ConclusionsParenchymal blood patching during introducer needle withdrawal decreased complications requiring intervention. Salvage pleural blood patching reduced the frequency of chest tube placement for pneumothorax.

CT-guided biopsy of lung nodules with pleural contact: Comparison of two puncture routes

PurposeThe purpose of this study was to retrospectively compare two puncture routes (transpleural vs. transpulmonary) for computed tomography (CT) fluoroscopy-guided cutting needle biopsy of lung nodules with pleural contact. Patients and methodsA total of 102 patients (72 men; mean age, 71.1±9.5 [SD] years) were included and 102 biopsies of 102 lung nodules (mean size, 16.7±5.9 [SD] mm; range, 6.0–29.4mm; mean length of pleural contact, 10.1±4.2 [SD] mm; range, 2.8–19.6mm) were analyzed. All procedures were classified as biopsies via the direct transpleural route or the transpulmonary route. The patient-, lesion-, and biopsy-related variables, diagnostic yields, and incidence of complications were compared between the two routes. ResultsBiopsy was performed via the direct transpleural route (n=59; 57.8%) and transpulmonary route (n=43; 42.2%). In the transpulmonary route group, the mean distance of the intrapulmonary pathway was 17.7±9.4 [SD] mm (range: 4.1–47.6mm; P<0.001) and the introducer needle trajectory angle of<45° was significantly observed (8.5% [5/59] vs. 60.5% [26/43]; P<0.001). There was no significant difference in diagnostic accuracy between the direct transpleural and transpulmonary routes (93.2% [55/59] vs. 90.7% [39/43]; P=0.718). The frequencies of all complications (64.4% [38/59] vs. 97.7% [42/43]; P<0.001), pneumothorax (33.9% [20/59] vs. 65.1% [28/43]; P=0.003), pneumothorax with chest tube placement (3.4% [2/59] vs. 18.6% [8/43]; P=0.016), and pulmonary hemorrhage (47.5% [28/59] vs. 76.7% [33/43]; P=0.004) were significantly lower in the direct transpleural group. ConclusionDirect transpleural route is recommended for CT fluoroscopy-guided biopsy of lung nodules with pleural contact because it is safer and yields similar diagnostic accuracy than transpulmonary route.

Abstract No. 226 Comparison of needle exchange methods in percutaneous needle lung biopsy in an in vitro air embolism model

Air embolism during transthoracic biopsy is a rare but dreaded complication with potential catastrophic complications. One suggested mechanism is vein to atmosphere fistula introduced by the coaxial needle. Given the low incidence, assessment of preventative techniques is not clinically feasible. The purpose of this study was to create an in vitro environment to compare the volume of air entering the introducer needle in the presence and absence of a saline seal in between coaxial exchanges.

The Influence of Ultrasound-Guided Technique Using a Catheter-Over-Needle on the Incidence of Accidental Intravascular Injection during Caudal Block-A Retrospective Case Series Study.

Background and Objectives: This study was conducted to investigate the influence of an ultrasound-guided technique using a catheter-over-needle when an intravascular injection occurs in patients undergoing a caudal block. Material and Methods: We retrospectively investigated 41 cases of an ultrasound-guided technique using an angiocatheter for caudal block. These had been performed between November 2019 through August 2020 to manage pain of lumbosacral origin. Under ultrasound guidance, after advancing the introducer needle through the sacrococcygeal ligament and then slowly withdrawing it, the outer catheter was continuously advanced into the sacral hiatus. We confirmed proper needle placement under fluoroscopic imaging, using 5 mL of contrast media. We assessed the contrast spread pattern with fluoroscopic imaging and checked it for the presence of intravascular injection. Results: In all recruited cases, the catheter-over-needle was guided successfully to the sacral hiatus and into the caudal epidural space. There was 100% accuracy under ultrasound guidance, without intravascular uptake, as confirmed by contrast media fluoroscopy. The incidence of ventral spread was 84.2% above the S1 with 5 mL of contrast. Conclusions: The technique of using a catheter-over-needle under ultrasound induced successful block without intravascular injection. Thus, this technique is a reliable option for conventional caudal block.

