Needle Catheter Research Articles

Amphiphilic Gelator-Based Shear-Thinning Hydrogel for Minimally Invasive Delivery via Endoscopy Catheter to Remove Gastrointestinal Polyps.

Injectable polymeric hydrogels delivered via endoscopic catheter have emerged as promising submucosal agents, offering durable, long-lasting cushions to enhance the efficacy of endoscopic submucosal dissection (ESD) for the removal of small, flat polyps from the gastrointestinal tract (GIT). However, polymer-based injections do not meet the easy-injectability criteria via catheter because their high viscosity tends to clog the catheter needle. To the best of knowledge, for the first time, report the fabrication of an amphiphile-based small molecule hydrogel of diglycerol monostearate (DGMS)thatself-assembles to form hydrogel (DGMSH) for delivery via an endoscopic catheter. Physicochemical characterization of the hydrogel reveals its fibrous morphology, shear-thinning behaviour, and easy injectability, along with its scalability and long shelf-life (6 months). Ex vivo studies on the goat's stomach and intestine demonstrate the ease of injectability through the catheters and the development of visible submucosal cushion depots with the desired height. Moreover, the hydrogel can encapsulate both hydrophobic and hydrophilic drugs/dyes. In vivo studies in small animals have found that the hydrogel depot is durable, biocompatible, non-immunogenic, and has a hemostatic effect. Endoscopic studies in the porcine model demonstrate a safe injection and endoscopic excision of GI polyps acting as a suitable agent for ESD.

Needlessly Treated: Evaluation of Prehospital Needle Thoracostomy.

Needle thoracostomy is a potentially life-saving intervention for tension pneumothorax but may be overused, potentially leading to unnecessary morbidity. To review prehospital needle thoracostomy indications, effectiveness, and adverse outcomes. A retrospective cohort study was conducted based on registry data for a United States Midwestern Level I trauma center for a 7.5-year period (January 2015 to May 2022). Included were patients who received prehospital needle thoracostomy and trauma activation before hospital arrival. The primary outcomes were correct indications and improvement in vital signs. Secondary outcomes were the need for chest tubes, correct needle placement, complications, and survival. A total of n =67 patients were reviewed, of which n =63 (94%) received a prehospital thoracostomy. Of the 63 prehospital thoracostomies, 54 (86%) survived to arrival. Of these 54, 44 (n=81%) had documented reduced/absent breath sounds, 15 (28%) hypotension, and 19 (35%) with difficulty breathing/ventilating. Only four patients met all three prehospital trauma life support criteria: hypotension, difficulty ventilating, and absent breath sounds. There were no significant changes in prehospital vitals before and after receiving needle thoracostomy. In patients receiving imaging (n=54), there was evidence of 15 (28%) lung lacerations, 6 (11%) of which had a pneumothorax and 3 (5%) near misses of important structures. Review of needle catheters visible on computer tomography imaging found 11 outside the chest and 1 in the abdominal cavity. The study presents evidence of potential needle thoracostomy overuse and morbidity. Adherence to specific guidelines for needle decompression is needed.

Evaluating the effects of comprehensive simulation on central venous catheterization training: a comparative observational study

BackgroundSimulation-based training (SBT) is vital to complex medical procedures such as ultrasound guided central venous catheterization (US-IJCVC), where the experience level of the physician impacts the likelihood of incurring complications. The Dynamic Haptic Robotic Trainer (DHRT) was developed to train residents in CVC as an improvement over manikin trainers, however, the DHRT and manikin trainer both only provide training on one specific portion of CVC, needle insertion. As such, CVC SBT would benefit from more comprehensive training. An extended version of the DHRT was created, the DHRT + , to provide hands-on training and automated feedback on additional steps of CVC. The DHRT + includes a full CVC medical kit, a false vein channel, and a personalized, reactive interface. When used together, the DHRT and DHRT + systems provide comprehensive training on needle insertion and catheter placement for CVC. This study evaluates the impact of the DHRT + on resident self-efficacy and CVC skill gains as compared to training on the DHRT alone.MethodsForty-seven medical residents completed training on the DHRT and 59 residents received comprehensive training on the DHRT and the DHRT + . Each resident filled out a central line self-efficacy (CLSE) survey before and after undergoing training on the simulators. After simulation training, each resident did one full CVC on a manikin while being observed by an expert rater and graded on a US-IJCVC checklist.ResultsFor two items on the US-IJCVC checklist, “verbalizing consent” and “aspirating blood through the catheter”, the DHRT + group performed significantly better than the DHRT only group. Both training groups showed significant improvements in self-efficacy from before to after training. However, type of training received was a significant predictor for CLSE items “using the proper equipment in the proper order”, and “securing the catheter with suture and applying dressing” with the comprehensive training group that received additional training on the DHRT + showing higher post training self-efficacy.ConclusionsThe integration of comprehensive training into SBT has the potential to improve US-IJCVC education for both learning gains and self-efficacy.

