Needle Catheter Research Articles

B-PO05-168 BEDSIDE PERCUTANEOUS SYMPATHETIC BLOCK IS SAFE AND EFFECTIVE IN REFRACTORY ELECTRICAL STORM AS A BRIDGE TO ADVANCED THERAPIES

Patients with electrical storm (ES) who fail standard medical and interventional therapies have a high mortality rate and are difficult to bridge to definitive therapies. Bedside, ultrasound-guided percutaneous sympathetic block (PSB) can stabilize these patients in the acute setting. To describe the outcomes of patients with electrical storm (ES), in whom PSB was used to bridge them to advanced therapies. Retrospective study of consecutive ES patients undergoing bedside ultrasound-guided PSB between 1/2017-3/2020 at our institution. Of the 19 PSB patients in ES, the majority were male (89.5%) with average age of 66.5±6.0 years and left ventricular ejection fraction (LVEF) 28± 10%. There was underlying ischemic cardiomyopathy in 52%. Catheter ablation was performed in 47.3% prior to PSB with average 1.1±1.4 ablations with 2.5±0.48 adjunctive anti-arrhythmia medications. The ventricular arrhythmia (VA) was monomorphic in 70% with cycle length 250-490ms. Despite intubation and mechanical ventilation in 47% of these patients, the majority were in ES (94%) the day of procedure. After PSB, no ventricular arrhythmia recurred in eight patients (42%). There was a significant decrease in amount of VA (4.4±2.5 vs. 2.2± 3.5 episodes P= 0.019) and number of patients with ES the day before and after procedure 18 vs. 16 patients P=0.00001. Minor reversible side effects were noted in 21% and no significant bleeding was reported despite all patients being on anticoagulants or antiplatelet agents. Follow up was 4.5±5 months: 5 patients died, one referred to hospice, 5 had heart transplant and 3 underwent surgical sympathetic denervation. Four patients underwent coronary revascularization, 2 were treated with immunosuppression, 2 underwent stereotactic body radiation therapy, 1 surgical cryoablation, one AAI pacing, 2 LVAD and 1 needle catheter ablation. Fifteen patients survived admission and 13 (86%) were free of any arrhythmia during follow up. PSB with continue infusion is a safe and effective beside procedure in patients who have exhausted conventional therapy and can offer a rescue bridge to facilitate advanced treatments.

Image Guided percutaneous pigtail catheter drainage of Liver Abscess technique and its outcome

Background: Liver abscesses are localized collections of necrotic inflammatory tissue caused by bacterial, parasitic or fungal agents. These abscesses are usually suspected clinically in cases having fever and tender hepatomegaly. The diagnosis is usually confirmed on the basis of imaging such as ultrasound and computerised tomography. Management includes antimicrobial agents and drainage of abscess. Percutaneous drainage of abscess is done using needle aspiration or catheter drainage.
 Aims and Objective: The main aim of the study was to evaluate the role of pigtail catheterization drainage procedure as a treatment option in cases of liver abscess.
 Materials and Methods: It was a prospective study conducted ata tertiary care medical college. Fifty patients having hepatic abscess were included in this study over a period of one year from August 2018 to September 2019 on the basis of a predefined inclusion and exclusion criteria. These patients underwent pigtail catheterization of liver abscess as a treatment. The demographic characteristics, hepatic lobe involvement, offending organisms and complications were studies in these patients.
 Results: Out of 50 patients 35 were male and 15 were femalewith a M: F ratio of 1:0.42. The age ranged from 4 years to 92 years. The mean age of the studied cases was found to be 38.64 +/- 18.17 years. Right lobe was involved in predominant cases. most common individual organism involved in hepatic abscess formation was klebsiella (30%) followed by streptococcus (20%) and E-coli (8%) organisms. Seven patients developed procedure related complications out of which 5 patients had catheter dislodgment requiring repositioning of catheter 1 patient developed pus discharge from catheter site and remaining 1 patient developed subcapsular hematoma.
 Conclusion: Percutaneous image guided pigtail catheter of liver abscess is an effective minimal procedure as a treatment option for liver abscess with high success rate with no mortality related to procedure.

