Catheter Location Research Articles

“COMPARISON OF ULTRASOUND AND CHEST X-RAY FOR LOCALIZATION OF CENTRAL VENOUS CATHETER

We are pleased to inform you that your manuscript No. MS/BCSRJ/2023/2200311305, Titled: “COMPARISON OF ULTRASOUND AND CHEST X-RAY FOR LOCALIZATION OF CENTRAL VENOUS CATHETER,” received on 9th September2022 and under consideration with BCSRJ has been approved by reviewers and our editorial team on 21st May 2023 for publication in the Volume 2023 of “Biological and Clinical Sciences Research Journal (BCSRJ).”

Contrast Injection from an Intermediate Catheter Placed in an Intradural Artery is Associated with Contrast-Induced Encephalopathy following Neurointervention.

Contrast-induced encephalopathy can result from neurotoxicity of contrast medium in the affected area. The development of intermediate catheters has allowed guidance of catheters to more distal arteries. This study focused on the association between contrast-induced encephalopathy and contrast injection from an intermediate catheter guided into a distal intradural artery during neurointervention for cerebral aneurysms. We retrospectively reviewed 420 consecutive aneurysms in 396 patients who underwent neurointervention for extracranial aneurysms and unruptured intracranial aneurysms at our institution from February 2012 to January 2023. Patients were divided into a group with contrast-induced encephalopathy and a group without. To identify risk factors for contrast-induced encephalopathy, we compared clinical, anatomic, and procedural factors between groups by multivariate logistic regression analysis and stepwise selection. Among the 396 patients who underwent neurointervention for cerebral aneurysms, 14 (3.5%) developed contrast-induced encephalopathy. Compared with the group without contrast-induced encephalopathy, the group with contrast-induced encephalopathy showed significantly higher rates of patients on hemodialysis, previously treated aneurysms, intradural placement of a catheter for angiography, nonionic contrast medium, and flow-diversion procedures in univariate analyses. Stepwise multivariate logistic regression analysis revealed intradural placement of a catheter for angiography (OR = 40.4; 95% CI, 8.63-189) and previously treated aneurysms (OR = 8.20; 95% CI, 2.26-29.6) as independent predictors of contrast-induced encephalopathy. Contrast injection from an intradural artery and retreatment of recurrent aneurysms were major risk factors for contrast-induced encephalopathy. Attention should be paid to the location of the intermediate catheter for angiography to avoid developing contrast-induced encephalopathy.

HBV, HCV, and HIV Seroprevalence in Hemodialysis Patients Admitted to a Tertiary Care Hospital in Mogadishu, Somalia

Hemodialysis (HD) patients are a special group of patients who are at high risk for infection and related complications. Blood-borne viruses associated with chronic diseases such as hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are important causes of morbidity and mortality in HD patients. Immunodeficiency of the patients, weak protective efficacy of vaccines (HBV etc.), invasive vascular procedures, long-term dialysis applications and device-related contaminated blood contact risk, need for blood transfusion, medical practices associated with the risk of nosocomial transmission are some of the factors associated with an increased risk of infection transmission in HD patients. In addition to standard precautions to prevent infection transmission, some additional practices specific to HD patients have been recommended. HBV vaccination, patient isolation (special staff and use of separated rooms, devices, and equipment) in case of indication, precautions to be taken during catheter application (selection of catheter location, catheter care, skin antisepsis, and performing the procedures under appropriate and sterile conditions), monitoring patients for infection markers (before dialysis and at recommended intervals), taking into account inadequate antibody production and the long incubation period of viral infections are some examples of preventive procedures specific to HD patients. In this study, the prevalence of HBV, HCV and HIV infections in HD patients treated in a tertiary care hospital in Somalia was investigated. A total of 744 HD patients, 419 (56.3%) males and 325 (43.7%) females, were included in the study. The mean age of the patients was 50.81±17.62 (range 7-91) and the median age was 53. 660 of the patients were tested for anti-HBs (386 positive patients; 58.5%), 718 for HBsAg (63 positive patients, 8.8%), 720 for anti-HCV (19 positive patients, 2.6%), and 599 for anti-HIV (one positive patient 0.17%). Seropositivity rates were found to increase with age in HD patients, in line with the prevalence of viral agents in the population. In 718 patients tested for HBsAg, the positivity rates in men and women were 10.8% (44/406) and 6.1% (19/312), respectively, and the seropositivity rate was significantly higher in men (p=0.026). Anti-HCV seropositivity (2.6%) was approximately twice and significantly higher in HD patients than the hospital general prevalence (1.41%) (p=0.005). Emergency responses to injuries related to ongoing conflict across the country, invasive procedures performed outside the hospital and under unsuitable conditions, lack of molecular diagnostic tests for viral infections in identifying seronegative cases, patients apply to various centers with different capabilities for dialysis procedures and irregular patient follow-up records, missing hemodialysis sessions due to economic or other reasons, high prevalence of HBV, and lack of trained and specialized personnel draw attention as problems specific to the region.

