Needle Catheter Research Articles

Continuous spinal anaesthesia for caesarean section in a patient with peripartum cardiomyopathy.

Continuous spinal anaesthesia for caesarean section in a patient with peripartum cardiomyopathy.

Treatment of Liver Abscess: A Comparison of Catheter Drainage and Needle Aspiration

Background The aim of the study was to evaluate the clinical presentation, and to investigate the effectiveness of continuous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses. Method This is a comparative study of 50 patients, presented in outpatient and emergency department at the hospital,equally into two groups, percutaneous needle aspiration and pigtail catheter drainage. The effectiveness of either treatment was measured in terms of duration of hospital stay, days to achieve clinical improvement, 50% reduction in abscess cavity size and total/near total resolution of abscess cavity. Results The success rate was significantly better in catheter drainage group. The patients in pigtail catheter drainage group showed earlier clinical improvement and decrease in abscess cavity volume as compared to those who underwent percutaneous needle aspiration. Conclusions Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or with thick pus.

Color your epidural: color flow Doppler to confirm labor epidural needle position.

Labor epidural analgesia success depends on precise needle position placement within the epidural space, with reported failure rates to be as high as 32%. In this study, we describe a novel technique employing color Doppler to aid in the confirmation of the correct position of the epidural needle tip. Retrospective evaluation of 35 patients who received labor combined spinal-epidural (CSE) with confirmation of epidural needle position with color flow Doppler (CFD) ultrasonography. Demographic data, intervertebral level of insertion and dermatome sensory level were extracted. Video and image evaluation of CFD patterns were used to confirm epidural needle tip and catheter position. CFD was used to visualize intrathecal injection of local anesthetic in two patients. Three different color flow patterns were visualized after the loss of resistance technique: visualization of a red and blue mosaic adjacent to the posterior complex, a mosaic pattern enveloping the trajectory of the epidural needle, and a linear deeper mosaic color pattern during spinal injection in relation to the posterior complex. Identification of epidural needle tip and epidural catheter tip occurred in 77% and 37.1% of patients, respectively. CFD is a novel and useful technique to confirm the precise position of the epidural needle tip in the context of labor analgesia. Identification of the epidural catheter with CFD is difficult despite an adequate CSE technique.

Surveying the Literature

Surveying the Literature

Real-world experience of the left distal transradial approach for coronary angiography and percutaneous coronary intervention: a prospective observational study (LeDRA).

This study aimed to evaluate the feasibility and safety of the left distal transradial approach (ldTRA) as a default route for coronary angiography (CAG) and percutaneous coronary intervention (PCI). Between October 2017 and January 2018, 200 consecutive patients were enrolled in a single centre. The left distal radial artery was punctured with a 20-gauge venipuncture catheter needle by three expert left radial approach operators. The success rates of arterial puncture, CAG, and PCI were 95.5% (191/200), 100% (187/187), and 98.9% (86/87), respectively. Four patients scheduled for staged PCI skipped the routine diagnostic CAG. Puncture time and fluoroscopic time were 3.0±2.8 minutes and 11.3±18.4 minutes, respectively. Haemostasis time was 151.8±39.9 minutes. A total of 15 (7.9%) puncture site complications occurred, including 14 (7.4%) minor haematomas and one (0.5%) arterial dissection, in which the artery was patent at one-month follow-up. Two patients complained of left thumb numbness at one-month follow-up. No distal radial artery occlusion, perforation, pseudoaneurysm, or arteriovenous fistula occurred. The success and complication rates of ldTRA support the feasibility and safety of this procedure. Larger randomised comparison studies are needed to support this preliminary evidence.

Joint EFLM-COLABIOCLI Recommendation for venous blood sampling

This document provides a joint recommendation for venous blood sampling of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE) and Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI). It offers guidance on the requirements for ensuring that blood collection is a safe and patient-centered procedure and provides practical guidance on how to successfully overcome potential barriers and obstacles to its widespread implementation. The target audience for this recommendation are healthcare staff members directly involved in blood collection. This recommendation applies to the use of a closed blood collection system and does not provide guidance for the blood collection with an open needle and syringe and catheter collections. Moreover, this document neither addresses patient consent, test ordering, sample handling and transport nor collection from children and unconscious patients. The recommended procedure is based on the best available evidence. Each step was graded using a system that scores the quality of the evidence and the strength of the recommendation. The process of grading was done at several face-to-face meetings involving the same mixture of stakeholders stated previously. The main parts of this recommendation are: 1) Pre-sampling procedures, 2) Sampling procedure, 3) Post-sampling procedures and 4) Implementation. A first draft of the recommendation was circulated to EFLM members for public consultation. WG-PRE-LATAM was also invited to comment the document. A revised version has been sent for voting on to all EFLM and COLABIOCLI members and has been officially endorsed by 33/40 EFLM and 21/21 COLABIOCLI members. We encourage professionals throughout Europe and Latin America to adopt and implement this recommendation to improve the quality of blood collection practices and increase patient and workers safety.

