Larger Catheter Size Research Articles

Impact of the size-dependent difference of excimer laser coronary angioplasty in ST-elevation acute myocardial infarction; nuclear scintigraphy findings

Abstract Background Excimer laser coronary angioplasty (ELCA) is reported to provide a good percutaneous coronary intervention (PCI) outcome. The current lineups of laser catheter sizes are 0.9-mm, 1.4-mm, and 1.7-mm catheter diameters. Although the cross ability and irradiation time is better in smaller catheter size, the available irradiation area is more significant in larger catheter size; however, it is unknown the difference in laser catheter size impacts good results in patients with ST-elevation myocardial infarction (STEMI). Aim To investigate the relationship between the laser catheter size and clinical outcome in patients with STEMI. Methods and Results We retrospectively enrolled 123 consecutive patients with STEMI who underwent primary PCI (median age: 67 [69-72] years, male: 102 [82.9%]). Patients were divided into 0.9-mm-catheter diameter group (small group, n = 47) and 1.4/1.7-mm-catheter diameter group (large group, n = 76). The patients’ characteristics, procedural results, peak creatine kinase/ creatinine kinase-myocardial band, final thrombolysis in myocardial infarction flow, and periprocedural complications were collected. Furthermore, from nuclear scintigraphy data based on a 17-segment model with a 5-point scoring system, which was calculated via the difference between 123I-BMIPP at 3-7 days and 99mTc-tetrofosmin at 3-6 months following PCI, the improvement of ejection fraction (EF) and myocardial salvage through summed rest score (SRS) were investigated. There was no significant difference in patients’ characteristics, PCI procedure, and results between the two groups. The occurrence of coronary slow flow was similar between the two groups. On the other hand, nuclear scintigraphy data demonstrated that the improvement of EF and SRS were significantly better in the small group (EF; 13.3% vs. 7.6%, p=0.016, SRS; 18 vs. 5, p=0.012, respectively). Conclusions The nuclear scintigraphy findings showed that ELCA with small catheter size is feasible in patients with STEMI.Figure 1

Evaluation of Complications of Peritoneal Dialysis Catheter in Children: A Retrospective Single Center Study

Introduction:Peritoneal dialysis is a long-term method of dialysis for children. Peritoneal dialysis, when performed effectively, saves valuable time for children with advanced kidney transplant, till they reach the appropriate age for the kidney transplant. In children, due to their rapid physical growth and the large catheter size, as well as the thin and weak abdominal wall, especially before the age of 4, the complications of catheterization such as catheter leak and incisional hernia are higher than that of adult population. In this study we aim to evaluatethedysfunction and complications of the cathetersof peritoneal dialysis in children. Materials and Methods:We assessedmedical records of all patients, who underwent peritoneal dialysis since 2006 till 2015 at Mofid hospital, Tehran, Iran. Total number of 41 records were evaluated, of which 11 cases were excluded dueto incomplete data and 30 patients were analyzed eventually.Complications of catheter were recorded. Results:We studied 30 patients, 14 males and 16 females; the mean age of the children was 72.6 months(5 to 12 years old). The leading cause of end stage renal disease(ESRD) were primary glomerulopathies. There were total of 3 catheterreplacements,mostly due to peritonitis and catheter obstruction. The incidence of infectious complications was 40.3%. The incidence of all complications was 1 out of 6.4 patients/month. Conclusion: Regarding the high prevalence of catheter-related complications in children undergoing chronic peritoneal dialysis, especially infectious complications, adopting standard surgical technique of catheter insertion accompanied bywell trained peritoneal dialysis team isessential to prevent the complications and to increase the functional life span of the catheter and to enhance the quality of life of the patient.