Assessing the educational value and content of YouTube videos for ultrasound-guided subclavian vein catheterization.

The European Society of Anaesthesiology (ESA) published a guideline regarding continuous ultrasound guidance for central venous catheters in 2020. YouTube has been a popular educational platform since its inception. The purpose of the present study was to evaluate the adequacy of videos on ultrasound-guided subclavian vein catheterization posted on YouTube based on this guideline. YouTube was scanned using the keywords associated with ultrasound-guided subclavian vein catheterization and 46 of the 106 most-watched videos were included in the study. The videos were divided into three groups, as individual, manufacturer, and academic according to their sources, and were evaluated as poor, satisfactory, and good in terms of the overall content. The videos were then evaluated based on ESA's six-title guide for more specific informational content. A total of 46 videos were reviewed and 52.2% (n = 24) were found to be prepared by individuals. Among the videos, the rate of videos describing only venipuncture (poor) was 23.9% (n = 11), 73.9% (n = 34) of videos described the verification of the guidewire location with venipuncture, and 2.2% of videos described all the recommendations suggested by the guide (n = 1). At the end of the catheterization procedure, 4.3% (n = 2) stated that the catheter location should be confirmed by using ultrasound, 15.2% (n = 7) recommended chest-X-ray, and 80.4% (n = 37) did not suggest any. Manufacturer and academic videos can be watched due to their high-quality scores, but it may be practical to prepare training videos with guidelines both for educators and students to have global access to the renewed guideline information.

Comparison of External Ventricular Drains with Ventricular Access Devices for the Emergency Management of Adult Hydrocephalus

We compared external ventricular drains (EVDs) with percutaneous continuous CSF drainage via ventricular access devices (VADs) for the acute management of hydrocephalus in adults. This was a retrospective review of all ventricular drains inserted for a new diagnosis of hydrocephalus into non-infected CSF over 4 years. We compared infection rates, return to theatre, and patient outcome between EVDs and VADs. We explored the effect of duration of drainage, frequency of sampling, hydrocephalus aetiology, and catheter location on these outcomes using multivariable logistic regression modelling. We included 179 drains (76 EVDs and 103 VADs). EVDs were associated with a higher rate of unplanned return to theatre for replacement or revision (27/76, 36%, vs 4/103, 4%, OR:13.4 95%CI:4.3-55.8). However, infection rates were higher in VADs (13/103, 13% vs 5/76, 7%, OR:2.0, 95%CI:0.65-7.7). EVDs were 91% antibiotic impregnated whereas VADs were 98% non-impregnated. In multivariable analysis, infection was associated with duration of drainage (median:11 days prior to infection for infected drains vs 7 days total for non-infected drains), but not drain type (VADs vs EVDs OR:1.6, 95%CI:0.5-6). EVDs had a higher rate of unplanned revisions but a lower infection rate compared to VADs. However, in multivariable analysis choice of drain type was not associated with infection. We suggest a prospective comparison of antibiotic impregnated VADs and EVDs using similar sampling protocols to assess whether VADs or EVDs for acute hydrocephalus have a lower overall complication rate.

