Modified Seldinger Technique Research Articles

Recommended recumbency to avoid insertional complications during small-bore wire-guided thoracostomy tube placement in cats—a cadaver study

BackgroundSmall-bore wire-guided thoracostomy tubes (SBWGTT) are commonly used in cats to manage pleural disease and generally have a low complication rate. Our study aimed to explore the correlation between recumbency of cats, placement method, and the occurrence of insertional complications to identify risk factors during SBWGTT placement.In this experimental cadaveric study, SBWGTT placement using a modified Seldinger technique was conducted in 24 feline cadavers. Cats, euthanized for reasons unrelated to the study, were randomly assigned to pleural effusion (EFF; n = 12) and pneumothorax (PNEU; n = 12) groups. Each cadaver was intubated and ventilated with a peak inspiratory pressure (PIP) of 10 mmHg, and sterile saline or air was instilled into the thorax over a 5 mm thoracoscopic trocar in the fourth intercostal space (ICS). Instillation was stopped when the lateral thoracic wall to lung distance (TWLD) reached 10 to 12 mm, measured with ultrasound in the favorable position. Sternal recumbency was the favorable position for the EFF group, and lateral recumbency for the PNEU group. Following the placement of the first SBWGTT in each group, the cadavers were positioned unfavorably (lateral recumbency for EFF group, sternal recumbency for PNEU group), and a second drain was introduced contralaterally. A bilateral 8th ICS thoracotomy was then performed to visually assess intrathoracic structures and drain integrity.A binary logistic regression mixed model was conducted to determine interaction between the induced condition and body position.ResultsA total of 48 SBWGTTs were placed, with complications observed in 33.3% (8/24) of cases. Five of these were major complications consisting of lung lacerations. Complications were more common in the unfavorable position, accounting for 75% of cases, although this result was not statistically significant. The odds of complication rates were > 70% in the unfavorable position and decreased with an increase in TWLD (< 30%).ConclusionComplications associated with SBWGTT placement are influenced by recumbency, although the data did not reach statistical significance. Placing cats in lateral recumbency for pneumothorax treatment and sternal recumbency for pleural effusion treatment may reduce insertional complications.

Safety and Efficiency of Cephalic Vein Puncture by Modified Seldinger Technique Compared to Subclavian Vein Puncture for Cardiac Implantable Electronic Devices.

The establishment of venous access is one of the driving factors for complications during implantation of pacemakers and defibrillators (cardiac implantable electronic devices [CIED]). Recently, a novel approach of accessing the cephalic vein for CIED by cephalic vein puncture (CVP) using a modified Seldinger technique has been described, promising high success rates and simplified handling with steeper learning curves. In this single-center registry, we analyzed the safety and efficiency of CVP to SVP access after defining CVP as the primary access route in our center. A total of 229 consecutive patients receiving a CIED were included in the registry. Sixty-one patients were implanted by primary or bail-out SVP; 168 patients received primary cephalic preparation and CVP was performed when possible, using a hydrophilic transradial sheath. Implantation of at least one lead via CVP was successful in 151 of 168 patients (90%), and implantation of all leads was possible in 122 of 168 patients (72.6%). Total implantation times and fluoroscopy times and doses did not differ between CVP and SVP implantations. Pneumothorax occurred in 0/122 patients implanted via CVP alone, but 8/107 (7.5%) patients received at least one lead via SVP. Our data confirms high success rates of the CVP for CIED implantation. Moreover, this method can be used without significantly prolonging the total procedure time or applying fluoroscopy dose compared to the highly efficient SVP while showing lower overall complication rates.