Complications of femoral arterial lines in infants under 12 months

Background: The risks of femoral arterial line placement in young children have been incompletely defined. We hypothesized that a low complication rate would be associated with ultrasound use. Subjects and Methods: Infants aged 0–12 months undergoing placement of a femoral arterial line at our institution over a 3.5-year period were identified through billing data, and their records were reviewed. Events concerning each line were recorded individually. Patients were excluded if there was incomplete documentation or if the line was in place for under 24 h. Demographics, information about line placement, and complications were recorded. Results: Three hundred and sixty-four femoral arterial lines were included. Eighty percent of lines were placed in the operating room, with the rest placed in the cardiac intensive care unit (ICU) (11%), the cardiac catheterization lab (6%), or the pediatric ICU (3%). Femoral artery occlusion occurred with 16% of lines placed, and limb ischemia in 6%. One patient had tissue loss. Occlusion was associated with lower gestational age at birth (44 [40–57] vs. 50 [41–60], P = 0.04), lower weight (3.7 [3.1–5.7] vs. 4.3 kg [3.3–6.2], P = 0.05), left-sided lines (52% vs. 66%, P = 0.05), placement in interventional catheterization lab (odds ratio [OR]: 3.28, confidence interval [CI]: 1.24–8.67, P = 0.02), >2 attempts (27% vs. 13%, P < 0.01), and catheter diameter (OR: 2.86, CI: 1.18–6.92, P = 0.02). Conclusion: Femoral arterial catheter placement in infants younger than 12 months resulted in a 16% rate of arterial occlusion at our institution, which was associated with low gestational age, larger catheter size, and left-sided lines but not ultrasound use, line duration, catheter length, use of anticoagulation, physician specialty, or physician training level.

Peripherally Inserted Central Catheter Thrombosis After Placement via Electrocardiography vs Traditional Methods

BackgroundPeripherally inserted central catheter tip placement at the cavoatrial junction is associated with reduced catheter-related deep vein thrombosis. Electrocardiographic tip confirmation purportedly improves accuracy of tip placement, but whether this approach can reduce deep vein thrombosis is unknown. MethodsProspectively collected data from patients that received peripherally inserted central catheters at 52 Michigan hospitals were analyzed. The method used to confirm tip confirmation at insertion and deep vein thrombosis outcomes were extracted from medical records. Multivariate models (accounting for the clustered nature of the data) were fitted to assess the association between peripherally inserted central catheter-related deep vein thrombosis and method of tip confirmation (electrocardiographic vs radiographic imaging). ResultsA total of 42,687 peripherally inserted central catheters (21,098 radiology vs 21,589 electrocardiographic) were included. Patients receiving electrocardiographic-confirmed peripherally inserted central catheters had fewer comorbidities compared with those that underwent placement via radiology. Overall, deep vein thrombosis occurred in 594 (1.3%) of all peripherally inserted central catheters. Larger catheter size (odds radio [OR] 1.32; 95% confidence interval [CI], 0.93-1.90 per unit increase in gauge), history of deep vein thrombosis, and cancer were associated with increased risk of deep vein thrombosis (OR 2.00; 95% CI, 1.65-2.43 and OR 1.62; 95% CI, 1.16-2.26, respectively) using logistic regression. Following adjustment, electrocardiographic guidance was associated with a significant reduction in peripherally inserted central catheter-related deep vein thrombosis compared with radiographic imaging (OR 0.74; 95% CI, 0.58-0.93; P = .0098). ConclusionThe use of electrocardiography to confirm peripherally inserted central catheter tip placement at the cavoatrial junction was associated with significantly fewer deep vein thrombosis events than radiographic imaging. Use of this approach for peripherally inserted central catheter insertion may help improve patient safety, particularly in high-risk patients.

Real-time magnetic resonance imaging \u2013 guided coronary intervention in a porcine model

X-ray fluoroscopy is the gold standard for coronary diagnostics and intervention. Magnetic resonance imaging is a radiation-free alternative to x-ray with excellent soft tissue contrast in arbitrary slice orientation. Here, we assessed real-time MRI-guided coronary interventions from femoral access using newly designed MRI technologies. Six Goettingen minipigs were used to investigate coronary intervention using real-time MRI. Catheters were custom-designed and equipped with an active receive tip-coil to improve visibility and navigation capabilities. Using modified standard clinical 5 F catheters, intubation of the left coronary ostium was successful in all animals. For the purpose of MR-guided coronary interventions, a custom-designed 8 F catheter was used. In spite of the large catheter size, and therefore limited steerability, intubation of the left coronary ostium was successful in 3 of 6 animals within seconds. Thereafter, real-time guided implantation of a non-metallic vascular scaffold into coronary arteries was possible. This study demonstrates that real-time MRI-guided coronary catheterization and intervention via femoral access is possible without the use of any contrast agents or radiation, including placement of non-metallic vascular scaffolds into coronary arteries. Further development, especially in catheter and guidewire technology, will be required to drive forward routine MR-guided coronary interventions as an alternative to x-ray fluoroscopy.