PERFORMANCE EVALUATION OF TUNNELED CATHETERS FOR HEMODIALYSIS ACCESS: A DESCRIPTIVE CASE SERIES STUDY

Renal failure in hospitalized patients is associated with significant morbidity, mortality, and resource utilization, with up to 18% of patients experiencing this condition. Hemodialysis is widely used as a renal replacement therapy worldwide. However, the long-term maintenance of functional upper extremity vascular access remains challenging for healthcare providers. This study assessed the performance of tunneled catheters used for dialysis access. A total of 97 eligible patients were included from Bahria Town International Hospital Lahore, and their demographic data and the duration of hemodialysis were recorded. The lead investigator inserted a tunneled catheter in each patient for dialysis purposes. After a three-month follow-up period, patients were evaluated for catheter use during their subsequent appointments. Infection was diagnosed if patients were presented with redness, discomfort, or pus. The catheter condition was assessed, noting any signs of breakage, dislodgement, exposed cuff, fractures, or obstructions. Data was collected using a standardized Performa. The study population had an average age of 47.76 ± 16.317 years, with an average duration of dialysis of 6.87 ± 2.754 months. Male patients constituted 60.824%, while female patients accounted for 39.176% of the sample. Catheter placements were performed in the internal jugular vein in 79 (81.44%) individuals, the subclavian vein in 13 (13.40%), and the femoral vein in 5 (5.154%). Infection was observed in 16.49% of patients, while 83.505% remained infection-free. Catheter failure was identified in 5.154% of patients. However, no significant correlations were found between the occurrence of catheter failure and age group, gender, body mass index (BMI), dialysis duration, or catheter site. All the pre-values for these variables were greater than 0.05. Similarly, age group, gender, BMI, dialysis duration, and catheter site did not exhibit a statistically significant association with the presence of infection. Catheter failure in patients with chronic renal disease undergoing continuous hemodialysis was observed in 5.154% of cases, while infection occurred in 16.49%. Age group, gender, BMI, dialysis duration, and catheter location were not found to be significant effect modifiers.

Use of a mixed reality system for navigational mapping during cardiac electrophysiological testing does not prolong case duration: A subanalysis from the Cardiac Augmented REality study

CommandEP™ is a mixed reality (MXR) system for cardiac electrophysiological (EP) procedures that provides a real-time 3-dimensional digital image of cardiac geometry and catheter locations. In a previous study, physicians using the system demonstrated improved navigational accuracy. This study investigated the impact of the CommandEP system on EP procedural times compared to the standard-of-care electroanatomic mapping system (EAMS) display. The purpose of this retrospective case-controlled analysis was to evaluate the impact of a novel MXR interface on EP procedural times compared to a case-matched cohort. Cases from the Cardiac Augmented REality (CARE) study were matched for diagnosis and weight using a contemporary cohort. Procedural time was compared from the roll-in and full implementation cohort. During routine EP procedures, operators performed tasks during the postablation waiting phase, including creation of cardiac geometry and 5-point navigation under 2 conditions: (1) EAMS first; and (2) CommandEP. From a total of 16 CARE study patients, the 10 full implementation patients were matched to a cohort of 20 control patients (2 controls:1 CARE, matched according to pathology and age/weight). No statistical difference in total case times between CARE study patients vs control group (118 ± 29 minutes vs 97 ± 20 minutes; P = .07) or fluoroscopy times (6 ± 4 minutes vs 7 ± 6 minutes; P = .9). No significant difference in case duration for CARE study patients comparing roll-in vs full-implementation cohort (121 ± 26 minutes vs 118 ± 29 minutes; P = .96). CommandEP wear time during cases was significantly longer in full implementation cases (53 ± 24 minutes vs 24 ± 5 minutes; P = .0009). During creation of a single cardiac geometry, no significant time difference was noted between CommandEP vs EAMS (284 ± 45 seconds vs 268 ± 43 seconds; P = .1) or fluoroscopy use (9 ± 19 seconds vs 6 ± 18 seconds; P = .25). During point navigation tasks, there was no difference in total time (CommandEP 31 ± 14 seconds vs EAMS 28 ± 15 seconds; P = .16) or fluoroscopy time (CommandEP 0 second vs EAMS 0 second). MXR did not prolong overall procedural time compared to a matched cohort. There was no prolongation in study task completion time. Future studies with experienced CommandEP users directly assessing procedural time and task completion time in a randomized study population would be of interest.