Pericatheter Leak Associated With Earlier Peritoneal Dialysis Initiation Does Not Influence Long-Term Outcomes

Internationally, peritoneal dialysis (PD) is increasingly being commenced within 2 weeks of catheter insertion. Studies are warranted to evaluate outcomes of this strategy. This study examines outcomes of early-start PD (ESPD) and conventional-start PD (CSPD), commencing at≤14 days and >14 days after catheter insertion, respectively. All adults with kidney failure within a large metropolitan PD unit initiating PD through a new catheter, inserted using laparoscopic or modified Seldinger technique, between August 2019 and August 2022, were included in this retrospective observational study. Demographic data and episodes of infectious and mechanical complications were collected using electronic medical records. Analysis was conducted using analysis of variance and Chi-square testing. A P-value< 0.05 was significant with Bonferroni correction performed where relevant. Kaplan-Meier and competing risks analyses were performed for time to PD-related peritonitis and transfer to hemodialysis. A total of 297 patients (70% male, mean age 58.7 years) were included, with 130 (43.8%) patients undertaking ESPD. Most patients had laparoscopically inserted catheters (65.3%) and 65 patients (22.0%) received prior hemodialysis. When compared to CSPD, ESPD was associated with a higher number of pericatheter leaks (6.9% vs. 0.6%, P= 0.003), with otherwise similar complication episodes and no significant difference with respect to time to PD-related peritonitis or transfer to hemodialysis. Catheter insertion technique or prior hemodialysis treatment did not significantly influence outcomes. ESPD is associated with increased pericatheter leaks when compared to CSPD, with an otherwise similar complication profile.

Comparing conventional and modified Seldinger techniques using a micro-insertion kit for PICC placement in neonates: a retrospective cohort study.

This study aims to assess the comparative effectiveness of a conventional splitting needle or a peelable cannula vs. the modified Seldinger technique (MST) by utilizing a dedicated micro-insertion kit across various clinically significant metrics, including insertion success, complications, and catheter-related infections. We conducted a retrospective observational cohort study using an anonymized data set spanning 3 years (2017-2019) in a large tertiary-level neonatal intensive care unit in Qatar. A total of 1,445 peripherally inserted central catheter (PICC) insertion procedures were included in the analysis, of which 1,285 (89%) were successful. The primary indication for insertion was mainly determined by the planned therapy duration, with the saphenous vein being the most frequently selected blood vessel. The patients exposed to MST were generally younger (7 ± 15 days vs. 11 ± 26 days), but exhibited similar mean weights and gestational ages. Although not statistically significant, the MST demonstrated slightly higher overall and first-attempt insertion success rates compared to conventional methods (91 vs. 88%). However, patients undergoing conventional insertion techniques experienced a greater incidence of catheter-related complications (p < 0.001). There were 39 cases of catheter-related bloodstream infections (CLABSI) in the conventional group (3.45/1,000 catheter days) and eight cases in the MST group (1.06/1,000 catheter days), indicating a statistically significant difference (p < 0.001). Throughout the study period, there was a noticeable shift toward the utilization of the MST kit for PICC insertions. The study underscores the viability of MST facilitated by an all-in-one micro kit for neonatal PICC insertion. Utilized by adept and trained inserters, this approach is associated with improved first-attempt success rates, decreased catheter-related complications, and fewer incidences of CLABSI. However, while these findings are promising, it is imperative to recognize potential confounding factors. Therefore, additional prospective multicenter studies are recommended to substantiate these results and ascertain the comprehensive benefits of employing the all-in-one kit.

Sinus arrest during thoracic drain placement in a dog

AbstractA 5‐year‐old female neutered Podenco Canario dog presented with a moderate pleural effusion and subsequently underwent placement of bilateral thoracic drains. Pre‐medication consisted of intravenous medetomidine (2 µg/kg) and methadone (0.2 mg/kg), followed by induction with propofol (2.1 mg/kg, via intravenous administration). Anaesthesia was maintained with isoflurane in 100% oxygen. The modified Seldinger technique was used to place bilateral small‐bore, wire‐guided thoracic drains. During placement of the first chest drain, the dog developed sinus arrest. It is suspected that there was direct vagal nerve stimulation by the guide wire during placement, leading to severe bradycardia and subsequent sinus arrest that was responsive to atropine. It is important to note that the definitive cause of the transient cardiac arrest could not be ascertained. It is possible that this is a rare complication of thoracic drain placement, warranting further research in this area.

