Large Catheter Research Articles

Bipolar ablation of refractory atrial and ventricular arrhythmias: Importance of temperature values of intracardiac return electrodes.

Bipolar radiofrequency catheter ablation (Bi-RFCA) emerged as an option for treatment of arrhythmias resistant to the conventional approach. Data on safety issues of Bi-RFCA, including temperature values of intracardiac return electrode (IRE) are lacking. To determine the safety profile of Bi-RFCA regarding temperature measurements obtained from nonirrigated IRE of different sizes. The study group consisted of consecutive patients after failed conventional RFCA who underwent Bi-RFCA. Out of 1510 RFCA performed in our center, 19 patients underwent Bi-RFCA due to refractory to previous RFCA ventricular arrhythmias (15 patients) or typical atrial flutter (four patients). Nonirrigated small (4 mm) and large (8 mm) tip catheters were used as IRE in 14 (including three cross-overs to 8 mm IRE) and five patients, respectively. A total number of 164 bipolar applications were performed (128 for 4 mm and 36 for 8 mm IRE). Maximal temperatures of 4 mm IRE were significantly higher than those of 8 mm IRE (63°C ± 16°C vs 43°C ± 4°C; P = .027). A significant rise of temperature and steam-pops, preventing further Bi-RFCA, occurred in seven patients treated with 4 mm IRE. Bi-RFCA using 4 mm IRE operated at significantly higher impedance values (211 ± 83 vs 143 ± 38; P = .04) and lower power values (mean 20 W ± 6 W vs 32 W ± 7 W, P = .0005; max 29 W ± 9 W vs 39 W ± 10 W, P = .027). The use of 8 mm IRE for Bi-RFCA is associated with lower temperatures of the catheter used as ground and lower incidence of steam-pops which may suggest a better safety profile than 4 mm IRE. Determination of safety/efficacy balance requires further studies.

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.

Molecular Techniques Complement Culture-Based Assessment of Bacteria Composition in Mixed Biofilms of Urinary Tract Catheter-Related Samples.

Urinary or ureteral catheter insertion remains one of the most common urological procedures, yet is considered a predisposing factor for urinary tract infection. Diverse bacterial consortia adhere to foreign body surfaces and create various difficult to treat biofilm structures. We analyzed 347 urinary catheter- and stent-related samples, treated with sonication, using both routine culture and broad-range 16S rDNA PCR followed by Denaturing Gradient Gel Electrophoresis and Sanger sequencing (PCR-DGGE-S). In 29 selected samples, 16S rRNA amplicon Illumina sequencing was performed. The results of all methods were compared. In 338 positive samples, from which 86.1% were polybacterial, 1,295 representatives of 153 unique OTUs were detected. Gram-positive microbes were found in 46.5 and 59.1% of catheter- and stent-related samples, respectively. PCR-DGGE-S was shown as a feasible method with higher overall specificity (95 vs. 85%, p < 0.01) though lower sensitivity (50 vs. 69%, p < 0.01) in comparison to standard culture. Molecular methods considerably widened a spectrum of microbes detected in biofilms, including the very prevalent emerging opportunistic pathogen Actinotignum schaalii. Using massive parallel sequencing as a reference method in selected specimens, culture combined with PCR-DGGE was shown to be an efficient and reliable tool for determining the composition of urinary catheter-related biofilms. This might be applicable particularly to immunocompromised patients, in whom catheter-colonizing bacteria may lead to severe infectious complications. For the first time, broad-range molecular detection sensitivity and specificity were evaluated in this setting. This study extends the knowledge of biofilm consortia composition by analyzing large urinary catheter and stent sample sets using both molecular and culture techniques, including the widest dataset of catheter-related samples characterized by 16S rRNA amplicon Illumina sequencing.