Study on incidence of phlebitis following the use of pherpheral intravenous catheter.

Context:Peripheral vein cannulation is commonly performed for rapid and accurate administration of medications. Phlebitis is one of the commonest complications that develop after intravenous catheter application.Aims:This study aims to investigate the incidence of phlebitis and to evaluate factors contributing to the development of phlebitis.Settings and Design:This was a prospective observational study conducted on patients admitted at 4 Air Force Hospital Kalaikunda.Methods:Study conducted on 150 patients who were admitted to the medical and surgical division of the hospital during the period from July 2018 to April 2019. The factors studied were age, gender, site of insertion, place of insertion, cannula size, IV medications, and blood products used. Phlebitis was graded using Visual Infusion Phlebitis Score.Statistical Analysis Used:The incidence of phlebitis was expressed in percentage and odds ratio was calculated to estimate the effects of suspected risk factors.Results:Incidence of phlebitis was found to be 31.4% from our study. The increased incidence rate of phlebitis was seen in the female gender, age less than 60 years, insertion in the lower limb, large catheter size, catheters inserted in emergency situations, and IV drugs administration.Conclusion:Phlebitis is an important on-going problem in present-day clinical practice. Avoiding of preventable risk factors, proper nursing care, and daily inspection of catheters needed for prevention of phlebitis.

ABO blood group related venous thrombosis risk in patients with peripherally inserted central catheters.

To investigate the association between ABO blood group and upper limb venous thrombosis (VT) risk in patients with peripherally inserted central catheters (PICC). Single centre retrospective cohort study. A cohort of patients who underwent PICC insertion from September 2010 to August 2014 were followed up for symptomatic VT presentations diagnosed by ultrasound. Blood group status was identified from hospital information systems. 2270 participants had 3020 PICCs inserted. There were 124 cases of symptomatic VT, an incident rate of 4% [95% confidence interval, CI (3-5%)]. Univariate analysis adjusting for the clustered sample showed that having chemotherapy, two or more previous PICCs, a larger catheter size, a diagnosis of cancer and having a blood group B were all associated with an increased risk of a VT. In the multivariate analysis, PICC diameter, cancer diagnosis and blood group B were all independently associated with increased risk of VT. Patients undergoing PICC insertion with a blood group B appear to have a higher risk of VT, independent of risks attached to the PICC procedure and cancer diagnosis. Without any existing guidelines for PICC-related VT, this investigation creates a platform for further research to be conducted in order to establish guidelines. Advances in knowledge: Previous studies investigating VT risk associated with blood group status related to large heterogeneous populations. In this article, we look at patients specifically with PICC, which reduces the heterogeneity in the cohort. In addition, due to the substantial number of patients enrolled, we had a chance to perform multivariate analyses with statistical significance.