A small‐bore wire‐guided chest tube for the initial stabilisation of septic uroperitoneum in a dog

AbstractThe purpose of this report was to describe the emergency management and subsequent surgical treatment of a 6‐year‐old, entire, male Epagneul Breton referred for septic uroperitoneum of 5 days duration. Clinical stabilisation was achieved by the insertion of a percutaneous small‐bore wire‐guided chest tube as an abdominal drain in association with conventional medical treatment. The small‐bore wire‐guided chest tube was inserted percutaneously into the abdomen, under ultrasound guidance, using a modified Seldinger technique. It was connected to a closed active collection system, and successfully drained the peritoneal urinary effusion. The medical treatment associated with the application of the small‐bore wire‐guided chest tube contributed to the patient's stabilisation, which was reached within 5 hours from arrival, allowing for an exploratory laparotomy with repair of the bladder laceration. The small‐bore wire‐guided chest tube was replaced during surgery by a Jackson–Pratt drain, which remained in place for 4 days postoperatively. The dog has completely recovered, and no complications were recorded.

One-year outcomes of percutaneous continuous ambulatory peritoneal dialysis catheter insertion by nephrologists: First experience from Sri Lanka

Introduction: Continuous ambulatory peritonealdialysis (CAPD) via a catheter placed in the peritoneum is an established mode of renal replacement therapy. CAPD catheters are placed using either percutaneous or surgical techniques. Percutaneous method is less invasive and avoids the need for general anaesthesia, surgical space, and expertise. This study was conducted to measure one-year outcomes of percutaneous CAPD catheter insertions performed by a nephrology team; the first experience from Sri Lanka.Methods: We retrospectively studied 96 patients in two centers, who underwent percutaneous CAPD catheter insertion over two years with a follow-up period of minimum one year. The catheter was placed using modified Seldinger technique under local anesthesia with ultrasound guidance.Results: Majority were males (78.1%) with a median age of 56 years. Most were on haemodialysis (HD) (85.4%) prior to CAPD catheter insertion. The commonest reason for opting for CAPD was to avoid hospital visits for HD (54.2%). During the follow-up of one year, 85.4% were free of complications. Frequent non-infectious complications were catheter removal (12.5%), visceral injury (4.2%), primary insertion failure (4.2%), and catheter dysfunction (2.1%). Pre-training peritonitis was found in 2.1% with an overall peritonitis rate of 0.4 episodes per patient a year. There was no significant association between catheter-related complications and gender (p=0.68), previous abdominal surgery (p=0.54), diabetes mellitus (p=0.84), and hypertension (p=0.46). One-year catheter survival was 92%.Discussion: One-year outcomes of percutaneous CAPD catheter insertion by nephrologists were efficacious and safe with low complication rates. Hence, CAPD catheter insertion by well-trained nephrologists should be encouraged. Further studies comparing percutaneous versus surgical catheter placement are warranted.

Risk of Diabetes Mellitus in Carotid Artery Involvement Among Coronary Artery Disease Patients Including History of Infection and Antibiotics Uses

Background: Diabetes mellitus causes involvement of coronary artery diseases. Objective: The purpose of the present study was to determine the risk of diabetes mellitus in the involvement of carotid artery among coronary artery disease patients. Methodology: This case-control study was conducted in the Department of Cardiology at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2013 to June 2015 for a period of two years. Patients who had coronary artery diseases or ischemic heart diseases and diabetes mellitus undergoing coronary angiography were selected as case of this study. In control group, age, sex match patients of IHD undergoing CAG not having DM were included. Every patient was clinically examined by detailed history and physical examination during entry into study. ECG, chest X-ray, echocardiogram, blood sugar (fasting), blood 2 hrs. after 75 gm of glucose and or breakfast were analyzed. Coronary angiography was done in all patients through femoral approach by modified Seldinger technique. Carotid arteriography was performed selective and non­selective method by Hunter head or right Judkin's catheter in standard AP, lateral and oblique views. Results: A total number of 100 patients were included in this study. Of them 50 patients were coronary artery disease with diabetes mellitus and another 50 patients were coronary artery disease without diabetes mellitus. The mean height of the DM was 163.4±8.5 cm and in NDM was 160.6±7.1 cm, mean weight of DM 63.5±7.2 kg, in NDM was 62.0±15.4 kg and mean BMI in DM was 26.24±2.36 kg/m2 and in NDM was 26.38±2.05 kg/m2. The mean total cholesterol in DM was 236.9±34.1 mg/dL and in NDM was 208.0±36.4 mg/dL, mean serum TG in DM 240.5±76.3 mg/dl and in NDM was 207.6±57.8 mg/dl and mean serum IDL in DM was 166.1±130.6 mg/dL and in NDM was 142.8±30.4 mg/dL, no significant mean difference was observed between DM and NDM in height, weight and BMI (P&gt;0.05). Concussion: In conclusion, significant mean difference is observed between DM and NDM in total cholesterol, serum triglycerides. Bangladesh Journal of Medical Microbiology, July 2023;17 (2):82-87