A novel technique of percutaneous intraluminal cracking using a puncture needle for severe calcified lesions of below-the-knee and below-the-ankle arteries.

Endovascular therapy has recently become acceptable for the reconstruction of below-the-knee (BTK) and below-the-ankle (BTA) arterial lesions. However, we have sometimes experienced BTK or BTA lesions with calcifications that are too severe for balloon catheters to cross or expand despite successful guidewire passage. In this study, we assessed the feasibility and safety of the novel inner PIERCE technique for breaking down the calcium burden of BTK and BTA arterial lesions. We retrospectively reviewed the records of patients who had undergone endovascular therapy between August 2018 and December 2019. The inner PIERCE technique was performed in those cases where low-profile balloon catheters were unable to pass through the target lesions or balloon indentation did not disappear beyond the rated burst pressure. An externalized guidewire system was established in 8 cases via bidirectional approaches, and a 20-gauge needle was directly inserted through the guidewires from the distal puncture site. In 10 cases of successful antegrade wiring, the tibial or pedal arteries distal to the lesion site were punctured for a retrograde guidewire approach to the lesion. The needle was slowly rotated and advanced across the lesion. We found that all lesions were severely calcified and 83.3% had chronic total occlusion. The inner PIERCE procedure allowed successful passage of the needle and subsequent low-profile balloon catheters in all cases. Optimal balloon dilatation was achieved in 94.4% of the cases using this technique. No procedure-related adverse events were observed. The novel inner PIERCE technique is a safe and feasible method for disrupting calcified BTK and BTA lesions.

Simultaneous needle catheter selection and dwell time optimization for preplanning of high-dose-rate brachytherapy of prostate cancer

Purpose. Needle catheter positions critically affect the quality of treatment plans in prostate cancer high-dose-rate (HDR) brachytherapy. The current standard needle positioning approach is based on human intuition, which cannot guarantee a high-quality plan. This study proposed a method to simultaneously select needle catheter positions and determine dwell time for preplanning of HDR brachytherapy of prostate cancer. Methods. We formulated the needle catheter selection problem and inverse dwell time optimization problem in a unified framework. In addition to the dose objectives of the planning target volume (PTV) and organs at risk (OARs), the objective function incorporated a group-sparsity term with a needle-specific adaptive weighting scheme to generate high-quality plans with the minimal number of needle catheters. The optimization problem was solved by a fast-iterative shrinkage-thresholding algorithm. For validation purposes, we tested the proposed algorithm on 10 patient cases previously treated at our institution and compared the resulting plans with plans generated using needle catheters selected manually. Results. Compared to the plan with manually selected needle catheters, when normalizing both plans to the same PTV coverage V 100% = 95%, the plans generated by the proposed algorithm reduced median V 125% from 65% to 64%, but increased median V 150% from 35% to 38%, and V 200% from 14% to 16%. All planning objectives were met. All clinically important dosimetric parameters of OARs were reduced. D 1cc of bladder and rectum were reduced from 8.57 Gy to 8.50 Gy and from 7.24 Gy to 6.80 Gy, respectively. D max of urethra was reduced from 15.85 Gy to 15.77 Gy. The median number of selected needle catheters was reduced by two. The computational time for solving the proposed optimization problem was ∼90 s using MATLAB. Conclusion. The proposed algorithm was able to generate plans for prostate cancer HDR brachytherapy preplanning with increased median conformity index (0.73–0.77) and slightly lower median homogeneity index (0.64–0.62) with the number of selected needles reduced by two compared to the manual needle selection approach.