Fibrin Sheath Formation during Mechanical Circulatory Support

Discontinuing mechanical circulatory support is often guided by transesophageal echocardiography (TEE).1,2 TEE was used to guide removal of an bicaval dual-lumen catheter (Avalon Elite, Maquet, Rastatt, Germany) after recovery of lung function in a patient supported with venovenous extracorporeal membrane oxygenation. TEE assessment of the right atrium showed a large fibrin sheath after removal of the catheter (arrow on panel A; LA, left atrium; RA, right atrium). Because of the large size and mobile nature of the retained fibrin sheath, it was percutaneously removed (panel B; LA, left atrium; RA, right atrium; SVC, superior vena cava; AngioVac system, AngioDynamics, USA) to avoid pulmonary embolization.Mechanical circulatory support therapy requires cannulae placement in central vessels for hemodynamic or ventilatory support. The presence of large catheters in central vessels, even for a brief period, can be complicated by fibrin sheath formation as shown in the presented image.1,3 Although unproven, low blood flow rate between a mechanical circulatory support catheter and a central vessel may be the reason for fibrin sheath formation around the catheter. Consequently, a fibrin sheath may form regardless of the degree of anticoagulation during mechanical circulatory support therapy, making routine TEE examination during mechanical circulatory support decannulation potentially important.2 Treatment options for a catheter-related fibrin sheath depend on the size, location, and mobility of the fibrin sheath and include observation, anticoagulation or percutaneous or open surgical removal.3Dr. Essandoh is a consultant for Boston Scientific (Marlborough, Massachusetts).

Effect of contrast medium injection rate on computed tomography-derived renal perfusion estimates obtained with the maximum slope method in healthy.

OBJECTIVE To evaluate the effect of contrast medium injection rate on CT-derived renal perfusion estimates obtained with the maximum slope method in healthy small dogs. ANIMALS 6 healthy sexually intact male purpose-bred Beagles. PROCEDURES All dogs underwent CT perfusion analysis 3 times in a crossover design, receiving a different contrast medium injection rate (1.5, 3.0, and 4.5 mL/s) each time, with a 1-week interval between imaging sessions. All CT images were obtained at the level of the left renal hilus. The time to peak aortic enhancement (TPAE) and time to initial renal venous enhancement (TIRVE) were measured from time-attenuation curves. The renal CT perfusion estimates (blood flow and blood volume) were estimated by use of the maximum slope method, which assumes no venous outflow of contrast medium during CT perfusion analysis. RESULTS The TPAE occurred at or before the TIRVE at all injection rates. Median values of estimated blood flow and blood volume did not differ significantly among injection rates. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that the assumption of no venous outflow of contrast medium during renal CT perfusion analysis with the maximum slope method was satisfied for all 3 contrast medium injection rates in the evaluated dogs. A low injection rate may be more practical than higher injection rates that require large catheters for CT perfusion analysis in small dogs such as Beagles.

Low Complication Rate of Surgical Mitral Valve Replacement in High-Risk Patients

Introduction: Transcatheter mitral valve replacement (MVR) has emerged in recent times as a new technique in the field of cardiac interventions. However, significant challenges have been encountered, including mitral valve anatomy complexity, subvalvular apparatus, interaction with the left ventricular outflow tract and aortic valve. It requires large transcatheter devices and large catheters, which are required to negotiate an extreme angle within a relatively small space (through the transseptal approach) to reach the mitral valve (Ruguiero et al., 2017, Guerro et al., 2017). Transcatheter MVR has been associated with high 30-day mortality rates ranging from 25–50%. This study aimed to explore the functional and health outcomes of surgical MVR.

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.

Failure Rate of Prehospital Needle Decompression for Tension Pneumothorax in Trauma Patients

Tension pneumothorax is commonly treated with needle decompression (ND) at the 2nd intercostal space midclavicular line (2nd ICS MCL) but is thought to have a high failure rate. Few studies have attempted to directly measure the failure rate in patients receiving the intervention. We performed a retrospective analysis of 10 years of patients receiving prehospital ND. CT scans were reviewed to record the location of catheters left indwelling and the proportion of patients who did not have any pneumothorax. Chest wall thickness was measured on both injured and uninjured sides at the 2nd ICS MCL and compared with the recommended alternative, the 5th ICS anterior axillary line (5th ICS AAL). We identified 335 patients that underwent prehospital ND who had CT scans performed. Using our two different radiologic methods of assessing failure, 39 per cent and 76 per cent of attempts at ND failed to reach the pleural space. In addition, at least 39 per cent of patients did not have a tension pneumothorax. Injured chest walls were significantly thicker than uninjured chest walls at both the 2nd ICS MCL and the 5th ICS AAL (both P < 0.005.) Increasing chest wall thickness correlated with the failure of the catheter to reach the pleural space. Using an 8-cm catheter at the 5th ICS AAL, iatrogenic cardiac injury was at risk in 42 per cent of patients. This series confirms the high failure rate of ND at the 2nd ICS MCL, but further studies are needed to assure the safety of using larger catheters at the 5th ICS AAL.