Characteristics of Carotid Artery among Ischemic Heart Disease Patients with or without Diabetes Mellitus

Background: Involvement of coronary artery can vary among the ischemic heart disease patients with or without diabetes mellitus. Objective: The purpose of the present study was to assess the characteristics of carotid artery among ischemic heart disease patients with or without diabetes mellitus. Methodology: This case-control study was conducted in the Department of Cardiology at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. The study was carried out from July 2003 to June 2005 for a period of two years. Patients who had coronary artery diseases or ischemic heart diseases and diabetes mellitus undergoing coronary angiography were selected as case of this study. In control group, age, sex match patients of IHD undergoing CAG not having DM were included. Every patient was clinically examined by detailed history and physical examination during entry into study. ECG, chest X-ray, echocardiogram, blood sugar (fasting), blood 2 hrs. after 75gm of glucose and or breakfast were analyzed. Coronary angiography was done in all patients through femoral approach by modified Seldinger technique. Carotid arteriography was performed selective and non­selective method by Hunter head or right Judkin's catheter in standard AP, lateral and oblique views. Results: A total number of 100 patients were included in this study. Of them 50 patients were coronary artery disease with diabetes mellitus and another 50 patients were coronary artery disease without diabetes mellitus. Morphological character of the lesion was also assessed. The mean age was found 57.48 years with 6.04 standard deviation (SD) in DM and 55.64 years with 6.34 standard deviation in NDM group and also 56.56 years with 6.49 standard deviation in the whole study population. The value of unpaired t-test was 0.158 and it was insignificant (p&gt;0.05). The common site of lesion was bifurcation, internal carotid, common carotid and external carotid artery which were 13 cases, 9 cases, 4 cases and 1 case respectively. The individual vessel involvement was 9(18.0%) cases in right, 6(12.0%) cases in left, and 3(6.0%) cases in both in DM group whereas 5 (10.0%) cases in right, 3(6.0%) cases in left, and 1(2.0%) case in both in NDM group. It observed that out of 100 study subjects 10 had complex carotid lesion in DM and 4 in NDM. Concussion: In conclusion the common site of lesion was bifurcation and internal carotid artery mostly in right side. Journal of Current and Advance Medical Research, January 2023;10(1):7-12

ARTERIAL CATHETERIZATION IN GREAT APES.

Anesthesia is frequently required to provide appropriate medical care to captive great apes. Anesthetic safety can be optimized through placement of an arterial catheter, which allows direct measurement of arterial blood pressure and easy sampling of arterial blood for blood-gas analysis. Arterial catheterization in great apes can be achieved through palpation-guided or ultrasound-guided placement with or without a modified Seldinger technique. Potential sites for arterial catheterization include the anterior tibial artery, caudal tibial and posterior saphenous arteries, dorsal pedal artery, femoral artery, radial artery, and brachial artery. Arterial catheterization is recommended for lengthy great ape anesthetic procedures or those involving invasive procedures.

Arterial Line Placement Using Modified Seldinger Technique: A Novel Approach.

How to cite this article: Srinivasan A, Naidu V, Dhivya P. Arterial Line Placement Using Modified Seldinger Technique: A Novel Approach. Indian J Crit Care Med 2023;27(7):515-516.

Percutaneous epicardial pacing in infants using direct visualization: A feasibility animal study.