A COMPARATIVE STUDY OF PERCUTANEOUS NEEDLE ASPIRATION AND CATHETER DRAINAGE IN MANAGEMENT OF LIVER ABCESS

Modern management of liver abcess include a combination of percutaneous Needle aspiration or percutaneous Catherter drainage along with intravenous antibiotic .Liver abcess is common disease in india, if not treated properly can lead to hazardous complication. MATERIAL AND METHOD; This was comparative study of 30 patient from august 2018 to August2020 in civil hospital ahmedabad. Randomization was done and dived into two groups of 25 each and assigned two group as percutaneous Catherter drainage and needle aspiration. Both groups were given intravenous antibiotics for 7 days .Both modalities were performed under guidance of ultrasound imaging. Needle aspiration was repeated for three times and if size of abcess cavity not reduced to half consider as failure of treatment. Effectiveness of treatment measured in term of days to achieve clinical improvement, total/near total resolution of abcess cavity and duration of hospital stay. RESULT; Needle aspiration was successful in 13 out of 15,whereas percutaneous drainage was successful in 14 out of 15.Duration of hospital stay were significantly lower in percutaneous drainage.one patient with needle aspiration developed subcapsular hematoma. CONCLUSION; We can conclude that percutaneous drainage is better modality is better modality as compared to needle aspiration in medium to large size liver abcess. The duration of hospital stay is comparatively lower in percutaneous drainage and days of clinical relief were earlier in percutaneous drainage. This study also verify that both were adequately effective in the treatment of liver abcess. *AIM OF THE STUDY To compare the effectiveness of percutaneous catheter drainage and percutaneous needle aspiration in management of liver abcess.

Comparison of the Effectiveness between 5% Eutectic Mixture of Local Anesthetic Cream and Ethyl Chloride Spray Applied on the Skin Prior to Intravenous Cannulation

Background: Since the patients scheduled for an endoscopic procedure had been unhappy with pain during intravenous cannulation. Objective: To compare the effectiveness between 5% eutectic mixture of local anesthetic cream and ethyl chloride spray applied on the skin prior to the procedure. Materials and Methods: One hundred eighty-six patients were randomized equally into three groups, A: 5% eutectic mixture of local anesthetic cream, B: ethyl chloride spray, and C: placebo. Then a nurse used a 22-gauge (22G) needle catheter to administer a cannula. Five minutes after the intravenous cannulation, a co-researcher assessed the patient’s pain perception and satisfaction as well as the nurse’s difficulty in performance by means of a numeric rating scale. Results: One hundred seventy-six patients completed the present study. Participants having the anesthetic cream and spray application as well as the placebo expressed their pain scores as 1.7±1.3, 1.6±1.2, and 2.2±1.3, respectively. Therefore, patients applied with local anesthetics had significantly less pain perception than those with the placebo (p=0.039); however, scores were not different between the anesthetic cream and the spray groups. Conclusion: Patients scheduled for an endoscopic procedure did not showed significant pain relief with either the 5% eutectic mixture of local anesthetic cream or the ethyl chloride spray. Keywords: 5% eutectic mixture of local anesthetic cream, Ethyl chloride spray, Endoscopic surgery, Intravenous cannulation, Pain

Small-Dose Endoscopic Tattooing Using a Novel Needle for Localization Prior to Laparoscopic Surgery of Colorectal Cancer.

Endoscopic tattooing failure by deep mural injection or tattoo leakage-induced massive staining causes localization errors or decreased laparoscopic visualization. To overcome these, we developed a novel tattoo needle with comparatively shorter needle (length, 2.5mm) and minimal-caliber catheter (volume, 0.3mL). The single-center, prospective observational study aimed to determine the efficacy and safety of a small-doze endoscopic tattooing prior to laparoscopic surgery for colorectal cancer, using the needle. Patients with colorectal cancer indicated for laparoscopic surgery were recruited. With the novel needle, a single tattoo was created at the anterior wall close to the lesion. During laparoscopic surgery, surgeons assessed the tattoo visibility, tattoo leakage, and the disturbance of laparoscopic view by tattoo leakage. The primary endpoint was an accurate localization by visible tattoo. Secondary endpoints were adverse events related to tattooing, the need for intraoperative endoscopy, and tattoo leakage. A total of 383 tattoos in 358 patients were analyzed. Accurate tumor localization rate was 96.6% (95% confidence interval [CI]: 94.3-98.0%). No adverse events occurred. Intraoperative colonoscopy was performed in 7 (1.8%) patients with invisible tattoo. Tattoo leakage was found in 4.2% (95%CI: 2.6-6.7%), and leakage disturbed the laparoscopic view of the surgical plane in 0.7% (95%CI: 0.3-2.3%). Prior to laparoscopic surgery for colorectal cancer, our endoscopic tattooing with a standardized protocol using a novel needle is considered a simple, highly reliable localization technique with an extremely safe profile, which would be valuable to reduce physician's efforts and redundant medical resources. Trial registration number UMIN000021012. Date of registration: June 2016.