Characteristic Of Catheter Double Lumen Infection In Chronic Kidney Disease Patients At Dr. Mohammad Hoesin Hospital Palembang

<div><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td align="left" valign="top"><p><em>The majority of chronic kidney failure patients (40-60%) require hemodialysis (HD) twice a week and often face problems with inadequate venous access. Hemodialysis patients with CKD often use an alternative to central venous access in the form of a well-tunneled double lumen (CDL) catheter or non-tunneled. However, the use of CDL causes many risks of infection This study aims to analyzed risk factors for CDL infection in patients with chronic kidney failure undergoing hemodialysis at dr. Mohammad Hoesin Hospital period January to December 2021.Descriptive study with retrospective study design was undertaken in the hemodialysis unit at dr. Mohammad Hoesin Hospital Palembang from January to December 2022. There were 100 samples who met the inclusion criteria. The relationship between independent and dependent variables was analyzed using the Chi Square test or Fisher's Exact. The most important risk factors were analyzed using the Logistic Regression test. All data were analyzed by SPPS version 22.0. In this study, there was no significant relationship between gender, age, ureum, creatinine, leucocyte and length of use with the incidence of CDL infection (p > 0,05), however there is a significant relationship between nutritional status with the incidence of CDL infection (OR = 31.418 (CI5% 10.028 – 98.438); p = 0.000); there was a significant relationship between catheter location with the incidence of CDL infection (p = 0.000); and there was a significant relationship between the type of catheter with the incidence of CDL infection (OR = 32.276 (CI5% 4.096 – 254.319); p = 0.000).In this study, it was found that the factors influencing CDL infection were nutritional status and type of catheter</em><em>.</em></p><p> </p></td></tr></tbody></table></div><strong><em>Keyword: Catheter, CDL, Chronic Kidney Failure, Haemodialysis, Infection</em></strong>

The relationship between the PICC tip position and weight gain, length growth of premature infants under ultrasonography: a correlation analysis study.

This study aimed to analyze the correlation between PICC tip position and weight/length changes in preterm infants in different positions using ultrasonography. The study is a prospective before and after self-control clinical trial. The study analyzed the distance between the PICC tip and the entrance of the heart under ultrasonography for premature infants who underwent PICC insertion. The infants were positioned and tracked weekly, and their weight and length were recorded. The Spearman rank correlation test was used to analyze the relationship between the displacement distance of the PICC tip under ultrasonography in different positions and weight/length changes. A total of 202 premature infants were included in the study, and 100% of them experienced changes in the PICC tip position. During the first week, 134 (66.33%) cases in a flexed position and 153 (75.74%) cases in a straight position showed displacement of the catheter toward the heart. The displacement distance of the tip during catheter retention was significantly correlated with weight change (rs = 0.681/0.661, P < 0.05) and length change (rs = 0.629/0.617, P < 0.05). In the third and fifth weeks, weight increased by 451 ± 178 and 750 (715-975) g, length increased by 1.50 (1.00-2.12) and 3.00 (2.00-3.70) cm, the catheter moved 1.27 ± 0.89 and 2.23 ± 0.95 cm, respectively, in a flexed position. The PICC tip position in preterm infants is influenced by weight and length changes. It is crucial to use ultrasonography to track and locate the catheter within the first week of placement and to increase the frequency of catheter localization starting from the third and fifth weeks. The flexed position is recommended during catheter localization.