Preventing Post Dural Puncture Headache after Intrathecal Drug Delivery System Implantation Through Preventive Fibrin Glue Application: A Retrospective Study

Cerebrospinal fluid (CSF) leakage resulting in post dural puncture headache (PDPH) is a frequent adverse effect observed after intrathecal drug delivery system (IDDS) implantation. CSF leakage symptoms negatively affect patient quality of life and can result in additional complications. Fibrin glue was used to treat CSF leakage syndrome. We developed a procedure to reduce the incidence of PDPH by preventing CSF leakage with the use of fibrin glue during surgery. The main outcome criterion for this study was the incidence of PDPH syndrome after IDDS implantation with or without preventive fibrin glue application during the procedure. We designed a monocentric retrospective cohort study to compare the incidence of PDPH due to CSF leakage syndrome after lumbar puncture in patients with an implanted intrathecal pump, with or without preventive fibrin glue application during the procedure. The study was held in the Anesthesiology and Pain department of the Integrative Cancer Institute (ICO), Angers - France. The study compared 2 patient cohorts over 2 successive periods. Fibrin glue was injected into the introducer needle puncture pathway after placement of the catheter immediately following needle removal. The no-glue group included 107 patients, whereas the glue group included 92 patients.Two application failures were observed (2.04%). Fibrin glue application results in a significant decrease in PDPH incidence, from 32.7% in the no-glue group to 10.92 % (P < 0.001) in the glue group. In regard to severity, in the no-glue group, 37.1% of PDPH syndromes were mild, 34.3% were moderate, and 28.6% were severe. In the fibrin glue group, 80% of PDPH syndromes were mild, and 20% were moderate. No severe PDPHs were reported after fibrin glue application. Duration of symptoms was also statistically shorter in the fibrin glue group (maximum of 3 days vs. 15 days in the no-glue group). In a univariate analysis, preventive fibrin glue application and age are significant to prevent PDPH. In multivariate analysis, only fibrin glue application was statistically significant (odds ratio, 0.26; P = 0.0008). No adverse effects linked to fibrin glue were observed. The main limitation of this study is its retrospective nature. In addition, this study is from a single center with a potential selection bias and a center effect. The novel use of fibrin glue is promising in terms of its effect on PDPH and its safety profile. Its moderate cost and reproducibility make it an affordable and efficient technique.

Needle artifact characteristics and insertion accuracy using a 1.2 T open MRI scanner: A phantom study

PurposeTo evaluate the characteristics of needle artifacts and the accuracy of needle insertion using a 1.2 Tesla open magnetic resonance imaging (MRI) system in a phantom. Materials and methodsFirst, the apparent width of the needle on the MRI and the needle tip position error of 16- and 18-gauge MRI-compatible introducer needles and a 17-gauge cryoneedle were examined with different needle angles (0°, 30°, 45°, 60°, and 90°) to the main magnetic field (B0), sequence types (balanced steady-state acquisition with rewound gradient echo [BASG] and T2-weighted fast spin echo [FSE] sequence), and frequency encoding directions. Second, the accuracy of needle insertion was evaluated after 10 MRI fluoroscopy-guided insertions in a phantom. ResultsThe apparent needle widths was larger when the angle of the needle axis relative to B0 was larger. The needles appeared larger on BASG than on T2-weighted FSE images, with the largest apparent widths of 16-, 17-, and 18-gauge needles of 14.3, 11.6, and 11.0mm, respectively. The apparent needle tip position was always more distal than the actual position on BASG images, with the largest longitudinal error of 4.0mm. Meanwhile, the 16- and 18-gauge needle tips appeared more proximal on T2-weighted FSE images with right-to-left frequency encoding direction. The mean accuracy of MRI fluoroscopy-guided needle insertion was 3.1mm. ConclusionThese experiments clarify the characteristics of needle artifacts in a 1.2 Tesla open MRI. With this system, the MRI fluoroscopy-guided needle insertion demonstrated an acceptable accuracy for clinical use.