In vitro Remote Aspiration Embolectomy for the Treatment of Acute Ischemic Stroke

Background: “Remote aspiration,” using suction from the proximal internal carotid artery (ICA) to open terminus occlusions, has been reported in small case series. However, it remains unclear whether remote aspiration is feasible for middle cerebral artery occlusions in the setting of potential inflow from communicating arteries. We performed an in vitro study to assess whether suction applied at various locations proximal to an occlusion could successfully aspirate the clot. Methods: A glass model of 4 mm inner diameter (ID) with 1 mm distal narrowing and 2 mm side branch to simulate a communicating artery was constructed. A proximal side branch was placed to simulate inflow from the proximal ICA. The impact of three different-sized catheters (ID 0.088, 0.070, and 0.056 in) on histologically different (red blood cell-cell rich, fibrin-rich, and mixed) clot analogues was tested with the catheter tip placed remotely either distal or proximal to the collateral branch. Aspiration was attempted with (1) open system (flow in both the ICA and the collateral branch, (2) flow arrest with open collateral (no flow in the ICA, but flow in the collateral branch), and (3) closed system (no flow in either the ICA or the collateral branch). The outcome was success or failure of remote aspiration. Results: For the 0.088-in catheter, remote aspiration was successful in all conditions. For the 0.070-in catheter, remote aspiration was unsuccessful without proximal flow arrest, but was successful in all other scenarios. For the 0.056-in catheter, remote aspiration was successful only with complete flow arrest. Conclusions: In a noncollapsible system, remote aspiration can be successfully achieved even in the setting of prominent branch arteries by using relatively large aspiration catheters. Proximal flow arrest may facilitate successful remote aspiration for some catheter sizes.

Novel aspiration catheter design for acute stroke thrombectomy

BackgroundNavigable, large diameter aspiration catheters demonstrate markedly improved recanalization rates over smaller lumen devices in suction embolectomy. We evaluated the performance of a novel aspiration catheter system designed to maximize...

A Retrospective Study of Catheter-Related Thrombosis Using the Central Vein Catheters for the Ulcerative Colitis Patients

Leukocyte apheresis is a therapeutic option for moderate-to-severe active ulcerative colitis in Japan. It causes fewer complications, however, leukocyte apheresis requires the use of a relatively large caliber of peripheral venous line for hemodialysis. We reluctantly used a large caliber catheter with a double-lumen into the central vein.

Two Small Intravenous Catheters for High-Rate Contrast Medium Injection for Computed Tomography in Patients Lacking Superficial Veins to Accommodate a Large Catheter.

ObjectiveTo prospectively investigate the feasibility of using 2 small intravenous catheters for high-rate computed tomography (CT) contrast injection in patients lacking superficial veins capable of accommodating ≤ 20-gauge catheters.Materials and MethodsSixty-eight consecutive eligible adults referred for dynamic liver CT were enrolled; 58 had previously undergone liver CT, including 8 that experienced extravasation. Two 22- or 24-gauge catheters were placed in all patients after 2–5 venipunctures, and 2 mL/kg of contrast agent (370 mg I/mL) was split-administered through both catheters to achieve total flow rate of 4 mL/s. Patients' experience and examination success rate, defined as uneventful scans completed at 4 mL/s or at < 4 mL/s achieving standard image quality in all phases, were analyzed. Quantitative hepatic signal-to-noise and hepatic vascular contrast-to-noise ratios (CNRs) were compared with 30 control examinations scanned at 4 mL/s using an 18-gauge catheter.ResultsOne case each of extravasation and severe injection pain caused the examination to be aborted. Success rate was 88.2% (60/68; 54 patients scanned at 4 mL/s, 6 at 3.5–3.9 mL/s). Fifty-five of 58 patients (94.8%) that had past CT regarded the venipuncture as more tolerable than (n = 36) or similar to (n = 19) past experiences; 45 of 58 patients (77.6%) found contrast injection less painful than (n = 35) or similar to (n = 10) past experiences. When compared with control examinations, signal-to-noise ratio was similar in all phases (p ≥ 0.502), but the hepatic arterial CNR in arterial phase was slightly inferior (p ≤ 0.047).ConclusionUsing 2 small intravenous catheters can effectively achieve high-rate CT contrast injection in patients lacking adequate superficial veins.