PO-04-200 ANALYSIS OF RELATIONSHIP BETWEEN PACING SITE AND EXIT SITE IN REGIONS WITH STIMULUS-QRS DELAY AND IMAGING DEFINED MYOCARDIAL FIBROSIS

Delay between ventricular pacing stimulus and QRS onset (S-QRS delay), often seen in regions of myocardial fibrosis, suggests conduction along a protected channel which often represents substrate for re-entrant arrhythmias. 1. To analyze the relationship between pacing stimulus site and myocardial exit site in regions with stimulus-QRS delay and imaging-defined myocardial fibrosis undergoing VT ablation and 2. To consider conduction time between these two locations. Six patients with structural heart disease who underwent VT catheter ablation with pre-procedural cardiac CT image processing (InHeart Models (Pessac, France)) and evidence of late-iodine enhancement were included. CT images were registered with electroanatomic mapping. At pacing sites with S-QRS delay >40 msec, catheter location was compared to the exit site, predicted using a previously validated algorithm (RAPID-VT). Imputed conduction velocity (CV) between stimulus site and exit site was calculated (stim-QRS time/Euclidian distance). Stimulus to QRS delay in regions of imaging derived fibrosis ranged 40 to 291.4 ms; At 9 pacing sites, multiple QRS morphologies were generated. Imputed CV was reduced in dense scar and borderzone compared to values seen in healthy myocardium and varied between 0.16 and 0.65 m/s. These results may under-estimate true tissue CV given complex routes between pacing and exit sites. In the same region, following delivery of RF, mean imputed CV was reduced, raising the possibility that conduction was altered, potentially diverted along a different path (0.21m/s vs 0.14m/s, p=0.024). Myocardial fibrosis defined on CT may be associated with slowed conduction through protected channels. Delivery of RF increases conduction time and results in different exit sites following pacing, indicating multiple and likely complex routes of conduction in regions of imaging-defined fibrosis. Visualization of predicted exit sites in real time could help focus RF to interrupt these conduction paths.Tabled 1Patient #Stim to QRS onset (ms)Imputed conduction velocity (m/s)166.8±15.20.18±0.09241.0±1.50.65±0.08351.0±9.10.30±0.10460.6±11.50.20±0.105103.7±0.160.16±0.10674.3±13.60.19±0.02 Open table in a new tab

PO-02-122 TRACKING AND ABLATING THE MUSCLE SLEEVE/FASCICLE FOR PULMONARY VEIN ISOLATION

Pulmonary vein isolation (PVI) remains the cornerstone for atrial fibrillation (AF) ablation. However, it yields unsatisfactory outcomes requiring repeat procedures especially in persistent AF. Additional linear ablation, or of complex fractionated atrial electrograms, atrial rotors or ganglionated plexi prolongs procedure time and increases complications with small additional benefits. We evaluated the efficacy of a new method of tracking and ablating pulmonary vein (PV) muscle sleeve/fascicle followed by wide area circumferential ablation (WACA) as a method of treatment of AF. To track a muscle sleeve/fascicle, a Lasso catheter was placed into one PV and based on the electrograms pattern on the catheter, sites of exit of muscle sleeves/fascicles were determined along the wide area circumferential ablation (WACA) line. (Panel A of figure shows the electrogram pattern, which suggests two muscle fascicles [red and blue arrows]). Focal ablation at sites on the planned WACA line was then performed to interrupt the muscle sleeve/fascicle connection with atrium (Panel B and C of figure shows point ablation resulting in partial and complete isolation; black arrow marks the location of ablation catheter). The same method was repeated to the ipsilateral PV before full WACA of both PVs was commenced. The strategy was repeated on the contralateral PVs. Ablation of these fascicle-atrium connections resulted in PVI isolation before WACA was completed in all 18 patients. Intravenous adenosine was used at the end to elicit dormant PV connections. We schematically labeled the areas around the PVs into zones and summarized the location of these muscle fascicles in each patient. (Panel D; each dot represents a fascicle and color matches with the PV with which it is associated). Eighteen patients (61±11 years old, 56% male) with AF (12 persistent {67%}) were analyzed in this study. Fascicles were identified in all patients and focal ablation of fascicles resulted in isolation of the PVs. In addition to PVI, 8 had Cavotricuspid isthmus ablation, 1 for right focal atrial tachycardia (AT), one left focal AT, and 1 for biatrial reentrant AT. With a follow-up of 155 ±120 days, 83% of paroxysmal and 75% of persistent AF remained in sinus rhythm. Left atrial dwell time for PVI alone was less than 2 hrs and no complications were seen. The tracking and ablating muscle sleeve/fascicle before performing WACA is a strategy with outcomes superior to previously reported in literature.