Comparison of Transesophageal Echocardiography Probe as Surface Probe with Vascular Probe During Right Internal Jugular Vein Catheterization in Cardiac Surgeries.

USG vascular probe and TEE probe can help during central venous catheterization (CVC) and can confirm the location of guide wire in the neck vessels. We proposed this study, as there are only few studies comparing between TEE probe as surface probe and USG vascular probe for right IJV cannulation. To compare the TEE probe as a surface probe and USG vascular probe during right IJV catheterization in cardiac surgeries. Prospective, comparative study. One twenty-four patients of either sex posted for major elective cardiac surgery were included in this study. Patients were divided into two groups (TEE group and USG group) of 62 by assigning the study participants alternatively to each group. The goal of this study was to compare the puncture time, visualization of IJV to first successful puncture, quality of the imaging with needle tip positioning, and catheter positioning using both TEE probe and vascular probe. The primary outcome was comparison of time from visualization of the IJV to successful puncture using both TEE probe as a surface probe and vascular probe. Secondary outcome was to compare the quality of image with respect to needle tip positioning and compare quality of image with respect to catheter position using both probes. Statistical analyses were performed by using a statistical software package SPSS, version 20.0. The observation and results of our study clearly show the feasibility of TEE as surface probe for guiding central venous catheter in right IJV just like the vascular linear probe. There was no significant difference between the two groups (P > 0.05). No statistical differences were found in the puncture time, image quality, needle tip positioning, wire positioning, and catheter positioning between the two groups. All the P values were greater than 0.05. The TEE probe can be used as an alternative method to guide IJV puncturing and catheterization when the vascular probe is not available. It is feasible especially in cardiac surgeries where the TEE monitoring machine is a must in modern anesthesia and readily available than an ultrasound machine.

Effect of catheter needle caliber on polidocanol foam stability in foam sclerotherapy.

Although sclerotherapy is widely used to treat vascular malformations (VMs), it is associated with several challenges. One significant issue is the insufficient understanding of the influence of various factors on the stability of polidocanol (POL) foam used in sclerotherapy. This study aimed to explore the effect of the catheter needle caliber on foam stability when using POL with or without hyaluronic acid (HA) for the treatment of VMs. The Tessari method generated sclerosant foam using POL both with and without HA. We used catheters and syringe needles of various calibers, and the resulting foam was transferred into new syringes to facilitate a comparison of foam stability. Foam half-life (FHT) was utilized as a metric to assess foam stability. The study found that narrower needle calibers produced a more stable foam when POL was used alone; however, no significant effect was observed when HA was added. Furthermore, when the foam was expelled using catheters and syringe needles of the same size, no noticeable changes in the stability were observed. When choosing needles of varying calibers, their effect on foam stability should be carefully considered, particularly when the foam contains HA.