Pacemaker implantation in infants and small children is limited to epicardial lead placement via open chest surgery. We propose a minimally invasive solution using a novel percutaneous access kit. To evaluate the acute safety and feasibility of a novel percutaneous pericardial access tool kit to implant pacemaker leads on the epicardium under direct visualization. A custom sheath with optical fiber lining the inside wall was built to provide intrathoracic illumination. A Veress needle inside the illumination sheath was inserted through a skin nick just to the left of the xiphoid process and angled toward the thorax. A needle containing a fiberscope within the lumen was inserted through the sheath and used to access the pericardium under direct visualization. A custom dilator and peel-away sheath with pre-tunneled fiberscope was passed over a guidewire into the pericardial space via modified Seldinger technique. A side-biting multipolar pacemaker lead was inserted through the sheath and affixed against the epicardium. Six piglets (weight 3.7-4.0 kg) had successful lead implantation. The pericardial space could be visualized and entered in all animals. Median time from skin nick to sheath access of the pericardium was 9.5 (interquartile range [IQR] 8-11) min. Median total procedure time was 16 (IQR 14-19) min. Median R wave sensing was 5.4 (IQR 4.0-7.3) mV. Median capture threshold was 2.1 (IQR 1.7-2.4) V at 0.4 ms and 1.3 (IQR 1.2-2.0) V at 1.0 ms. There were no complications. Percutaneous epicardial lead implantation under direct visualization was successful in six piglets of neonatal size and weight with clinically acceptable acute pacing parameters.

PO-05-014 SUCCESSFUL IMPLANTATION OF A MICRA LEADLESS PACEMAKER THROUGH THE LEFT SUBCLAVIAN VEIN IN A PATIENT WITH SITUS AMBIGUOUS

Primary ciliary dyskinesia patients often have situs ambiguous, a congenital condition with abnormal arrangement of visceral organs in the abdomen and chest. It is associated with an increased risk of congenital heart defects and anomalous venous connections. As a result, placement of the leadless pacemaker through the femoral approach may not be viable in these patients. Herein we describe a successful placement of a leadless pacemaker through the left subclavian approach in a patient with primary ciliary dyskinesia with associated interrupted IVC, right internal jugular (RIJ) thrombus, failed epicardial pacers, and extraction of infected transvenous pacer. N/A A 36-year-old female with primary ciliary dyskinesia, situs ambiguous, RIJ thrombus, and azygous venous connection presents with paroxysmal atrial fibrillation, sinus node dysfunction and syncope (A); History of multiple pacemakers, including failed epicardial pacer, substance abuse and recurrent bacteremia with multiple transvenous pacer infections requiring extractions. Ultrasound access was gained in the left subclavian vein via the modified Seldinger technique. Access was serially dilated until a 23Fr dilator. A manual curve was applied to the tip of the Micra-introducer sheath and the long 27Fr hydrophilic micra-introducer sheath was advanced over a Lunderquist wire, using a stiff rail, into middle of the right atrium (B). The 105 cm Micra delivery catheter was inserted into the sheath, and advanced with fluoroscopic guidance into the right atrium. The introducer sheath was pulled back into the SVC and the delivery catheter was counter-clocked, flexed downward and advanced across the tricuspid valve. The pacemaker was directed to the midseptal position. Contrast was injected to verify positioning against the myocardium (C). The device was deployed with satisfactory parameters noting R waves of 12mV and threshold less than 1V at 0.24 msec pulse with. The pacer was then released with tugging testing confirming adequate deployment. (D). The patient was discharged safely home 2 days later. The left subclavian vein is a viable and safe approach for placing the Micra leadless pacemaker.

Development and content validation of the checklist for assessing placement of a small-bore chest tube (CAPS) for small-bore chest tube placement.

Small-bore chest tube (SBCT) placement via modified Seldinger technique is a commonly performed invasive procedure for treatment of pleural effusion and pneumothorax. When performed suboptimally, it may lead to serious complications. Validated checklists are central to teaching and assessing procedural skills and may result in improved health care quality. In this paper, we describe the development and content validation of a SBCT placement checklist. A literature review across multiple medical databases and seminal textbooks was performed to identify all publications describing procedural steps involved in SBCT placement. No studies were identified that involved systematic development of a checklist for this purpose. After the first iteration of a comprehensive checklist (CAPS) based on literature review was developed, the modified Delphi technique involving a panel of nine multidisciplinary experts was used to modify it and establish its content validity. After four Delphi rounds, the mean expert-rated Likert score across all checklist items was 6.85 ± 0.68 (out of 7). The final, 31-item checklist had a high internal consistency (Cronbach's alpha=0.846) with 95% of the responses (by nine experts across 31 checklist items) being a numerical score of 6 or 7. This study reports the development and content validity of a comprehensive checklist for teaching and assessing SBCT placement. For purposes of demonstrating construct validity, this checklist should next be studied in the simulation and clinical setting.