PO-01-119 CATHETER STABILITY ANALYSIS IN ABLATION OF PAROXYSMAL ATRIAL FIBRILLATION: IMPACT OF A NOVEL FLEXIBLE ELECTRODE TIP

Catheter electrode stability is a key factor of a successful radiofrequency (RF) ablation lesion formation. Current techniques to enhance or monitor catheter stability include the use of steerable introducers, high-frequency jet ventilation, and the incorporation of objective lesion marker placement via Electroanatomic Mapping (EAM) Systems. In addition to automatic lesion marker placement, the EnSite™ AutoMark Module records catheter location during RF energy delivery, providing insight into catheter electrode stability during ablation. To demonstrate improved stability during ablation with a flexible laser cut tip electrode vs. a solid-6-hole electrode tip during de novo PVI ablation for the treatment of PAF and concomitant CTI-lines for the treatment of typical AFL. AutoMark™ ablation data gathered during the TactiFlex AF IDE NCT04356040 (flex tip catheter) and TactiSense IDE NCT03354663 (solid tip catheter) trials was analyzed (FIGURE). Both trials were prospective, non-randomized multicenter clinical studies which enrolled 355 and 150 subjects worldwide, respectively. PVI and CTI lesions from point-by-point ablation style operators with discrete lesions were included. Anatomic region assignment of each RF episode was accomplished using machine learning. Average distance and standard deviations of the ablation electrode movement from the mean positional centroid were calculated for each RF episode. Stability was evaluated as the percent of time during an RF episode where the ablation electrode remained within 2.5mm of the ablation lesion centroid. A total of 10285 flexible tip and 2141 solid tip RF episodes were analyzed from 112 and 21 cases, respectively. The average RF episode duration for the flexible tip and solid tip lesions, was 10.6 ± 4.8 and 17.1 ± 9.8 seconds, respectively. The flexible tip and solid tip catheters remained positionally stable within a 2.5 mm sphere for 85.3% ± 22.7 and 79.9% ± 26.1 of the RF episode duration, respectively, (p <0.001) (FIGURE). In the subset of lesions <10 seconds, the difference in stability was even more pronounced (TABLE). A flexible tip ablation catheter (TactiFlex™ SE) demonstrated greater stability than a solid tip ablation catheter (TactiCath™ SE) during ablation of atrial fibrillation and CTI-dependent atrial flutter. Greater stability during lesion formation may result in more durable lesions and better patient outcomes.Tabled 1Catheter# RF EpisodesRF Episode Duration, sec (SD)Mean (SD)Median [Q1, Q3]p-valueAll RF EpisodesFlexible Tip1028510.6 (4.8)85.3% (22.7)96.9% [79.9, 100]< 0.001Solid Tip214817.1 (9.8)79.9% (26.1)92.6% [66.7, 100]< 0.001RF Episodes < 10 secFlexible Tip43406.4 (2.8)85.0% (24.2)98.7% [80.7, 100]< 0.001Solid Tip5427.3 (2.3)73.6% (32.9)89.8% [51.7, 100]< 0.001Stability of a solid tip (TactiCath™ Contact Force Ablation Catheter, Sensor Enabled™) versus flexible tip (TactiFlex™ Contact Force Ablation Catheter, Sensor Enabled™), reported as the percent time the catheter tip remained within a 2.5 mm radius sphere. Open table in a new tab

Adverse events related to central venous catheters (CVC) and the influence of CVC characteristics on peripheral blood hematopoietic progenitor cell collection in children.