Accidental Dural Puncture With An Introducer Needle (18 G) For Elective Caesarean Section: A case report

A 23-year-old parturient with a body mass index of 20.8 kg/m2 at term was admitted for elective caesarean section. Spinal anaesthesia was done using a 27-G pencil-point needle without an introducer guide, with the usage of a separate 18-G introducer needle. After the introduction of the introducer at the level of L4–L5, accidental free flow of cerebrospinal fluid (CSF) was seen. The introducer was withdrawn and inserted at the level of L3–L4, followed by the spinal needle. CSF backflow was seen; an anaesthetic mixture was given. Block was successful and caesarean section was done with no intraoperative complications.

Semiautomated robotic, CT-guided needle placement for postmortem CSF sampling – a Novel application of the Virtobot

The sampling of cerebrospinal fluid (CSF) for chemical analysis is usually performed by a freehand lumbar puncture in a routine clinical procedure, while the suboccipital region is used for postmortem examinations. We introduce a new application for a semiautomated robotic, computed tomography (CT)-guided needle placement for postmortem lumbar and suboccipital CSF sampling. Postmortem computed tomography (PMCT) imaging was performed, and the data were sent to a custom-made Virtopsy Control Center and Virtopsy Planning and Navigation Station. Needle trajectories were planned for both suboccipital and lumbar approaches. Coaxial introducer needles were fully inserted automatically by the robotic system. PMCT was repeated to verify correct placement of the needles. Subsequently, CSF samples were taken using a syringe. By using this new application, the puncture of the spinal canal and cerebellomedullary cistern could be accurately performed to within a millimeter. Thus, failure of puncture and iatrogenic injury of the medulla oblongata may be prevented, and the risk of infection is significantly reduced. An early analysis of the CSF sample allows for a risk assessment in regard to the subsequent autopsy. Our application allows for minimally invasive, fast, efficient and safe CSF sampling prior to autopsy, enabling an analysis for metabolic imbalance, infection, etc.

A Novel Approach to Brachial Plexus Injections: A Technical Report

Background: Brachial plexus injects are common procedures for pain management of the upper limb. Complications from theses injections, however, can be severe leading to permanent neurological deficit. The purpose of this technical report is to introduces a safe novel approach for brachial plexus injections. Case Presentation: A 45-year-old woman with type 2 complex region pain disorder underwent a novel brachial plexus injection. The patient was brought to the operating room where fluoroscopy was used to locate the T2 lamina. A 17-gauge introducer needle was maneuvered through the interlaminar space and into the epidural space. The stylet was removed and a Brevi Kath® (Epimed, Dallas, TX) was passed through the C7-T1 foramen into the brachial plexus region. Contrast was used to ensure proper placement and absence of vascular pickup. The injection was then given, and the catheter withdrawn. The procedure was done without complication and the patient had a 40% reduction in pain symptoms based on a visual analog scale. She was cleared to restart physical therapy. Conclusions: This novel technique approaches the brachial plexus by gaining access to the thoracic epidural space and following the spinal nerves through their respective foramen. The use of fluoroscopy and contrast ensures correct placement of injection. A blunt catheter limits the risk of injury. This approach may benefit patients who have failed standard techniques using local landmarks or those that are not ideal candidates due to previous injury or pre-existing conditions. Key words: Interventional pain, injection, brachial plexus, pain management, fluoroscopy