Iatrogenic ocular trauma associated with infraorbital block performed for rhinoscopy in a cat: case report and preliminary imaging findings.

ObjectivesThis paper describes a case of endophthalmitis in a feline patient caused by globe penetration during an infraorbital block performed to provide analgesia during rhinoscopy, and presents additional imaging and dissection data demonstrating risk of iatrogenic ocular trauma during infraorbital blocks in cats when the infraorbital canal is entered.MethodsCase records and accompanying histopathologic reports were reviewed for the feline patient. Separately, two feline cadavers were imaged using CT following placement of 5/8" 25 G needles or 1" 22 G over the needle catheters in the infraorbital canal. Infraorbital blocks with injection of trypan blue dye followed by dissection were performed in two further feline cadavers to assess the potential for globe penetration and to provide preliminary information regarding the potential efficacy of infraorbital blocks for analgesia during rhinoscopy.ResultsClinical and histopathologic findings support inadvertent globe penetration during infraorbital block as the cause for endophthalmitis in the feline patient described. CT imaging and dye injection studies further demonstrate the risks involved with this local anesthetic technique in cats.Conclusions and relevanceFurther study is needed to assess the safety and efficacy of infraorbital blocks performed for rhinoscopy in cats. Catheters may be safer anesthetic delivery devices than needles. Extreme caution should be used when entering the infraorbital canal in cats.

Endoscopic balloon dilation for complete anastomotic obstruction: Non‐electrosurgical technique using injection needle catheter

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Impact of myocardial fiber orientation on lesions created by a novel heated saline-enhanced radiofrequency needle-tip catheter: An MRI lesion validation study

Irrigated needle catheter ablation is efficacious for creation of transmural lesions in the left ventricle (LV). However, interdependence of needle orientation and myocardial fiber orientation and the resulting influence on lesion creation remain unclear. The purpose of this study was to investigate the impact of myocardial fiber orientation on reproducibility and controllability of lesion creation in LV myocardium using a heated saline-enhanced radiofrequency (SERF) needle-tip catheter system. Eleven dogs underwent catheter ablation using this novel catheter. Ablative lesions were created using different power and ablation times (15-50 W; application 25-120 seconds; 60°C irrigation saline at 10 mL/min). Hearts were explanted, and lesions were evaluated using 3-T cardiac magnetic resonance (CMR), gross pathologic, and histologic investigations. Forty-three of 57 lesions (75.4%) were transmural, and lesion depth reached approximately 90% of LV wall thickness. Lesion volume in both gross pathology and exvivo CMR showed a positive linear correlation with power × radiofrequency (RF) time index (r = 0.637, P <.001; and r = 0.786, P <.001, respectively). Maximum width (circumferential direction of LV) and maximum length (long-axis direction) of all lesions were distributed in the middle layer of LV where myocardium runs circumferentially. Paired-sample t-test showed maximum lesion width was significantly greater than maximum lesion length by both CMR and gross pathologic evaluation (26.1 ± 9.6 mm vs 17.2 ± 6.7 mm, P <.001; and 22.5 ± 7.7 mm vs 18.6 ± 5.9 mm, P <.001, respectively). This catheter showed feasibility in creating transmural LV lesions. Power × RF time index was strongly correlated with lesion volume and predicted lesion size. More importantly, SERF lesions extended along the myocardial fiber orientation.

Ultrasound increases the success rate of spinal needle placement through the epidural needle during combined spinal-epidural anaesthesia: A randomised controlled study.