The effect of a biofeedback-based virtual reality game on pain, fear and anxiety levels during port catheter needle insertion in pediatric oncology patients: A randomized controlled study

PurposeIt is essential to control pain, fear, and anxiety related to medical procedures to improve the well-being of the child and family trying to cope with the disease process. This study investigated the impact of the biofeedback-based virtual reality game (BioVirtualPed) on pain, fear, and anxiety levels during port needle insertion in pediatric oncology patients (POPs). MethodsThis randomized controlled study was conducted at a hospital between August and December 2023 involving 62 POPs aged 6–12 and their mothers. The intervention group wore a virtual reality headset and a respiratory sensor during the procedure. Data were collected using the Descriptive Information Form, Wong-Baker Pain Assessment Scale, Child Fear Scale, Children's State Anxiety, Satisfaction Scoring-Visual Analog Scale, and ADXL354 Sensor. Statistical analysis was performed using IBM SPSS for Windows Version 24.0. ResultsThe intervention group showed lower mean pain scores than the control group (p < 0.001). There was no difference in pre-procedure fear and anxiety scores between groups (p > 0.05 and p > 0.05, respectively). Post-procedure fear and anxiety scores were lower in the intervention group (p < 0.001 and p < 0.001, respectively). The intervention group's mean respiratory rates were lower (p < 0.001), and their satisfaction scores were higher (p < 0.001). Agreements between POPs and mothers on pain, fear, and anxiety scores were good and excellent across groups (p < 0.001). ConclusionsThe BioVirtualPed reduced procedure-related pain, anxiety, and fear, increased care satisfaction, and had a positive effect on the mean respiratory rate, hence it shows promising results, but these findings need further comfirmation.

SlicerPIT: software development and implementation for planning and image-guided therapy in photoimmunotherapy.

Photoimmunotherapy is a treatment modality that induces targeted cell death by binding a molecular-targeted drug activated by infrared light to the tumor cells and subsequently illuminating the lesion with infrared light. For deep lesions, a needle catheter is used to puncture the tumor, and an illumination fiber (cylindrical diffuser) is inserted into the catheter lumen for internal illumination. However, it can be challenging to place the cylindrical diffusers in an appropriate position as the deep lesions cannot be often confirmed accurately during surgery. We have developed "SlicerPIT", a planning simulation software for photoimmunotherapy. SlicerPIT allows users to place the cylindrical diffuser with its illumination range on preoperative images in 2D and 3D and export the planning data to external image-guided surgical navigation systems. We performed seven cycles of photoimmunotherapy with SlicerPIT in three patients with recurrent head and neck cancer. Preoperative planning for photoimmunotherapy was conducted using SlicerPIT, which could be imported into the navigation system. During the operation, we punctured the needle catheters along with the treatment plan on the navigation screen. Subsequently, intraoperative CT imaging was performed and overlaid with the preoperative treatment plan to confirm the alignment of the cylindrical diffusers as planned, followed by infrared light illumination. Postoperative imaging showed necrosis and shrinkage of the entire tumor in all cycles. SlicerPIT allows for detailed preoperative treatment planning and accurate puncture. It may be a valuable tool to improve the accuracy of photoimmunotherapy for deep lesions and improve patient outcomes.

The Hypoechoic Triangle: A New Sonographic Landmark for Rectus Sheath Block.

Rectus sheath blocks can provide analgesia for upper abdominal midline incisions. These blocks can be placed on patients who are anticoagulated, supine, and under general anesthesia. However, block success rates remain low, presumably because of the difficulty of placing local anesthetic between the correct fascial layers. Here we characterize a hypoechoic triangle with sonography, an anatomic space between adjacent rectus abdominis segments that can be accessed for easier needle tip and catheter placement. This approach could reduce reliance on hydrodissection to correctly identify the potential space and instead improve block efficacy by offering providers a discrete target for local anesthesia.

Modified sclerotherapy needle catheter as protective sheath for laser fibre passage in channelled flexible laryngoscopes.

Modified sclerotherapy needle catheter as protective sheath for laser fibre passage in channelled flexible laryngoscopes.

Highly reproducible rat arterial injury model of neointimal hyperplasia.