Evaluation of Flow Characteristics of 3-Way Catheters

We evaluated the flow characteristics of various 3-way catheters. We evaluated 14, 3-way catheters, including 18Fr, 20Fr, 22Fr and 24Fr Rusch(R), 18Fr, 20Fr, 22Fr and 24Fr Bardex(R), 18Fr, 20Fr, 22Fr and 24Fr Dover, and 20Fr and 22Fr Mentor (Mentor, Santa Barbara, California) catheters. Ten operators applied maximum 1-hand pressure with a 60 ml bladder wash syringe. Maximum and average flow rates were evaluated. The catheter was connected to an irrigation bottle and free flow irrigation speed was noted. The catheter was inserted into a latex balloon containing a prefilled volume of 100 ml and continuous irrigation characteristics were noted. Statistical analysis was performed using 1-way ANOVA and the Kruskal-Wallis test. Rusch catheters had the best flow characteristics when the drainage port was used for manual irrigation with 18Fr catheters (Rusch and Dover 24.8 and 19.2 ml per second, p = 0.003, vs Bardex 17.67 ml per second, p <0.001), and with 20Fr Rusch, Bardex, Mentor and Dover catheters (27.7, 21.42, 27.1 and 24 ml per second, respectively, p = 0.034). In the other categories of catheters tested there was no significant difference among 22Fr Rusch, Bardex, Dover and Mentor catheters (29.4, 28.9, 25 and 28.27 ml per second, p = 0.32), and among 24Fr Rusch, Bardex and Dover catheters (32.2, 29.79 and 29.9 ml per second, respectively, p = 0.27). Upon using the irrigation channel for manual irrigation all catheters had similar flow characteristics (no statistically significant difference). When connected to the irrigation tube with free flow, although the 18Fr, 20Fr and 22Fr Rusch, and 24Fr Dover catheters had slightly better flow than the others, this was not statistically significant. There was no marked difference in flow rate as catheter size increased above 20Fr. When the artificial bladder was used, the Rusch catheters had the maximum drainage in the 18Fr and 20Fr sizes, whereas the Mentor and Dover catheters had the maximum drainage in the 22Fr and 24Fr sizes, respectively (no statistically significant difference). The 18Fr and 20Fr Rusch 3-way catheters have better flow than other catheters when the drainage port is used for washout. In the 22Fr and 24Fr categories all different catheters had equivalent irrigation and drainage properties. Larger catheter size does not equate to better irrigation or drainage when continuous irrigation is used.

Optical coherence tomographic imaging of a bioabsorbable magnesium stent lost in a porcine coronary artery

1553-8389/07/$ – see front matter © 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.carrev.2007.09.002 completely unexpanded (Fig. 1). The OCT imaging catheter was small enough to fit next to the stent in the vessel lumen. IVUS imaging was attempted, but the larger catheter size forced the stent to be propelled distally, and it could not be imaged with that technology. There were no clinical sequelae to the loss of the unexpanded stent, and

Vascular injuries resulting from arterial puncture of catheterization.

Abstract Diagnostic puncture or catheterization is probably the commonest cause of serious arterial injury in current civilian surgical practice. The most frequent complications are arterial thrombosis, bleeding from the puncture site, false and arteriovenous aneurysm formation, and cerebral embolism. Eight instances of arterial occlusion have been treated in one hospital in less than 18 months–1 followed arterial puncture, 3 followed operative insertion of catheters maintained for repeated blood-sampling, I followed Seldinger catheterization for arteriography, and 3 followed cardiac catheter studies–during which time 1400 such procedures were carried out. Arterial spasm and trauma, large catheter size, protracted catheter maintenance, and low cardiac output seem to be factors particularly liable to produce sufficient damage to precipitate complications, together with thrombosis consequent to sustained heavy local pressure to arrest haemorrhage from the site of arterial puncture. Early surgical correction was successful on each of 6 occasions, but in the 2 cases in which procrastination had occurred major arm amputations became necessary.

The evolution and function of central venous catheters for dialysis.

The use of central venous catheters (CVC) for acute or chronic dialysis has been a relatively recent innovation in Nephrology. The first problem addressed has been how to allow removal and return of blood at high flow rates throughout a dialysis treatment. Four solutions have emerged: place the lumens within the right atrium; place the removal lumen on the inside of the catheter; use a large catheter size; or provide independent limbs with multiple blood-entry ports to draw and return blood in all directions. Many other requirements include resistance to infection, especially the passage of organisms around the catheter. A subcutaneous Dacron cuff within a tunnel has successfully accomplished this goal for most chronic CVC dialysis catheters, but other immobilizing devices such as plugs have also been successful. Materials for CVC dialysis catheters have improved, providing strength to allow the catheters to last for several years, with flexibility to avoid vein damage (in general). However, component and material failures still occur, and some materials are incompatible with medications placed at the exit site. CVC for dialysis will remain a necessary choice for many patients beginning and continuing dialysis therapy.