Clinical practice of emergency department-initiated extracorporeal cardiopulmonary resuscitation for cardiac arrest in adults.

Clinical practice of emergency department-initiated extracorporeal cardiopulmonary resuscitation for cardiac arrest in adults.

Ultrasound-guided radial artery cannulation: A report of a simple and low-cost model for training

IntroductionPracticing models for invasive procedure have proven useful in achieving better rates of success for physicians in training. Often, these models are not easy to get because of its expensive price. Radial artery cannulation is a common practice and its performance with ultrasonographic guidance has proven to be more efficient than traditional ways. We developed a low-cost practicing model that may aid physicians in training to master the ultrasound-guided radial artery cannulation technique and achieve better rates of success when performing this procedure. MethodsUsing ordinary materials such as a piece of pork ham and rubber torniquets, we were able to build a 3-vessel artery model with pulsatile flow. ResultsUltrasonographic imaging revealed a vessel-like material embedded inside the piece of ham. This material resembles an artery which can be punctured with an in-plane or out-of-plane technique and cannulated afterwards, either with a Seldinger or a modified Seldinger technique. Once cannulated, pulsatile flow can be obtained through the catheter used. ConclusionOur model building time was 30 minutes, and its price doesn’t exceed more than $7.50 USD. This model can be used by physicians in training to practice the cannulation of a radial artery using ultrasonographic guidance.

Implementation of modified Seldinger technology for percutaneous catheterization in critically ill newborns.

To describe the implementation of Modified Seldinger Technology for percutaneous catheterization in critically ill newborns. A quasi-experimental before- and-after study, carried out with neonatologist nurses in a Neonatal Intensive Care Unit. Seven nurses participated in the research. Catheter pre-insertion, insertion and maintenance were assessed using the conventional and modified Seldinger technique. Reliability was satisfactory in pre-test, 5.40 (Md = 6.00), and post-test, 5.94 (Md = 7.00), and perfect in the items about device insertion and maintenance. There was low assertiveness in the items on indication, microintroduction procedure via ultrasound, limb repositioning and disinfection of connections/connectors. Despite the Modified Seldinger Technique expanding some stages of execution over the traditional method of percutaneous catheterization, nurses were more assertive after theoretical-practical training. The technology was implemented and is in the process of being implemented in the health service.

PERCUTANEOUS TRACHEOTOMY IN ICU: OUR EXPERIENCE IN 2020-2021 (COVID-19 PANDEMIC).