Baerveldt tube shunt implantation through a long scleral tunnel.

To develop a new technique for the placement of a Baerveldt glaucoma implant tube through a long scleral tunnel. Patients with refractory glaucoma undergoing the maximum tolerated medical therapy were recruited. We created a scleral tunnel with a 24-gauge catheter needle and used the external tube for guidance when introducing a Baerveldt glaucoma implant tube. Main outcome measures included intraocular pressure, supplemental medical therapy score, intraoperative complications, and postoperative complications. Nine eyes of six patients were included in the study. The mean preoperative intraocular pressure (score) was 41.0 mmHg (4.78). Mean postoperative intraocular pressures were 18.3 mmHg (0.22), 18.8 mmHg (0.13), and 16.9 mmHg (0.50) at postoperative 1, 3, and 6 months, respectively. Minor vitreous hemorrhages were observed in three cases. Postoperative hypotony (<5 mmHg) was observed only in the first case at postoperative day 3. In one case, a stent suture could not be placed because the patient was restive intraoperatively, which resulted in an expulsive hemorrhage at 3 months postoperatively. The tube could have penetrated into the anterior chamber in another case. Tube exposure and corneal erosions were not observed in all cases. We developed a new technique to place a Baerveldt glaucoma implant tube through a long scleral tunnel. The outcomes were comparable to other reports of Baerveldt glaucoma implant surgery, although the number of cases was limited in this study. A long scleral tunnel can substitute for a preserved scleral patch and self-scleral flap to avoid tube-related complications.

Use of platelet transfusions prior to lumbar punctures or epidural anaesthesia for the prevention of complications in people with thrombocytopenia.

Use of platelet transfusions prior to lumbar punctures or epidural anaesthesia for the prevention of complications in people with thrombocytopenia.

MICROWAVE ABLATION IN COMBINED TREATMENT OF PRIMARY AND METASTATIC LIVER TUMORS

Aim. To increase the effectiveness of treatment of patients with primary and metastatic liver cancer. Material and Methods. Microwave ablation was performed in 29 patients including 13 cases of hepatocellular carcinoma stage 0-A (byBarcelona classification and TNM) and 16 patients with colorectal cancer and liver metastases stage I (by Gennari). For microwave ablation of liver tumors AveCure MWG881 (MedWaves) device was used. Procedure was performed via percutaneous transhepatic approach (25), under ultrasonic guidance and intraoperatively simultaneously with liver resection in 4 cases. Effectiveness was estimated using CT and sonography. Results. There were no deaths. We observed following complications: moderate bleeding from the point of needle catheter entry that has stopped independently in 1 case; residual cavity formed in one case that did not require additional surgery. Intrahepatic hematoma was diagnosed in 1 case. Burns of the skin were revealed in 2 cases. The average hospital stay was 7 days. Local recurrences after ablation were not observed. 1- and 2-year survival was 78.5% and 63.3% respectively. Conclusion. Microwave ablation in patients with primary and secondary liver cancer and concomitant cirrhosis increases 1- and 2-year survival. Percutaneous microwave ablation reduces the incidence of complications in high risk patients due to low invasiveness and less trauma.

Determining procedures for simulation-based training in radiology: a nationwide needs assessment.

New training modalities such as simulation are widely accepted in radiology; however, development of effective simulation-based training programs is challenging. They are often unstructured and based on convenience or coincidence. The study objective was to perform a nationwide needs assessment to identify and prioritize technical procedures that should be included in a simulation-based curriculum. A needs assessment using the Delphi method was completed among 91 key leaders in radiology. Round 1 identified technical procedures that radiologists should learn. Round 2 explored frequency of procedure, number of radiologists performing the procedure, risk and/or discomfort for patients, and feasibility for simulation. Round 3 was elimination and prioritization of procedures. Response rates were 67 %, 70 % and 66 %, respectively. In Round 1, 22 technical procedures were included. Round 2 resulted in pre-prioritization of procedures. In round 3, 13 procedures were included in the final prioritized list. The three highly prioritized procedures were ultrasound-guided (US) histological biopsy and fine-needle aspiration, US-guided needle puncture and catheter drainage, and basic abdominal ultrasound. A needs assessment identified and prioritized 13 technical procedures to include in a simulation-based curriculum. The list may be used as guide for development of training programs. • Simulation-based training can supplement training on patients in radiology. • Development of simulation-based training should follow a structured approach. • The CAMES Needs Assessment Formula explores needs for simulation training. • A national Delphi study identified and prioritized procedures suitable for simulation training. • The prioritized list serves as guide for development of courses in radiology.