Vascular complications of the intraaortic balloon pump in patients undergoing open heart operations: 15-year experience

Background. The beneficial effects of the intraaortic balloon pump (IABP) in providing circulatory support must be weighed against its complications, particularly its vascular trauma. Methods. Five hundred nine patients who underwent open heart operations at our institution and who were treated with the IABP from January 1980 through December 1994 were studied retrospectively to assess IABP-related vascular complications and their independent preoperative predictors and the implications of IABP-related vascular complications on the patients’ mortality, morbidity (clinical sepsis and organ failure), and long-term survival. Results. Early vascular complications occurred in 56 patients (11%) and major complications occurred in 41 patients (8%). The latter consisted of aortic perforation in 1 patient, aortoiliac dissection in 2 patients, and limb ischemia in 38 patients. Logistic regression analysis identified concomitant peripheral vascular disease ( p < 0.001), elevated preoperative end-diastolic pressure, small body surface area, and large catheter size ( p < 0.05) as independent risk factors for IABP-related major vascular complications in patients who survived the day of operation. Late IABP-related sequelae occurred in 10 patients, 9 of whom had had early vascular complications. The presence of vascular complications per se was not a significant independent factor among other risk factors for mortality, morbidity, or long-term survival. Conclusions. Careful clinical assessment of the aortofemoral vascular tree is a cornerstone of early diagnosis and early intervention and usually prevents limb loss. The significant decrease in major vascular complications that has occurred over the last 5 years can be explained by the increased use of catheters with smaller diameters. The timing of IABP insertion in relation to operation and the duration of IABP use were the only device-related risk factors identified for morbidity and survival.

Vascular complications of coronary interventions

Vascular complications such as hematoma, pseudoaneurysm, and arteriovenous fistula that occur after intracoronary or intracardiac procedures are responsible for considerable morbidity and some mortality. In addition, many of these complications result in considerable increases in hospital stays and in the costs associated with the procedures. A number of risk factors for vascular complications after coronary interventions have been identified. They include excessive anticoagulation, use of femoral sheaths for extended lengths of time, multiple interventions during the same hospitalization, catheter insertion in the superficial or deep femoral artery, larger catheter size, and complex interventions such as stent deployment or atherectomy. Specific interventions have been identified that help to decrease procedural risk, improve early detection and prompt treatment of the vascular injury, and prevent long-term disability.

Intravascular Ultrasound Catheter Evaluation of the Left Ventricle in Mice: A Feasibility Study.

With the advent of transgenic technology, it has become increasingly important to find a method for evaluating left ventricular (LV) anatomy and function in intact wild type, intervened, and transgenic mice. Mice are 1/10th the size of rats, and have body masses of 10-60 g, LV masses of 40-150 mg, LV wall thicknesses of 0.5-2 mm, and LV internal dimensions of 1-3 mm. Although the murine LV has been imaged by transthoracic (TTE) two-dimensional directed M-mode echocardiography, we explored the use of intravascular ultrasound (IVUS) catheters, with imaging from various positions, to see if better two-dimensional images of the LV could be obtained by IVUS than TTE. Eight normal mice were anesthetized using pentobarbital or avertin. The mice were studied using a commercially available IVUS system (Endosonics, Inc.). Two IVUS catheters (3.5 and 5.0 Fr) with 20-MHz multielement array transducers were used. Each catheter had a 4.0-mm imaging depth of field in all directions (360 degrees ) from the mid-point of the catheter core. Multiple imaging approaches were attempted: transesophageal (TEE); transjugular (TJ); transperitoneal (TP); and open chest, from both epicardial surface (Ep) and via direct LV puncture. TEE and TJ approaches afforded insufficient depth of field to image the entire LV in cross section. TP and Ep approaches resulted in poor images, related both to inadequate depth of field and to relatively small sector angles subtended by imaging elements. LVP (intracavitary imaging) was capable of satisfactorily imaging the LV epicardium, but was unable to image the endocardium, probably because the latter was within the 1.9-mm "ringdown" catheter artifact. All IVUS approach studies lacked sufficient temporal resolution (10 frames/sec) to reliably display systolic and diastolic frames necessary for evaluation of LV function. In contrast, as previously reported, transthoracic two-dimensionally directed M-mode echocardiograms have sufficient temporal and spatial resolution to permit accurate estimates of LV mass and systolic function. Currently, IVUS catheter-based approaches are not feasible for imaging murine LV anatomy and function. Limitations include: (1) inadequate temporal resolution might be improved by ECG gating; (2) limited depth of field possibly resolvable by lower frequency transducers; and (3) relatively large catheter size. (ECHOCARDIOGRAPHY, Volume 13, November 1996)

Effect of catheter diameter on resting pressures in anal fissure patients.