Pressure-related flow rates for continuous renal replacement therapy in very small children: an in vitro study

ObjectiveContinuous renal replacement therapy (CRRT) is extremely challenging in very small children, as most CRRT intravascular access devices are too large. We aimed to quantify flow rates through several alternative...

Acute Pancreatitis Induced by Compression of Main Pancreatic Duct due to Large Stones and Catheter in the Common Bile Duct

급성 췌장염은 다양한 원인에 의해 발생되는 췌장의 염증성 질환으로 담도질환에 대한 내시경 ì‹œìˆ ì´ë‚˜ ì˜ìƒì˜í•™ì  ì‹œìˆ ì— 의해서 ìœ ë°œë˜ê¸°ë„ 한다. 담도 ì‹œìˆ ê³¼ ê´€ë ¨í•˜ì—¬ 발생하는 췌장염은 담도에 대한 조작보다는 바터팽대부를 ì ˆê°œ 또는 확장시키거나 바터팽대부를 통과시켜 ìŠ¤í íŠ¸ 혹은 도관을 거치하면서 ìœ ë°œë˜ëŠ” 췌관의 압박에 의해 발생하는 것으로 ì•Œë ¤ì ¸ 있다. 바터팽대부에 대한 조작을 시행하지 않는 경우에는 췌장염 발생의 위험성이 없는 것으로 되어 ìžˆê³ ë”í•˜ì—¬ 경피경관담도경 ì‹œìˆ ì„ 위한 도관 ì‚½ìž í›„ì— 췌장염이 발생한 경우는 ë³´ê³ ëœ 바가 없었다. 본 증례에서는 3 cm 가량의 거대 총담관 담석들에 의해 발생된 담도염에 대해 경피경관담도경 ì‹œìˆ ì„ 준비하는 ê³¼ì • 중 총담관에 도관을 ì‚½ìž í•œ 이후 급성 췌장염이 발생하였다. 이에 ì €ìžë“¤ì€ 원위부 총담관 내부에 ì‚½ìž ëœ 도관으로 인해 거대 총담관 담석이 췌장두부를 ì••ë°•í•˜ì˜€ê³ ì´ë¡œ 인한 주췌관의 ê°€ì—­ì ì¸ 폐색이 ìœ ë°œë˜ì–´ 급성 췌장염이 발병한 증례를 경험하였기에 문헌 ê³ ì°°ê³¼ 함께 ë³´ê³ í•˜ëŠ” 바이다. Keywords: 췌장염, 총담관, 담석, ì¹´í Œí„°

Endovascular Treatment of Stroke Patients

Stroke patients with proximal occlusions of the main stems of cerebral arteries are no optimal candidates for i. v. thrombolysis. For many years interventional stroke treatment could not be established as alternative. This changed with the introduction of stent retrievers and flexible large lumen aspiration catheters. Randomized trials now proved a significant benefit from intervention for a wide spectrum of severely compromised stroke patients in time windows of up to 8 hrs. However, the randomized trials leave open questions concerning proper patient selection. The benefit for patients with larger infarcts with an ASPECTS between 3 and 5 or patients in time windows above 8 hrs is still uncertain. Especially for critical candidates imaging for reliable detection of the ischemic core and surrounding salvageable brain tissue plays an important role. Technically equivalence between new aspiration techniques as alternative to the use of stent-retrievers is not finally proven. Recanalization of tandem occlusions with the necessity of acute stenting demands better materials for plaque coverage and thrombus withhold. Management of cases with occlusions due to intracranial atherosclerosis is also debatable. The positive trial results provide especially new challenges to establish countrywide neurointerventional services. Even in developed countries recruitment and training of interventional radiologists as well as priority transportation of stroke patients is challenging to organize. This is an abstract presented in the 33rd Iranian congress of radiology (ICR) and the 15th congress of Iranian radiographic science association (IRSA).