Surgical Approach of the Anatomical Sites for Bone Marrow Aspiration in Dogs

Bone marrow as a soft material found in the central core of bones is vitally important for the production of blood cells and platelets. Bone marrow is commonly collected and examined when abnormalities are found in the circulating blood. The presented investigation aimed to describe the best anatomical sites for aspiration of the bone marrow in dogs and to record the computed tomographic anatomy and detection the site of needle aspiration. The present study was carried out on 7 apparently clinically healthy mongrel dogs (3 male and 4 female). The dog's weights were 15 - 50 kg bwt and their ages were 8 - 24 months. Three dogs (one male and two females) were euthanized to perform a cadaveric study to approach humerus, sternum, iliac crest and femur to detect the best site to introduce different sizes of aspiration needles to aspirate bone marrow samples. The other four dogs were undergone three dimensions (3D) computed tomography (CT) to detect the length of the needle inside the bone to aspirate bone marrow samples. In conclusion, the anatomical details of long bones (humerus and femur) and flat bones (sternum and ilium) were well showed by bone window of anatomical computed tomography. The Transverse plane showed that, humerus, femur and ilium are viewed in this plane with clear defined intra medullary cavity and the aspiration needle was obvious through head of humerus; Meanwhile, this plane was not valuable to detect medullary cavity of the sternum. The three dimensional view cleared that, the humerus, femur, ilium and sternum were viewed from all directions to detect anatomical sites for needle introduction. The sternum is anatomically detailed as a different lengths of sternebrae and needle insertion is safe in the longest sternebra (2nd one).

Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation: A Pragmatic Effectiveness Trial of a Nonpharmacologic Alternative for the Treatment of Postoperative Pain

Percutaneous peripheral nerve stimulation (PNS) is an analgesic modality involving the insertion of a lead through an introducer needle followed by the delivery of electric current after needle withdrawal. This modality has been used extensively to treat chronic pain, but only small series have been published involving postoperative pain. The ultimate objective of this study is to determine the postoperative effects of percutaneous PNS following moderately to severely painful ambulatory surgery within a real-world clinical practice setting. The primary hypothesis is that surgical pain and opioid consumption during the initial 7days after surgery will be reduced by percutaneous PNS compared with usual and customary analgesia (dual primary outcome measures). A multicenter pragmatic effectiveness trial. We are randomizing participants having painful orthopedic surgical procedures of the upper and lower extremity to receive 14days of either 1) electrical stimulation or 2) sham in a double-masked fashion. End points are being assessed at various time points over 12 postoperative months. The postoperative experience will be much improved if percutaneous PNS provides potent analgesia while concurrently decreasing opioid requirements following painful surgery. Because this modality can be administered for up to 60days at home, it may provide postoperative analgesia that outlasts surgical pain yet has relatively few risks and, unlike opioids, has no systemic side effects or potential for abuse, addiction, and overdose. Percutaneous PNS has the potential to revolutionize postoperative analgesia as it has been practiced for the past century. This study will inform key stakeholders regarding an evidence-based nonpharmacologic approach to the management of postoperative pain.

Comparison of external jugular vein-based surface landmark approach and ultrasound-guided approach for internal jugular venous cannulation: A randomised crossover clinical trial.

Historically, landmark techniques for central venous access through the internal jugular vein (IJV) have yielded a lesser success rate and higher complication rate than the ultrasound (US)-guided approach. The purpose of this study is to assess the success and safety of a novel external jugular vein (EJV)-based landmark (EJV-LM) approach compared with the real-time US-guided approach for central venous access through the IJV. This was a prospective, randomised, crossover trial performed in patients during elective cardiac and non-cardiac surgery. Each resident randomly inserted a central venous catheter using EJV-LM approach and real-time US-guided approach. The primary outcome was first-attempt success. Secondary outcomes included overall success rate, number of puncture attempts, cannulation time, haematoma and mechanical complications. A total of 188 patients were randomly assigned to the EJV-LM and US groups. The demographic characteristics of the groups were comparable. The first-attempt success was not different between EJV-LM and US-guided techniques (79.8%; [95% CI: 70.2-87.4] vs 89.4% [95% CI 81.3-94.8]; P=.06). The overall success rate was 100% with both techniques. There were no differences in the number of puncture attempts with introducer needle (1[1-3] vs 1[1-2]; P=.07). Cannulation time was longer in the EJV-LM group compared with the US group (58.11±6.6 vs 44.27±5.28seconds; P=.0001). EJV-LM technique was associated with a higher occurrence of overall complications compared with the US technique (12.8% [95% CI: 6.7- 21.2] vs 4.2% [95% CI: 1.1-10.5]; P=.03). No major mechanical complications were observed with either techniques. In patients with non-distorted neck anatomy and a visible EJV, IJV catheterisation using the EJV-based LM approach and standard US-guided technique yielded similar first-attempt and overall success rates. Cannulation time was longer and complications occurred more frequently in the EJV-based LM compared with the standard US-guided technique.