Controversy exists as to whether fissure patients have elevated resting pressures when compared with control patients. The diameter of manometry catheters used in past studies varies widely (1.5-25 mm) and may have contributed to differences observed in resting pressures. A prospective study was undertaken to determine the influence of manometry catheter diameter on maximum resting pressure in patients with idiopathic chronic anal fissures. A total of 28 fissure patients and 28 control patients had manometry performed with both a 1.8-mm and a 4.8-mm (external diameter) water-perfused catheter. Mean maximum resting pressure (RP) for fissure patients as measured with the 1.8-mm catheter was 86 (range, 65-115) mmHg and 83 (range, 47-117) mmHg with the 4.8-mm catheter (P = 0.65). Mean maximum RP for control patients with the 1.8-mm catheter was 70 (range, 30-108) mmHg and 72 (range, 35-109) mmHg with the 4.8-mm catheter (P = 0.07). When fissure and control patients were compared, a significantly higher mean RP was observed in the fissure group for both the 1.8-mm catheter (86 vs. 70 mmHg, respectively; P = 0.01) and the 4.8-mm catheter (83 vs. 72 mmHg, respectively; P = 0.03). There was no significant difference in length of the high-pressure zone within each group or when the fissure group and controls were compared, regardless of catheter used. For both groups of patients, there was a significantly higher incidence of ultraslow waves (USWs) observed with the 4.8-mm catheter when compared with the 1.8-mm catheter. The USW frequency was not significantly different when fissure and control groups were compared with either catheter type. Catheter size did not influence measured maximum RP in fissure patients. The maximum RP was significantly greater for fissure patients overall when compared with the control group, regardless of catheter used. There was an increased frequency of USWs noted with the larger catheter size in all patients; however, these USWs only became apparent when catheter was left at each station until a true baseline RP was obtained.

Intracardiac echocardiography with a steerable low-frequency linear-array probe for left-sided heart imaging from the right side: Experimental studies

Despite a need for intracardiac echocardiographic guidance during interventional procedures, an optimal catheter device is not available. The depth of field of catheters bearing 10 to 20 MHz transducers does not allow easy or complete visualization of the left side of the heart from the right side of the heart. Lower frequency transducers would be required to increase the depth of view of such rotational devices. These low-frequency transducers would require an expanded aperture and thus a larger catheter size. Other transducer modalities that could exploit the length of the imaging device rather than the circumference could potentially solve the problem of aperture size. To examine whether a linear-array transducer could provide adequate images of the left side of the heart from the venous side, we employed a prototype 7 MHz linear-array probe with a steerable tip inside eight animal hearts. Atrial and ventricular septal defects were created experimentally. The device was introduced into the right side of the heart through the inferior and superior vena cavae. Intracardiac imaging with this probe allowed visualization of the left side of the heart and major arteries from the right side with excellent image quality. By advancing the probe in various locations in the right side of the heart and using the steerability of this device, we were able to identify useful imaging planes for different cardiac structures. Atrial and ventricular septal defects were also detected easily and delineated clearly. The concept of a low-frequency (< 8 mHz) linear-array probe for intracardiac echocardiography may represent another step toward "whole-heart imaging" from the venous side.(ABSTRACT TRUNCATED AT 250 WORDS)

Failure of the Percutaneous Intra-Aortic Balloon to Unwrap–A Case Report

An intra-aortic balloon which can be inserted percutaneously has become an attractive adjunct in the past few years. The major benefits of this technique are ease and speed of insertion and the lack of need for a surgical cutdown. Early concerns about post balloon removal hemorrhage due to the large catheter size (12 French) have largely proven to be unfounded. Early experience suggests that the most frequent problem associated with percutaneous insertion has been failure of the balloon to completely unwrap. This problem was observed in 17 of 96 patients (17 .8%) in whom the balloon was inserted perioperatively. Usually, the problem is recognized immediately. The balloon is then withdrawn, re-wrapped, and reinserted or replaced with another balloon. In two patients, failure to completely unwrap was not recognized until later. One patient had the balloon removed while another was simultaneously inserted into the contralateral femoral artery without complication followed by improved and normal balloon function. The second patient is presented depicting recognition of the problem and subsequent solution.