Models of arterial injury in rodents have been invaluable to our current understanding of vessel restenosis and play a continuing role in the development of endovascular interventions for cardiovascular disease. Mechanical distention of the vessel wall and denudation of the vessel endothelium are the two major modes of vessel injury observed in most clinical pathologies and are critical to the reproducible modelling of progressive neointimal hyperplasia. The current models which have dominated this research area are the mouse wire carotid or femoral injury and the rat carotid balloon injury. While these elicit simultaneous distension of the vessel wall and denudation of the luminal endothelium, each model carries limitations that need to be addressed using a complementary injury model. Wire injuries in mice are highly technical and procedurally challenging due to small vessel diameters, while rat balloon injuries require permanent blood vessel ligation and disruption of native blood flow. Complementary models of vascular injury with reproducibility, convenience, and increased physiological relevance to the pathophysiology of endovascular injury would allow for improved studies of neointimal hyperplasia in both basic and translational research. In this study, we developed a new surgical model that elicits vessel distention and endothelial denudation injury using sequential steps using microforceps and a standard needle catheter inserted via arteriotomy into a rat common carotid artery, without requiring permanent ligation of branching arteries. After 2 weeks post-injury this model elicits highly reproducible neointimal hyperplasia and rates of re-endothelialisation similar to current wire and balloon injury models. Furthermore, evaluation of the smooth muscle cell phenotype profile, inflammatory response and extracellular matrix within the developing neointima, showed that our model replicated the vessel remodelling outcomes critical to restenosis and those becoming increasingly focused upon in the development of new anti-restenosis therapies.

Worldwide Experience With an Irrigated Needle Catheter for Ablation of Refractory Ventricular Arrhythmias: Final Report

BackgroundWe previously reported feasibility of irrigated needle ablation (INA) with a retractable 27-G end-hole needle catheter to treat nonendocardial ventricular arrhythmia substrate, an important cause of ablation failure. ObjectivesThe purpose of this study was to report outcomes and complications in our entire INA-treated population. MethodsPatients with recurrent sustained monomorphic ventricular tachycardia (VT) or high-density premature ventricular contractions (PVCs) despite radiofrequency ablation were prospectively enrolled at 4 centers. Endpoints included a 70% decrease in VT frequency or PVC burden decrease to <5,000/24 h at 6 months. ResultsINA was performed in 111 patients (median: 2 failed prior ablations, 71% nonischemic heart disease, and left ventricular ejection fraction 36% ± 14%). INA acutely abolished targeted PVCs in 33 of 37 patients (89%), and PVCs were reduced to <5,000/day in 29 patients (78%). During 6-month follow-up, freedom from hospitalization was observed in 50 of 72 patients with VT (69%), and improvement or abolition of VT occurred in 47%. All patients received multiple INA applications, with more in the VT group than in the PVC group (median: 12 [IQR: 7-19] vs 7 [5-15]; P < 0.01). After INA, additional endocardial standard radiofrequency ablation was required in 23% of patients. Adverse events included 4 pericardial effusions (3.5%), 3 cases of (anticipated) atrioventricular block (2.6%), and 3 heart failure exacerbations (2.6%). During 6-month follow-up, 5 deaths occurred; none were procedure-related. ConclusionsINA achieves improved arrhythmia control in 78% of patients with PVCs and avoids hospitalization in 69% of patients with VT refractory to standard ablation at 6-month follow-up. Procedural risks are acceptable. (Intramural Needle Ablation for Ablation of Recurrent Ventricular Tachycardia, NCT01791543; Intramural Needle Ablation for the Treatment of Refractory Ventricular Arrhythmias, NCT03204981)

LB-456089-3 WORLD WIDE EXPERIENCE WITH AN END-HOLE IRRIGATED NEEDLE CATHETER FOR ABLATION OF REFRACTORY VENTRICULAR ARRHYTHMIAS: FINAL REPORT

Deep intramural ventricular arrhythmia (VA) substrate is a frequent cause of failed radiofrequency catheter ablation (RFA). Feasibility of irrigated needle ablation (INA) with a retractable 27G end-hole needle catheter has been previously reported. Here we report the findings, outcomes and complications in the entire population treated with this catheter.

Intervertebral Foramen - A Gateway to Epidural Space in Severe Lumbar Scoliosis.

We describe cases in which a preoperative computed tomography was used to guide the placement of an epidural catheter through the defect in the intervertebral foramina in patients with severe lumbar scoliosis. We demonstrate the adroitness with which epidural catheters were inserted through the intervertebral foramina. Computed tomography scan illustrates and plots the needle path creating a 3-dimensional image of the vertebral body rotation, needle trajectory, and the distance from the skin to the intervertebral foramina. Severe scoliosis is defined as a lateral curvature (Cobb's angle) of more than 50 degrees. It was proposed in severe idiopathic scoliosis that interventional pain management techniques are managed with fluoroscopic imaging or an alternative form. However, after a computed tomography evaluation of the scoliotic spine, we assumed that the intervertebral foraminal anatomy would facilitate a safe and efficient epidural needle and subsequent catheter positioning in severe scoliotic patients.