<h3>INTRODUCTION</h3> Percutaneous tracheostomy (PT) is a surgical procedure for the placement of a tracheal tube through the anterior wall of the trachea. It is performed using a modified Seldinger technique between the second and third tracheal rings and guided under direct vision by the fiberoptic bronchoscope. It is a minimally invasive procedure with a low number of complications by experienced physicians. It is considered a safe alternative to surgical tracheostomies (ST), a more aggressive procedure. According to the internal protocols of the Anesthesia Intensive Care Unit (ICU) of the Valencia University General Hospital (CHGUV), PT are performed by anaesthesiologists, while ST are performed by otorhinolaryngologists. This study aims to confirm that PT is just as safe as ST, as well as that it presents the same or fewer immediate complications, understanding these as bleeding, loss of the airway due to the exit of the endotracheal tube, creation of a false pathway, injury to the posterior wall, injury to one or more tracheal rings, the appearance of subcutaneous emphysema and damage to the fiberoptic bronchoscope with the puncture needle. Due to the Covid-19 pandemic, patients with Covid-19 have been included. The modified protocol for this type of patient has been followed, following the consensus document of the Spanish Societies of Intensive Medicine (SEMICYUV), Otorhinolaryngology (SEORL-CCC), and Anesthesia (SEDAR). <h3>OBJECTIVE</h3> Review the total number of tracheotomies performed by anesthesiologists and otolaryngologists in the CHGUV ICU in 2020-2021, including patients with SARS-COV2 infection, as well as the total of immediate complications that occurred concerning the procedure. Confirm that PT is the technique of choice in critically ill patients due to its lower number and less severity of complications. <h3>MATERIAL AND METHODS</h3> Descriptive, observational, and retrospective study, in which each one of the tracheotomies performed in the CHGUV anesthesia ICU in 2020-2021, as well as their immediate complications, were collected. Patients with Covid-19 were included too. <h3>RESULTS</h3> A total of 294 tracheostomies were performed (20 were patients with SARS-COV2 infection). 294 were TP (12 with SARS-COV2) and 11 TQ (8 with SARS-COV2). Among the complications recorded, the most frequent was mild bleeding appearing in a total of 35 patients. Of these patients, only 30% belonged to the PD group. No cases required a surgical revision. In addition, within the ST, there was one case of accidental decannulation with loss of the airway. <h3>CONCLUSIONS</h3> Our study shows in general a low rate of early complications in tracheostomies, however, ST caused a higher incidence of immediate complications. Furthermore, PT has shown not only a lower incidence of complications but a lower severity of these too. The data from this study support the PT performed by experimented anesthesiologists as the technique of choice in critical patients compared to CT.

Design and Functionality of a Multilumen Thoracic Access Port for Pericardial Access Under Direct Visualization.

Small vasculature, venous obstruction, or congenital anomalies can preclude transvenous access to the heart, often resulting in open chest surgery to implant cardiac therapy leads for pacing, defibrillation, or cardiac resynchronization. A minimally invasive approach under direct visualization could reduce tissue damage, minimize pain, shorten recovery time, and obviate the need for fluoroscopy. Therefore, PeriPath was designed as a single-use, low-cost pericardial access tool based on clinical requirements. Its mechanical design aids in safe placement of conductive leads to the pericardium using a modified Seldinger technique. The crossed working channels provide an optimal view of the surgical field under direct visualization. Finite element analysis (FEA) confirms that the device is likely not to fail under clinical working conditions. Mechanical testing demonstrates that the tensile strength of its components is sufficient for use, with minimal risk of fracture. The PeriPath procedure is also compatible with common lead implantation tools and can be readily adopted by interventional cardiologists and electrophysiologists, allowing for widespread implementation. Prior animal work and a physician preliminary validation study suggest that PeriPath functions effectively for minimally invasive lead implantation procedures.

Ultrasound-Guided Modified Seldinger Placement of Tenckhoff Catheters in Pediatric Patients Undergoing Peritoneal Dialysis: Single Center Experience.

Minimally invasive peritoneal dialysis (PD) catheterization is increasingly common, and percutaneous PD catheters may be placed using a trocar or the Seldinger technique. There are few reports of pediatric percutaneous PD catheter insertion. We retrospectively compared the outcomes from percutaneous placement of Tenckhoff catheters using a modified Seldinger technique with catheter placement by open surgery. This single-center retrospective study compared 14 pediatric patients who received percutaneous PD catheter insertion using an ultrasound-guided modified Seldinger technique (August 2018–February 2021) with 10 patients who received open-surgical PD catheter insertion (2015–2018). Complications and catheter survival were evaluated. The overall technical success rate was 100%, but the Seldinger technique required less time (30 vs. 45 min) and smaller incisions (1.1 vs. 4.4 cm). The early complications in the Seldinger and control groups were bleeding (1 vs. 0), catheter dysfunction (1 vs. 1), abdominal pain (3 vs. 7), and exit leakage (0 vs. 1). In the Seldinger group, the median time from insertion to first use was 3 days, and the minimum follow-up was 6 months. Catheter survival at 6 months was 93% (Seldinger group) and 90% (open surgery group). The adoption of this technique at our institution led to a significant increase in the percentage of new pediatric dialysis patients commencing PD rather than hemodialysis. Collectively, the modified Seldinger technique described here was safe and feasible in pediatric patients. This approach is simpler and more rapid than open surgery, and reduces early complications and increases PD uptake.