Combined spinal-epidural anaesthesia (CSEA) using a needle-through-needle technique is currently widely used. However, successful epidural needle placement does not mean a successful spinal needle placement during CSEA. Whether ultrasound assistance could increase the first-pass success rate of spinal needle placement for CSEA remains unknown. The aim of this study was to investigate if ultrasound assistance could increase the first-pass success rate of spinal needle placement through the epidural needle during CSEA performed by experienced anaesthesiologists in patients undergoing caesarean section. A prospective, randomised, double-blind study. Single centre, Department of Anaesthesiology, Shengjing Hospital, China Medical University, China, from June 2019 to September 2019. A total of 185 patients (aged 24 years to 52 years, American Society of Anesthesiologists grade (ASA) II-III, 38 to 40 weeks gestation) scheduled to undergo elective caesarean section under CSEA were enrolled. The patients were randomised to either an ultrasound group (patients received a preprocedural ultrasound scan, and the puncture site was identified by ultrasound imaging) and a palpation group (patients received a sham procedural ultrasound scan, and the puncture site was identified by conventional palpation). The primary outcome measure was the first-pass success rate for spinal needle placement through the epidural needle. Secondary outcome measures were total duration of CSEA, time required for successful epidural needle and spinal needle placement, number of epidural needle redirections and complications. Preprocedural ultrasound imaging significantly increased the first-pass success rate of spinal needle placement through the epidural needle compared with conventional palpation (93.8 vs. 68.8%, P < 0.001). Preprocedural ultrasound imaging also decreased the total duration of CSEA (186.9 ± 37.1 vs. 213 ± 60.4 s, P = 0.0015) and the time required for successful spinal needle placement (78.3 ± 22.9 vs. 100.1 ± 53.7 s, P < 0.01) compared with conventional palpation. Fewer patients in the ultrasound group needed epidural needle redirections during the spinal needle placement procedure than in the palpation group (four patients vs. 20 patients, P < 0.01). For experienced anaesthesiologists, preprocedural ultrasound imaging significantly increased the first-pass success rate of spinal needle placement through the epidural needle for obstetric patients undergoing caesarean section under CSEA. chictr.org.cn, identifier: ChiCTR1900024132.

Needle Catheter Jejunostomy in Patients Undergoing Surgery for Upper Gastrointestinal and Pancreato-Biliary Cancer-Impact on Nutritional and Clinical Outcome in the Early and Late Postoperative Period.

The metabolic risk for patients undergoing abdominal cancer resection increases in the perioperative period and malnutrition may be observed. In order to prevent further weight loss, the guidelines recommend for high-risk patients the placement of a needle catheter jejunostomy (NCJ) for supplementing enteral feeding in the early and late postoperative period. Our aim was to evaluate the safety of NCJ placement and its potential benefits regarding the nutritional status in the postoperative course. We retrospectively analyzed patients undergoing surgery for upper gastrointestinal cancer, such as esophageal, gastric, and pancreato-biliary cancer, and NCJ placement during the operation. The nutritional parameters body mass index (BMI), perioperative weight loss, phase angle measured by bioelectrical impedance analysis (BIA) and the clinical outcome were assessed perioperatively and during follow-up visits 1 to 3 months and 4 to 6 months after surgery. In 102 patients a NCJ was placed between January 2006 and December 2016. Follow-up visits 1 to 3 months and 4 to 6 months after surgery were performed in 90 patients and 88 patients, respectively. No severe complications were seen after the NCJ placement. The supplementing enteral nutrition via NCJ did not improve the nutritional status of the patients postoperatively. There was a significant postoperative decline of weight and phase angle, especially in the first to third month after surgery, which could be stabilized until 4–6 months after surgery. Placement of NCJ is safe. In patients with upper gastrointestinal and pancreato-biliary cancer, supplementing enteral nutrition during the postoperative course and continued after discharge may attenuate unavoidable weight loss and a reduction of body cell mass within the first six months.

Suturing the Anterior Cruciate Ligament Using a No. 16 Intravenous Catheter Needle in Avulsion Anterior Cruciate Ligament Injury

Avulsion anterior cruciate ligament injuries are more common in pediatric patients. There are several methods of fixation available for these injuries (tibial intercondylar eminence fractures), such as the pullout suture technique, screw fixation, and suture anchor fixation. Currently, a pullout technique is widely used for fixation. We purpose a pullout technique method using a modified No. 16 intravenous catheter needle to suture the anterior cruciate ligament fiber instead of a suture hook or suture passer. We also use one anterior tibial tunnel for this arthroscopic pullout fixation technique to decrease the incidence of physeal injury in pediatric patients by using many tibial tunnels.