The use of peripheral blood progenitor cells (PBPCs) as a source for hematopoietic stem cell transplantation (HSCT) in pediatric healthy donors is still under debate. The risk of a central venous catheter (CVC) placement and catheter-related complications continue to be the main arguments to discourage its use. we present a retrospective analysis of 140 PBPC collections in pediatric patients and donors, describing adverse events (AE) related to CVCs as well as the influence of catheterrelated variables on the efficiency of the leukapheresis. 14 CVC-related AEs were recorded (10%). The most common was fever in 5 patients, 4 of which had a catheter-related bacteriemia. Thrombotic events were only observed in 3 patients with active malignancy. A healthy donor presented a moderate bleeding after catheter withdrawal that resolved with local measures, and none of the rest presented any AE. Regarding variables related to the development of AEs, the subject group (patient or donor) was the only one significantly associated (p < 0.0001). Of interest, efficiency was also related to catheter location, being worse in those located in the femoral vein than in into the jugular or the subclavian veins (p < 0.05). In a multivariate analysis, the only variable significantly associated was catheter size (beta 0.238, p < 0.01). Placing a CVC for PBPC collection in pediatric subjects is overall safe; CVC-related complications in pediatric healthy donors are very rare. Furthermore, we should try to place catheters of the largest caliber possible, since the efficiency of the collection is related to this variable.

768 The Device for Intraventricular Entry (DIVE) Guide: A Novel Solution to a Perpetual Problem

INTRODUCTION: Safe and reliable access to the ventricular system is a necessary skill in the neurosurgical armamentarium. The freehand technique for catheter placement remains an accepted method, yet the inaccuracy rate can be as high as 40%, with as many as 3 passes per procedure, and complication rates between 10-40%. A number of devices have been developed to assist with catheter placement, however, these devices inhibit ergonomics or require larger incisions and expensive navigation technology. METHODS: A novel device for ventricular entry, the DIVE guide, was designed by the first and senior author. 50 patients undergoing extra ventricular drain (EVD) or shunt placement were prospectively enrolled for DIVE assisted catheter placement under an IRB approved study with a non-significant risk (NSR) device designation. The primary outcome is catheter location on CT. Secondary outcomes include number of catheter passes, clinically significant hemorrhages and procedure-related infections. RESULTS: 50 patients were enrolled at a single academic center for ventricular access with DIVE assistance. Indications included subarachnoid or intraventricular hemorrhage, TBI, hydrocephalus, pseudotumor and post-surgical wound drainage. 76% (38/50) underwent right sided placement and 24% (12/20) underwent left. 100% (50/50) had successful cannulation in an average of 1.06 passes. Post procedure head CT confirmed ipsilateral frontal horn or 3rd ventricle placement (Kakarla Grade 1) in 92% (46/50) and 8% (4/50) in the contralateral lateral ventricle (Grade 2). There were no significant tract hemorrhages or procedural infections. CONCLUSIONS: This a prospective study to investigate the safety and efficacy of DIVE-assisted ventricular access. 100% of procedures had successful ventricular cannulation, with 92% achieving Kakarla Grade 1, in an average of 1.06 passes.

Early Mobility in Patients With Femoral Catheters

Early Mobility in Patients With Femoral Catheters

Identification of the Position of a Tethered Delivery Catheter to Retrieve an Untethered Magnetic Robot in a Vascular Environment.

In this paper, we propose a method of identifying the position of a tethered delivery catheter in a vascular environment, recombining an untethered magnetic robot (UMR) to the tethered delivery catheter, and safely retrieving them from the vascular environment in an endovascular intervention by utilizing a separable and recombinable magnetic robot (SRMR) and a magnetic navigation system (MNS). From images of a blood vessel and a tethered delivery catheter taken from two different angles, we developed a method of extracting the position of the delivery catheter in the blood vessel by introducing dimensionless cross-sectional coordinates. Then, we propose a retrieval method for the UMR by using the magnetic force considering the delivery catheter's position, suction force, and rotating magnetic field. We used thane MNS and feeding robot to simultaneously apply magnetic force and suction force to the UMR. In this process, we determined a current solution for generating magnetic force by using a linear optimization method. Finally, we conducted in vitro and in vivo experiments to verify the proposed method. In the in vitro experiment, which was in a glass tube environment, by using an RGB camera, we confirmed that the location of the delivery catheter in the glass tube could be recognized within an average error of 0.05 mm in each of the X- and Z-coordinates and that the retrieval success rate was greatly improved in comparison with that in the case without the use of magnetic force. In an in vivo experiment, we successfully retrieved the UMR in the femoral arteries of pigs.

Abstract Number ‐ 23: In vitro evaluation of thrombectomy techniques: What is the most efficient combined technique?