Practical Tips for Needle Introduction in Laparoscopy

Study Objective The objectives for this video are 1) to provide an overview of common suture and needle types that are used in gynecologic laparoscopy and 2) to present various strategies to introduce different needles into the abdomen. Design In this video, we discuss approaches to introducing the needle into the abdomen during laparoscopy. The needle can generally be introduced either vaginally or abdominally. Setting During laparoscopy, all patients were positioned in dorsal lithotomy and in Tredelendburg position for the needle introduction process. Patients or Participants N/A Interventions N/A Measurements and Main Results In order to maintain small incisions while introducing a needle for suturing, one must have an understanding of the various needles, trocars, and techniques that can be used to introduce them. Abdominal introduction can further be subdivided into direct trocar entry, backloading the needle, and skiing the needle techniques. Direct trocar entry is dependent on the size of the needle and the diameter of the trocar. Backloading and skiing the needle are techniques that can be used when there is a need to pass a needle through a smaller trocar, for example when using 5 milimeter trocars. Generally, the 5 milimeter trocar will only be able to directly accommodate a Keith needle. Conclusion For laparoscopic procedures such as hysterectomy, needle introduction is the first step in the suturing process and familiarly with needle types, trocar size, and introduction techniques can assist with surgical efficiency.

Training novice in ultrasound-guided venipuncture: A randomized controlled trial comparing out-of-plane needle-guided versus free-hand ultrasound techniques on a simulator.

Peripheral intravenous access is a common medical procedure, however, it can be difficult to perform in some patients. Success rates have proved greater with ultrasound guidance. Peripheral intravenous access using ultrasound requires specific training, especially for new ultrasound users. To overcome these difficulties, guidance devices on ultrasound probes are able to control the angle of penetration into tissues. We hypothesized that, and particularly for new ultrasound users, the use of a needle guide (NG) paired with the out-of-plane approach would facilitate puncture of a simulation model of vessel more effectively than similar free hand (FH) techniques. A prospective controlled randomized study was conducted of new ultrasound users using a guide wire introducer needle on gelatine phantom. After a 30-min lecture, one group performed the FH technique and the other group performed the NG technique both in an out-of-plane approach. The main criterion was the number of attempts before success of catheterization of this model of vessel. Thirty-four nurse anesthetist students participated in the study. The number of attempts before success using the NG technique was significantly lower: 3.7 (±0.9) in the NG group versus 6.7 (±3.3) in the FH group (p = 0.01). In the NG group, 100% of the participants achieved success after the sixth attempt. In the FH group, only 81.25% (n = 13/16) reached success. NG technique has been proved to have a steeper learning curve compared with the FH technique. A study on a learning curve in clinical practice is needed to confirm these results.

Technical Nuances of Ventriculoatrial Shunt Using Seldinger Technique for Percutaneous Insertion of Distal Shunt Catheter

Abstract Introduction One of the most seen neurosurgical complications is the ventriculoperitoneal (VP) shunt failure. The cause can be often due to peritoneal malabsorption of cerebrospinal fluid. The next safer alternative is to place a ventriculoatrial (VA) shunt. Various methods of access to the right atrium had been described. The percutaneous method of insertion of distal catheter using Seldinger technique is a safer alternative to open method. We describe the percutaneous insertion of distal catheter using Seldinger technique, modifications in the method, and specific tools required for the insertion. Clinical History The patient is a 22-year-old male who is a known case of tubercular meningitis with recurrent failure of VP shunt due to malabsorption at peritoneal end of catheter. During the last hospital visit, he presented with altered sensorium and computed tomography scan brain showed ventriculomegaly. He was planned for VA shunt placement. Surgical Technique The insertion of ventricular end of the catheter is similar to any other shunt placement. The internal jugular vein (IJV) was punctured using introducer needle and guide wire was placed in the IJV at the level of T6-T7 and the serial dilators passed on the guide wire for creating a track for passage of shunt catheter. The shunt catheter was passed over the guide wire to the desired vertebral level and distal shunt catheter is connected proximally to the shunt catheter in the neck. Conclusion The percutaneous insertion of distal catheter with serial dilators using Seldinger technique is a safe and effective method for VA shunt placement.