Intravascular Ultrasound–Guided Revascularization of Chronic Juxtarenal Aortoiliac Occlusion

Chronic juxtarenal aortoiliac occlusion (JRO) represents the most severe form of aortoiliac occlusive disease, classified under Trans-Atlantic Inter-Society Consensus (TASC II) as a TASC II D lesion with surgical treatment as the main recommendation. Although endovascular revascularization of other TASC II D lesions are routinely performed, JRO is often considered a contraindication for endovascular treatment due to the extensive nature, extending from the level of the renal arteries down to the iliac arteries. We hereby illustrate an intravascular ultrasound-guided re-entry based technique to facilitate endovascular reconstruction of a JRO. A 58-year-old man with JRO presented with an infected nonhealing forefoot ulcer. A transradial pigtail catheter was positioned at the level of the occlusion as an imaging catheter and landmark for re-entry. Subintimal wiring was performed through bilateral groin accesses to the level of the pigtail catheter. Intravascular-guided re-entry catheter was used to identify the true lumen guide firing of the needle catheter, allowing passage for a guidewire into the true lumen of the suprarenal aorta. The intimal fenestration was dilated using a 4-mm angioplasty balloon which allowed passage of the contralateral guidewire. Kissing stent grafts were deployed bilaterally, extending from the level of the infrarenal aorta down to the level of the distal external iliac arteries in overlapping fashion. Completion angiography showed brisk flow from the aorta through the stented portion into the femoral arteries. The patient underwent forefoot amputation 2 days later with successful wound healing and limb salvage at 6months.

Electromagnetic (EM) catheter path tracking in ultrasound-guided brachytherapy of the breast.

To evaluate a novel navigation system for breast brachytherapy, based on ultrasound (US)-guided catheter needle implantations followed by electromagnetic (EM) tracking of catheter paths. Breast phantoms were produced, containing US-visible tumors. Ultrasound was used to localize the tumor pose and volume within the phantom, followed by planning an optimal catheter pattern through the tumor using navigation software. An electromagnetic (EM)-tracked catheter needle was used to insert the catheters in the desired pattern. The inserted catheters were visualized on a post-implant CT, serving as ground truth. Electromagnetic (EM) tracking and reconstruction of the inserted catheter paths were performed by pulling a flexible EM guidewire through each catheter, performed in two clinical brachytherapy suites. The accuracy of EM catheter tracking was evaluated by calculating the Hausdorff distance between the EM-tracked and CT-based catheter paths. The accuracy and clinical feasibility of EM catheter tracking were also evaluated in three breast cancer patients, performed in a separate experiment room. A total of 71 catheter needles were implanted into 12 phantoms using US guidance and EM navigation, in an average ± SD time of 8.1 ± 2.9min. The accuracy of EM catheter tracking was dependent on the brachytherapy suite: 2.0 ± 1.2mm in suite 1 and 0.6 ± 0.2mm in suite 2. EM catheter tracking was successfully performed in three breast brachytherapy patients. Catheter tracking typically took less than 5min and had an average accuracy of 1.7 ± 0.3mm. Our preliminary results show a potential role for US guidance and EM needle navigation for implantation of catheters for breast brachytherapy. EM catheter tracking can accurately assess the implant geometry in breast brachytherapy patients. This methodology has the potential to evaluate catheter positions directly after the implantation and during the several fractions of the treatment.

Management of complex hepatic abscess by percutaneous catheter drainage: a case report

Liver abscesses are a commonly encountered pathology in the tropical setting. Most commonly these are secondary to amoebic infestation. Majority of liver abscesses present with abdominal pain confined to the right hypochondrium. Smaller abscesses are easily dealt with by needle aspiration or catheter drainage under image guidance. Larger and complex abscesses are commonly dealt with by surgical drainage. We deal here with a case of complex liver abscesses which even had perforated into the pleural cavity. Keeping a close watch on the patient’s general condition which was satisfactory, we did not rush into a major surgical procedure. Wide antibiotic coverage and pulmonary care were initiated. Two pig-tail catheters were placed in separate abscesses and metronidazole irrigation periodically done. The daily drain output gradually reduced and we could successfully remove the two catheters at an interval. The patient made a good recovery and continues to do well on follow-up. We see in this case that even large and multiple abscesses if meticulously managed, surgical drainage can be avoided and catheter drainage provides satisfactory results. Good antibiotic coverage must continue in the follow-up period too.