Incidence of Cardiac Perforation With Conventional and With Leadless Pacemaker Systems: A Systematic Review and Meta-Analysis.

Two leadless pacemaker (PM) systems were recently developed to avoid pocket- and lead-related complications. As leadless PMs are implanted with a large delivery catheter, cardiac perforation remains a major safety concern. We aimed to provide a literature review on incidence of cardiac perforation with conventional and with leadless PM systems. A systematic review over the last 25 years for studies reporting data on PM lead perforation was performed. Findings were synthesized descriptively. Where control groups were available, data were meta-analyzed to identify important clinical risk factors. A total of 28 studies comprising 60,744 patients undergoing conventional PM implantation were analyzed. The incidence of lead perforation ranged from 0% to 6.37% (mean 0.82%, weighted mean 0.31%, median of 0.40%). There was no significant difference in perforation risk between atrial and ventricular electrodes (POR 0.72, 95% confidence interval [CI], 0.28-1.87, P = 0.50) and between MRI conditional and conventional leads (POR 5.93, 95% CI, 0.72-48.76, P = 0.10). The use of active fixation leads (POR 4.25, 95% CI, 1.00-17.95, P = 0.05) and utilization of DDD versus VVI PM systems (POR 3.50, 95% CI, 1.48-8.28, P < 0.01) were associated with higher rates of perforation. In the 2 leadless PM studies, the incidence of cardiac perforation was 1.52% for each. PM lead perforation rates vary in individual studies with an overall low incidence. Leadless PMs seem to be associated with a slightly higher perforation risk, most likely reflecting a learning curve effect of this novel technology.

Comparing the effect of endotracheal tube suction using open method with two different size catheters 12 and 14 on discharge secretion, pain, heart rate, blood pressure, and arterial oxygen saturation of patients in the intensive care unit: A randomized clinical trial

Background and Purpose: Performing suction with complications such as tachycardia or bradycardia, increase or decrease blood pressure, pain, discharge, and decrease arterial oxygen saturation. The aim of this study was to compare the effect of endotracheal tube suctioning to open two different size catheters 12 and 14 on the discharge, pain, heart rate, blood pressure, and blood oxygen saturation in patients admitted to the Intensive Care Unit (ICU). Materials and Methods: This clinical trial compared two interventions of a pre- and post-test, and sampling was random. 36 patients admitted to the ICU in Yasuj martyr Beheshti Hospital iran, in a group of suctioning with catheter size 12 and 14. Changes in heart rate, blood pressure, pain, discharge, and arterial oxygen saturation before, during, 5 min and 20 min after the suction were recorded. Data analysis was performed by analysis of variance with repeated measures and paired t-test. Results: The Heart rate increased during suction catheter 14 than to 12, and the difference was statistically significant (P = 0.000). Suctioning with both catheters decreased oxygen saturation, but the reduction was not significant between both (P = 0.149). Systolic pressure increased after suction, and this increase was significantly in the higher catheter (P = 0.05). Diastolic pressure increased during suction with the highest increase of 5 min. There were no significant differences between the two catheters (P = 0.186). In the third episode, the highest rated pain during suctioning was observed and the difference was significant between large and small catheters (P = 0.000). Post-suction discharge was in the higher catheter was more and statistically significant (P = .000). Conclusion: The use of small size suction catheter To a lesser extent in heart rate, blood pressure, pain and suffering oxygen saturation changed.