CT-guided radiofrequency ablation of osteoid osteoma: established concepts and new ideas.

Osteoid osteoma is a painful benign bone tumour of children and young adults with characteristic clinico-radiological features depending upon the location of the lesion. Intraoperative visualisation of the nidus is difficult and therefore curative surgery is often associated with excessive bone removal, significant perioperative morbidity and potential need of bone grafting procedures. With advancement in cross-sectional imaging and radiofrequency ablation (RFA) technology, CT-guided RFA has emerged as the treatment of choice for the osteoid osteoma. This procedure involves accurate cannulation of the nidus and subsequent thermocoagulation-induced necrosis.Multidisciplinary management approach is the standard of care for patients with osteoid osteoma. Appropriate patient selection, identification of imaging pitfalls, pre-anaesthetic evaluation and a protocol-based interventional approach are the cornerstone for a favourable outcome. Comprehensive patient preparation with proper patient position and insulation is important to prevent complications. Use of spinal needle-guided placement of introducer needle, namely, "rail-road technique" is associated with fewer needle trajectory modifications, reduced radiation dose and patient morbidity and less intervention time. Certain other procedural modifications are employed in special situations, for example, intra-articular osteoid osteoma and osteoid osteoma of the subcutaneous bone in order to reduce complications. Treatment follow-up generally includes radiographic assessment and evaluation of pain score. Dynamic contrast-enhanced MRI has been recently found useful for demonstrating post-RFA healing.

69-LB: A Wearable Microneedle Array Sensor Shows High Correlation between Dermal Glucose and Venous Blood Glucose

Objective: Current continuous glucose monitors (CGM) measure glucose in the subcutaneous interstitial fluid (ISF). Previous ex vivo research with hypodermic needles has shown that glucose in the dermal ISF is highly correlated to venous glucose with little or no lag time. However, this methodology is not viable for continuous measurement. In this study, we have developed and tested a wearable microneedle array sensor for continuous in situ measurement of glucose in the dermal ISF. A dermal CGM could be applied without an introducer needle and without pain during application. Methods: In this study the microneedle array sensor was tested against venous glucose measured every 15 minutes from a YSI analyzer in 8-hour sessions over 2 days (Phase One) and 5-7 days (Phase Two). Results: Five participants without diabetes and 10 participants with diabetes were recruited for phase One and 10 participants with diabetes were recruited for phase Two. A high degree of linear correlation (R2 ≥ 0 .90) between the microneedle array measured dermal ISF glucose and venous glucose was observed. The figure shows the linear correlation (A) and temporal profile (B) for one microneedle array sensor over 8 hours. Conclusions: A wearable microneedle array measuring dermal ISF glucose can accurately track glucose values. The study demonstrated early human feasibility of a CGM based on microneedle sensing of dermal ISF. Disclosure P.P. Samant: Employee; Self; Biolinq. M.P. Christiansen: Research Support; Self; Abbott, Ascensia Diabetes Care, Biolinq, Dexcom, Inc., Eli Lilly and Company, Lexicon Pharmaceuticals, Inc., Medtronic, Merck &amp; Co., Inc., Novo Nordisk A/S, Sanofi-Aventis, Senseonics, ViroMed Laboratories, Xeris Pharmaceuticals, Inc. S. Sattayasamitsathit: None. A. Campbell: None. T.A. Peyser: Consultant; Self; Insulet Corporation. Employee; Self; Biolinq. J.R. Windmiller: Employee; Self; Biolinq. J.R. Tangney: Board Member; Self; Biolinq. R. Lal: Consultant; Self; Abbott, Biolinq. N.C. Bhavaraju: Employee; Self; Biolinq.

A Novel Smart Assistance System for Blood Vessel Approaching: A Technical Report Based on Oximetry.