Dual-wavelength fiber-optic technique to assist needle cricothyroidotomy

The traditional needle cricothyroidotomy procedure is performed blindly without any medical equipment. Complications including posterior tracheal wall perforation, accidental vessel puncture, and missed tracheal puncture are reported. Therefore, we proposed a dual-wavelength fiber-optic technique based on the technique of near-infrared spectroscopy to assist operators performing needle cricothyroidotomy in a swine model. We embedded optical fibers in a 16-gauge intravenous needle catheter. Real-time data were displayed on an oscilloscope, and we used the program to analyze the data immediately. The change of optical density corresponding to 690-nm and 850-nm wavelengths and hemoglobin parameters (HbO2 and Hb concentrations) was analyzed immediately using the program in the laptop. Unique and significant optical differences were presented in this experiment. We could easily identify every different tissue by the change of optical density corresponding to 690-nm and 850-nm wavelengths and hemoglobin parameters (HbO2 and Hb concentrations). Statistical method (Kruskal-Wallis H test) was used to compare differences in tissues at each time-point, respectively. The p values in every tissue in optical density change corresponding to 690 nm and 850 nm were all < 0.001. Furthermore, the p values in every tissue in Hb and HbO2 were also all < 0.001. The results were statistically significant. This is the first and novel study to introduce a dual-wavelength embedded fibers into a standard cricothyroidotomy needle. This proposed system might be helpful to provide us real-time information of the advanced needle tip to decrease possible complications.

A safe and reliable technique for fascial closure without special devices after laparoscopic surgery.

To prevent port-site hernia, we established a simple and low-cost closure method that uses a venous catheter needle and suture, without any other special devices. We used the inner needle of a 16-G venous catheter and a 2-0 absorbable bladed suture. To evaluate the efficacy of this technique, the procedure time was noted and compared among three operators (an experienced surgeon and two inexperienced surgeons). The median suturing time was 60.5 seconds (range, 26-130 seconds) per incision. Even an unexperienced surgeon can close the fascia safely and quickly after some experience with the procedure.

A systematic review of the use of progressive preoperative pneumoperitoneum since its inception.

Preoperative progressive pneumoperitoneum (PPP) is a technique that has been used since 1947 to expand the abdominal cavity volume, for presurgical preparation of patients with large hernias. This systematic review attempts to answer some unresolved questions about PPP, while using the evidence to clarify the different forms that the procedure has taken over time. The purpose of the paper was to analyze the literature about PPP and gather information about the procedure and its indications, advantages, and disadvantages. A systematic review was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The database searches, in English and Spanish, were made using the terms "preoperative pneumoperitoneum," "progressive pneumoperitoneum," "preoperative pneumoperitoneum," and "progressive pneumoperitoneum," for the period between 1 January 1940 and 31 May 2019. Indications, techniques, results, and complications were registered. The statistical analysis was based on means, standard deviations, medians, mode, and interquartile ranges for quantitative variables, and frequencies and percentages for categories. The qualitative synthesis was made on the basis of 53 articles that reported the treatment of a total of 1216 patients. The most frequent indication for PPP was a large incisional hernia with loss of domain. The most common technique employed a spinal needle or multipurpose catheter by the anatomical method in the left hypochondrium. In spite of the heterogeneity of the data and the management of different volumes of air and daily insufflations, 99.6% of visceral reintroduction and 86% of primary fascial closure was achieved. Complications had an incidence of 12%, mostly minor, and there were five mortalities. Preoperative progressive pneumoperitoneum (PPP) is a beneficial and safe technique to use in preparing patients with large hernias, but the procedure is not free of complications. The technique has evolved through the years and, although many variations exist, it is possible to establish an algorithm for its application.