Introduction A combined technique with contact aspiration and stent retriever is widely used for the treatment of patients with acute ischemic stroke due to the potential synergistic effect of the two technologies. However, there are no large studies that conclude the combined technique is more efficient compared to stent retriever only or contact aspiration. One of the issues in combined techniques may be the complexity, and multiple variations of combined techniques exist. We performed an in vitro study using three‐dimensional (3D) flow models and performed clot retrieval in order to explore effective and safe techniques for mechanical thrombectomy. Methods In a 3D silicone flow model with moderate tortuosity, we compared several techniques: 1. a pinching combination method (pull out stent retriever and aspiration catheter as a unit) with several variations of aspiration catheter locations; 2. an ingestion combination method (stent retriever removal through aspiration catheter); 3. stent retriever only; and 4. contact aspiration. We evaluated the success retrieval rates of a thrombus in the M2 branch. In addition, we measured pulling force during each technique to determine the amount of force exerted on the distal MCA vessel. Results The highest clot retrieval rate was achieved with a pinching combination technique with close contact with an aspiration catheter. The pulling force on the distal MCA vessel was high with the techniques that had high clot retrieval rates and low with the techniques that had low success rates. The pulling force was higher when the stent retriever was fully deployed compared with a pinching technique with a stent partially covered with an aspiration catheter. Conclusions In our in vitro model, the pinching combination method showed the highest clot retrieval rate when the aspiration catheter was advanced to the clot and the stent retriever. The pulling force experiments suggested the shorter stent retriever may decrease the rate of subarachnoid hemorrhage due to low pulling force.

Extraction of Blood Vessels Geometric Shape Features with Catheter Localization and Geodesic Distance Transform for Right Coronary Artery Detection.

Extraction of Blood Vessels Geometric Shape Features with Catheter Localization and Geodesic Distance Transform for Right Coronary Artery Detection.

Capnography for catheter location confirmation in minimally invasive surfactant administration.

Minimally Invasive Surfactant Treatment (MIST) is a common method for administering surfactant as a treatment for respiratory distress syndrome. However, tracheal catheter placement can be difficult to confirm. We assessed the presence of carbon dioxide (CO2) in tracheal and esophageal gas aspirated using CO2 detector. Retrospective arm: 20 infants, MIST catheter placement was assessed with a CO2 detector in two techniques and confirmed with clinical response. Prospective arm-10 infants, aimed to check for CO2 presence in aspirated esophageal gas during routine nasogastric tube insertion. Retrospective arm: All infants had positive capnography. One infant that had no clinical response to MIST was diagnosed with total anomalous pulmonary venous return. All 10 infants of the prospective arm had a Negative capnography (P < 0.001, Fisher's exact test). Readily available CO2 detectors can distinguish between tracheal and esophageal placement of MIST catheters prior to MIST.

Technical notes on the placement of cerebral microdialysis: A single center experience.

Cerebral microdialysis enables monitoring of brain metabolism and can be an important part of multimodal monitoring strategies in a variety of brain injuries. Microdialysis catheters can be placed in brain parenchyma through a burr hole, a cranial bolt, or directly at the time of an open craniotomy or craniectomy. The location of catheters in relation to brain pathology is important to the interpretation of data and guidance of interventions. Here we retrospectively review the use of cerebral microdialysis at a US Regional Medical Center between March 2018 and February 2022 and provide detailed descriptions and technical nuances of the different methods to place microdialysis catheters. Eighty two unique microdialysis catheters were utilized in 52 patients. 35 (42.68%) were placed via a quad-lumen bolt and 47 (57.32%) were placed through craniotomies. 27 catheters (32.93%) were placed in a perilesional location, 50 (60.98%) were located in healthy tissue, and 6 (7.32%) were mispositioned. No significant difference was seen between placement by bolt or craniotomy in regard to perilesional location, mispositioning, or complications. With careful planning and thoughtful execution, cerebral microdialysis catheters can be successfully placed though a variety of strategies to optimize and individualize brain monitoring in different clinical settings. This paper provides a detailed guide for the various methods of catheter placement to help providers begin or expand their use of cerebral microdialysis.