Collection of Peripheral Blood Stem Cells in 118 Small Children Weighing 20 Kg or less: Experience of a Single Centre

Background: Peripheral blood stem cells (PBSC) are increasingly used as a source of stem cells for either autologous or allogeneic hematopoietic transplantation in children.Although technically similar to adult procedures, PBSC harvest may be difficult in young children, especially in the very small children.Aim: In this study, we aimed to evaluatethe safety and efficacy of harvesting peripheral blood hematopoietic stem cells in very small children,and to provide a guideline.Methods: Between Jan 2013 to Mar 2016, we evaluated 118 children weighing 20 kg or less, with the smallest patient weighing 11 kg. The patients had a median age of 59 months and included 72 children with thalassemia major and 46 young donors. The granulocyte-colony stimulating factor (G-CSF) analogs were used at a dose of 10 mg/kg/day administered subcutaneously once a day and receiving oral calcium for five days before harvesting. Blood was withdrawn at a mean rate of 30-40 ml/min through a temporaryfemoral vein catheter (12 or 14 guage) to ensure adequate blood flow and returned through a larger catheter in a peripheral vein.Total nucleated cells(TNC) and CD34+ cells were estimated in the peripheral blood before collection of the apheresis product.Results: We collected sufficient products from all the children with one to three apheresis procedures. No serious complication was detected in all children and all aphereses were completed within 4 hours.The volume of blood per kilogram processed for each apheresis ranged from 55 to 160ml (median, 85ml). The median number of TNC and CD34+ cells collected were 12×108/kg and 15×106/kg per apheresis, respectively.Conclusions:We conclude that collection of PBSC is a safe and practical procedure in children, even in very small children. DisclosuresNo relevant conflicts of interest to declare.

Small versus Large Catheters for Ventriculostomy in the Management of Intraventricular Hemorrhage

Intraventricular hemorrhage (IVH) often requires the insertion of an external ventricular drain (EVD), but blood clots could occlude the catheters. Large EVD catheters may help to reduce the risk of catheter occlusion. Here, we compared small catheters with large catheters for ventriculostomy in patients suffering from IVH. We conducted a retrospective cohort study. Patients were included if they had IVH requiring EVD insertion. We then compared baseline characteristics and outcomes of patients treated with large catheters with patients treated with small catheters. Between 2011 and 2015, 227 IVH patients were admitted to our 2 hospitals. Among the patients, 28 were treated in first intention with large catheters, and 46 controls were identified. Insertion of large catheter decreased the risk of temporary and permanent catheter occlusion without impact on the occurrence of intracerebral hemorrhage (ICH) related to catheter insertion. There was 38.5% more catheter-related infections in the small catheter group when compared with the large catheter group, but this result was not significant. There was no impact on functional outcomes. Surprisingly, the rate of death was higher in the large catheter group. In patients suffering from IVH, the use of large catheters for EVD reduced the risk of catheter occlusion without increasing the risk of ICH related to catheter insertion. The risk of catheter-related infection may subsequently be decreased by using large catheters. A prospective randomized trial would be necessary to seek out any benefits that large catheters may provide for the risk of death and functional outcome.

Percutaneous Catheter Drainage in Infected Pancreatitis Necrosis: a Systematic Review.

The primary aim of this study was to present the outcomes of percutaneous catheter drainage (PCD) in patients with infected pancreatitis necrosis. A second aim was to focus on disease severity, catheter size, and additional surgical intervention. A literature search of the PubMed/MEDLINE/Cochrane Library (January 1998 to February 2015) databases was conducted. All randomized, non-randomized, and retrospective studies with data on PCD techniques and outcomes in patients with infected pancreatitis necrosis were included. Studies that reported data on PCD along with other interventions without the possibility to discriminate results specific to PCD were excluded. The main outcomes were mortality, major complications, and definitive successful treatment with percutaneous catheter drainage alone. Fifteen studies of 577 patients were included. There was only one randomized, controlled trial, and most others were retrospective case series. Organ failure before PCD occurred in 55.3% of patients. With PCD alone, definitive successful treatment was 56.2% of patients. Additional surgical intervention was required after PCD in 38.5% of patients. The overall mortality rate was 18% (104 of 577 patients). Complications occurred in 25.1% of patients, and fistula was the most common complication. PCD is an efficient tool for treatment in the majority of patients with infected pancreatitis necrosis as the only intervention. Multiple organ failures before PCD are negative parameters for the outcome of the disease. Large catheters fail to prove to be more effective for draining necrotic tissue. However, in the extent of multi-morbid patients, to determine one single prognostic factor seems to be difficult.