Emergency nurse use of ultrasound guidance for vein cannulation: a three site quality improvement initiative and registry

&#x0D; Background &#x0D; &#x0D; AHS suggests a limit of four attempts at traditional peripheral vascular access, however there are limited current options at many sites for these patients. Between 10 and 25 percent of patients present to the emergency department (ED) with difficult to cannulate veins. In these patients ultrasound guided catheter placement decreases the number of IV attempts, decreases time to successful IV placement, improves patient satisfaction, and in adult patients decreases central line use. Emergency nurses have been shown to successfully employ ultrasound-guided peripheral vascular access. Physician and Nursing clinical practice guidelines place a high recommendation for this practice. Despite the evidence and recommendations, in Canadian EDs, with notable exceptions there remains minimal standard procedural uptake or ED research.&#x0D; &#x0D; Implementation &#x0D; For difficult peripheral intravenous access a standardized ultrasound guided nurse performed procedure was implemented in 2016 at the University of Alberta (UAH) ED, in 2017 to the Royal Alexandra Hospital (RAH) ED, and in 2018 the Misericordia Community Hospital (MCH) ED. An education module was created that included didactic learning and an exam, approximately one hour of in-person training which included vessel and structure identification and cannulation practice on a gel model until competence was achieved, and finally three successful mentored starts prior to independent practice. Mentorship ensured good technique was followed, provided additional tips to improve practice, and most importantly ensured an IV attempt was on a patient with veins amenable to a novice ultrasound provider attempt (e.g. if a patient was assessed to be a challenging ultrasound start with limited vein options the mentor would place the IV in much the same way as traditional IV placement mentoring). The ultrasound technique taught was a single operator, short access or traverse approach with dynamic tip tracking where the catheter needle tip is continually visualized as the target vessel is cannulated. Catheter placement is confirmed with the catheter tip visualized intraluminal and with an ultrasound visualized saline flush. This study reports on the first 30 nurses trained at the UAH, 12 at the RAH and 6 at the MCH.&#x0D; &#x0D; Evaluation Methods &#x0D; A quality improvement (QI) registry documented complications and was used to improve education, training, and procedural success. The two QI study objectives were 1) to determine ultrasound program success for all sites by comparing QI results to historic results from other programs 2) to determine if an abbreviated training regimen (shorter than previously documented for adult patients in Canada) can be used to train nurses in EDs with minimal support or pre-existing experience with UGIVC.&#x0D; Staff who had achieved independent practice voluntarily completed a tracking form whenever an ultrasound procedure occurred. Completed forms were assessed on a continual basis for any opportunities for improvement. Qualitative feedback was also obtained from informal interviews, a focus group, and a survey of the newly trained nurses. Feedback was thematically analyzed and grouped into themes for reporting. Data and trends from the registry were used to reinforce education to promote greater procedural success. Also identified were questions to add to the tracking form to improve the usefulness of the registry. Ongoing review will identify if these efforts improve practice. Opportunities for system improvements were managed through consultation with all stake holders including nursing management, CNEs, physicians, and bedside nurses. Program evaluation will shape all aspects of the program development.&#x0D; &#x0D; Results &#x0D; At the UAH, RAH, and MCH respectively; the mean number of failed IV attempts [SD] before UGIV was: 4.2 [2.5]; 3.4 [2.1]; 4.77 [2.9]; while first pass success by novice provider (1-10 UGIV starts) was 76%; 66%; and 62%. Success increased rapidly with the number of starts and plateaued after 100. Complications occurred in 4/374 (1%) starts. Qualitative feedback suggests that provider and patient positioning, and equipment preparation improve individual success; engaged staff and a QI registry improve program success; even in cases with more reported pain, patients prefer UGIV to traditional placement.&#x0D; Advice and Lessons Learned &#x0D; Creating an ultrasound guided peripheral IV program and quality registry that supports emergency nurse use of this procedure is possible. First pass and overall catheter success rates and low reported compilications are reassuring.&#x0D; &#x0D; The quality registry has provided useful data to support practice and suggest modifications to the education and site specific system level supports provided. An example of system feedback is that newly trained staff need to have a clinical assignment that allows the opportnuity to utilize the procedure. Also enough mentors are required to support new staff. A third interesting system issue identifed is the possible effects of the training on traditional difficult IV placement skill and how to best support this.&#x0D; Emergency physicians and nurse champions can play a key supportive role to ensure the success of the program.&#x0D;