Robotic Devices for Assisted and Autonomous Intravenous Access

Intravenous Access (IVA) is the most common invasive medical procedure. Globally, it is estimated that over one billion IVA devices (needles/catheters) are used annually. However, the overall failure rate in this procedure is unacceptably high, reaching values between 35 and 50%. This has driven a great deal of research and technological development over recent decades, including the integration of different levels of autonomy in IVA medical devices to greatly improve this process. This paper will review these recent technical developments, including methods and systems for vein imaging and localization, needle insertion, venipuncture detection, catheter placement, and complete robotic IVA platforms. Furthermore, this paper explores emerging technical aspects, current limitations, and new research directions that may enable wider clinical translation and better acceptance of robotic IVA technologies.

Hemolysis Control in the Emergency Department by Interventional Blood Sampling.

The hemolysis rate in the emergency department (ED) is higher compared to that in other departments. We propose a new blood sampling technique without repeated venipuncture to reduce hemolysis and compare the hemolysis rate between blood collected by this method and that collected with an intravenous (IV) catheter. This prospective study included a nonconsecutive sample of patients visiting the ED (aged ≥ 18 years) of a tertiary urban university hospital. The intravenous catheterization was performed by three pre-trained nurses. The new blood collection technique involved sample collection without removing the catheter needle, performed immediately before the conventional method (through an IV catheter), without additional venipuncture. Two blood samples were collected from each patient using both the new and conventional methods, and the hemolysis index was evaluated. We compared the hemolysis rate between the two methods. From the 260 patients enrolled in this study, 147 (56.5%) were male, and the mean age was 58.3 years. The hemolysis rate of the new blood collection method was 1.9% (5/260), which was significantly lower than that of the conventional method (7.3%; 19/260) (p = 0.001). The new blood collection method can reduce the hemolysis rate as compared to the conventional blood collection method.

Dynamic analysis of small droplets at constant pressure and analytical model for drip systems and very low pressure drop-on-demand applications

We study the evolution of the growing volume of a droplet formed out of a capillary tube driven at a constant applied pressure by optical volume detection. A particular application aims at modeling the dynamic of the drop in the case of the injection of drugs in the middle-ear cavity using a small target drug delivery system. Various dispense tips such as a steel needle or silicone catheters and different t-BuOH aqueous solutions were used. A physical model based on the simplified Laplace–Young equation for a spherical droplet was developed to interpret the experimental results and model the observed deviation of the mean flow rate from the Poiseuille law when the drop radius is smaller than the capillary length. We emphasize the large influence of the surface tension which introduces a highly nonlinear effect at low applied pressure just above the capillary threshold pressure. The model fits well the evolution of the growing volume at various applied pressure up to a maximum diameter corresponding to the drop size close to the capillary length of the fluid, lc=γ/ρg, based on the liquid density ρ, gravity g and surface tension γ. We demonstrate that the model can also be applied to non spherical pendant droplets providing the apex elongation over the drop height of a spherical cap of the same volume is kept in a 30% range.

Balloon-assisted Jejunostomy Placement

Jejunal feeding is indicated in patients with functional or physical abnormalities that prevent gastrostomy tube placement or feeding. J-tubes are most often placed using one of four techniques: Open surgical, laparoscopic, needle catheter, or direct percutaneous placement, depending on the patient needs and expertise of the surgeon. Minimally invasive techniques are considered standard of care, and thus, J-tube placement most often occurs through laparoscopic methods. While percutaneous insertion using balloon dilation rather than serial dilation has shown greater success rates, lower complication rates, and alleviates patient discomfort in G-tube placement, this procedure has not been utilized for J-tube placement. Here, we report a balloon-assisted jejunostomy placement technique utilized to replace a previous surgical jejunostomy tube that the cutaneous tract had healed over.