In clinical practice, the catheter has to be placed at an accurate position during anesthesia administration. However, effectively guiding the catheter to the accurate position in deeper tissues can be difficult for an inexperienced practitioner. We aimed to address the current issues associated with catheter placement using a novel smart assistance system for blood vessel catheter placement. We used a hollow introducer needle embedded with dual wavelength (690 and 850 nm) optical fibers to advance the tip into the subclavian vessels in anesthetized piglets. The results showed average optical density changes, and the difference between the absorption spectra and hemoglobin concentrations of different tissue components effectively identified different tissues (p < 0.05). The radial basis function neural network (RBFNN) technique was applied to distinguish tissue components (the F-measure value and accuracy were 93.02% and 94%, respectively). Finally, animal experiments were designed to validate the performance of the proposed system. Using this system based on oximetry, we easily navigated the needle tip to the target vessel. Based on the experimental results, the proposed system could effectively distinguish different tissue layers of the animals.

Abstract No. 586 Is the Biosentry tract sealant system effective in reducing pneumothorax rate after computed tomography–guided transthoracic lung biopsy with an 18-gauge biopsy needle?

Biosentry tract sealant system (BTS) is a Food and Drug Administration–approved device that deploys a hydrogel plug to seal the pleural puncture after CT-guided transthoracic lung biopsy (CTLB). It has been shown to reduce pneumothorax (PTX) rates with a 20G biopsy-19G introducer needle. The purpose of this study is to evaluate if BTS reduces PTX rates in patients undergoing CTLB with 18G biopsy-17G introducer needle (17G/18G system). In this retrospective study, 272 patients (mean age, 69.4 years) underwent CTLB between January 2015 and February 2019 using a 17G/18G system. BTS was used in 125 patients, and no pleural sealant was used in 147. The variables assessed were PTX on postbiopsy CT images or chest x-ray, chest tube insertion, lesion size, pleura to lesion distance, and presence of emphysema. Comparison between the two groups using T-tests with a significance level set at 0.05 was performed. 23 subjects (18%) had a PTX in BTS group compared to 38 (26%) in controls (P <0.05). 4 patients (17%) required a chest tube in the BTS group, and 3 (8%) in the control (P = 0.28). Mean lesion size in those with PTX was 1.62 cm in the BTS group and 2.44 cm in controls (P = 0.27). Mean pleura to lesion distance in those with PTX was 2.23 cm in the BTS group and 1.52 cm in controls (P = 0.17). Emphysema was present in 47% of patients in the BTS group and 30% in control group (P < 0.05). BTS reduced the pneumothorax rates in CTLB patients with a 17G/18G biopsy system, despite a higher proportion of emphysema patients in BTS group compared to controls. However, the rate of chest tube insertion did not change, in contrast to previous studies in which 19G/20G biopsy systems were used. Additionally, PTX rate was not affected by lesion size or pleura to lesion distance.Table 1BTS (n = 125)Controls (n = 147)PMean/StdDevMean/StdDevPTX rate0.18/0.030.26/0.04<0.05Chest tube insertion rate0.17/0.380.08/0.270.28Lesion size in PTX subjects (cm)1.62/1.122.4/3.50.27Pleura to lesion distance in PTX subjects (cm)2.23/2.231.5/1.80.17% with Emphysema4730<0.05PTX = Pneumothorax, StdDev = Standard Deviation Open table in a new tab

A Senior Management Perspective on the Policy Debate of Needle and Syringe Exchange Program Provision in Irish Prisons.

This study examined from an Irish perspective the contentious policy debate about providing clean needles to injecting drug users within prison systems; specifically, it examined the views of six senior managers who were prison health staff and security management. Research participants were generally opposed to the introduction of prison-based needle and syringe exchange programs (PNSP) in Ireland. They argued that (1) PNSP were unnecessary since injecting drug use within Irish prisons has declined significantly, (2) PNSP, by making needles freely available to prisoners, would make prisons riskier since these needles might be used as weapons against prison staff or other prisoners, and (3) PNSP might be seen as condoning illicit drug use and sending the "wrong message." It is concluded that, for the moment at least, there is little likelihood of PNSP becoming a reality in the Irish Prison Service.