Randomized controlled trial to assess reducing the pain of venipuncture in adult patients using an ice pack

Background: Venipuncture is a common procedure in the emergency department, and in some patients, the procedure may cause pain, anxiety, and fear. There are different studies in the literature looking for ways to reduce the pain, either pharmacologically or non-pharmacologically. Most of the studies were done in pediatrics but a few were in adult patients. We conducted this study to determine whether an ice pack application reduces venipuncture pain among emergency department adult patients compared to the conventional way. Methods: We conducted this randomized controlled clinical trial on adult patients in the Security Forces Hospital, Riyadh, Saudi Arabia, from 1 March 2021 to 30 June 2021. Computer randomization was done to randomize subjects to either control or intervention. The 22-gauge needle catheter was inserted in the antecubital fossa in all participants. Results: We included 281 patients aged 18–60 years, who were randomized to the control or intervention group. There were 140 patients in the control group and 141 in the intervention group. The mean average pain score in the control group was 2.19 and 1.66 in the intervention group, with a statistically significant difference (p-value: 0.016). Conclusion: The ice pack application reduces venipuncture pain in adult emergency department patients and was associated with a better first attempt success rate.

Risk of Harm in Needle Decompression for Tension Pneumothorax.

Tension pneumothorax (TPX) is the third most common cause of preventable death in trauma. Needle decompression at the fifth intercostal space at anterior axillary line (5th ICS AAL) is recommended by Tactical Combat Casualty Care (TCCC) with an 83-mm needle catheter unit (NCU). We sought to determine the risk of cardiac injury at this site. Institutional data sets from two trauma centers were queried for 200 patients with CT chest. Inclusion criteria include body mass index of =30 and age 18-40 years. Measurements were taken at 2nd ICS mid clavicular line (MCL), 5th ICS AAL and distance from the skin to pericardium at 5th ICS AAL. Groups were compared using Mann-Whitney U and chi-squared tests. The median age was 27 years with median BMI of 23.8 kg/m2. The cohort was 69.5% male. Mean chest wall thickness at 2nd ICS MCL was 38-mm (interquartile range (IQR) 32-45). At 5th ICS AAL, the median chest wall thickness was 30-mm (IQR 21-40) and the distance from skin to pericardium was 66-mm (IQR 54-79). The distance from skin to pericardium for 75% of patients falls within the length of the recommended needle catheter unit (83-mm). The current TCCC recommendation to "hub" the 83mm needle catheter unit has potential risk of cardiac injury.

Ultrasound-Guided Drainage of Breast Abscess

Objective: To assess the efficacy of ultrasound-guided drainage of breast abscesses with special attention to the risk of recurrence and the need for surgical treatment, to avoid postoperative morbidity, to reduce the hospital stay and cost of treatment, to determine the need for termination of breast feeding. Methods: 100 patients with breast were selected conveniently among those who were admitted in Dinajpur Medical College hospital or visited to surgery OPD with breast abscess. They were evaluated by short history, clinical examination and ultrasonogram. After counseling and taking consent they were treated with ultrasound-guided drainage, by needle or pigtail catheter under local anaesthesia. Follow-up punctures were performed at 2 or 3 day intervals until the clinical condition and ultrasound findings had improved. All patients were treated with oral antibiotics. Mammography was performed to search for underlying cancer. Results: Among the 100 cases included in the study, ninety-seven 97% patients with puerperal abscesses and 81% with non-puerperal abscesses recovered after the first round of ultrasound-guided drainage. One patient in each group had recurrence in loco but recovered after further ultrasound-guided drainage. Seven patients, 6 with non-puerperal and 01 with puerperal abscesses, underwent surgical excision of the abscess cavity or fistulas. Breastfeeding continued and 23 patients were treated as outpatients. The median number of follow up examinations in the ultrasound-department was four (range 1–10) for the group of patients with puerperal abscess and three (range 1–7) in the group of patients with non- puerperal abscess. The corresponding figure for the median number of punctures was for both groups one (range 1–6 and 1–4). There were no reports of newly diagnosed breast cancer in the 1-year follow-up period. Conclusion: Treatment of breast abscess with US-guided Percutaneous aspiration or Pigtail catheter drainage both in puerperal and .......