Comparison of dural puncture epidural technique versus conventional epidural technique for labor analgesia in primigravida

Background: Dural puncture epidural (DPE) is a method in which a dural hole is created prior to epidural injection. This study was planned to evaluate whether dural puncture improves onset and duration of labor analgesia when compared to conventional epidural technique. Methods and Materials: Sixty term primigravida parturients of ASA grade I and II were randomly assigned to two groups of 30 each (Group E for conventional epidural and Group DE for dural puncture epidural). In group E, epidural space was identified and 18-gauge multi-orifice catheter was threaded 5 cm into the epidural space. In group DE, dura was punctured using the combines spinal epidural (CSE) spinal needle and epidural catheter threaded as in group E followed by 10 ml of injection of Ropivacaine (0.2%) with 20 mcg of Fentanyl (2 mcg/ml) in fractions of 2.5 ml. Later, Ropivacaine 10 ml was given as a top-up on patient request. Onset, visual analouge scale (VAS), sensory and motor block, haemodynamic variables, duration of analgesia of initial dose were noted along with mode of delivery and the neonatal outcome. Results: Six parturients in group DE achieved adequate analgesia in 5 minutes while none of those in group E (P 0.05). Conclusions: Both techniques of labor analgesia are efficacious; dural puncture epidural has the potential to fasten onset and improve quality of labor analgesia when compared with conventional epidural technique.

Percutaneous Needle Aspiration versus Catheter Drainage in Treating Hepatic Abscess

Aim of the study: was to investigate the effectiveness of Percutaneous Needle Aspiration in comparison to continuous catheter drainage in the treatment of hepatic abscesses. Methods: A review of the scientific literature (From 1980 to October 2017) MEDLINE, EMBASE, SCOPUS, Current Contents, Cochrane Library, and Clinicaltrials.gov were searched to identify randomized controlled trials that investigated thoroughly the Percutaneous Needle Aspiration Versus Catheter Drainage in the treating of hepatic abscess and clearly met the inclusion criteria and the study primary endpoints (success rate, total resolution and mortality). Identification of papers and data extraction were performed by independent researchers. Results: the search yielded six eligible RCTs covering 348 patients. The meta-analysis showed that outcomes in patients treated with PCD were superior to those in patients treated with PNA in terms of success rate (RR: 0.79, 95% CI=0.64–0.97; P = 0.04), days to achieve a 50% reduction in abscess cavity size (SMD: −1.076, 95% CI 0.63–1.51; P < 0.00001) and overall clinical improvement (SMD: 0.71, 95% CI 0.35–1.09; P =0.0001). On the other hand, no significant difference was notable in the duration of hospitalization (SMD: −0.15, 95% CI −2.03 to 1.72, P = 0.84) or procedure-related complications (RR: 0.48, 95% CI 0.13–2.58; P = 0.39). Conclusion: The results of the present meta-analysis and systematic review indicated that PCD and PNA can be less safe and less invasive methods for the treatment of hepatic abscesses yet PCD is suggested to be more advantageous and superior to PNA.

Intratunnel Pressure Measurement in Patients with Carpal Tunnel Syndrome in Vietnam

Objective: Measure the intratunnel pressure of carpal tunnel in patients who underwent surgical treatment for carpal tunnel syndrome in Hanoi Medical University Hospital Patients and method: Prospective cross-sectional study of 33 carpal tunnel syndrome patients (61 hands) treated surgically at Hanoi Medical University Hospital. Measure the preoperative intratunnel pressure with manometer using needle catheter with 3 positions: neutral position, 90º of flexion and 90º of extension. Results: the average intratunnel pressure was 13.87 ±1.56 mmHg, it increased when wrist at 90º of flexion and 90º of extension (27.60 ± 2.53 and 34.76 ± 3.25, respectively). Conclusion: There is a high intratunnel pressure situation in the carpal tunnel syndrome.

Feasibility of the Use of Transesophageal Echocardiography as a Surface Probe for Puncturing and Catheterization of the Internal Jugular Vein: A Randomized Controlled Pilot Study

To compare the transesophageal echocardiography (TEE) probe as a surface probe with the vascular probe for guiding internal jugular vein (IJV) catheterization. Prospective, randomized, controlled pilot study. University hospital. One hundred cardiac surgery patients, including 50 adult and 50 pediatric patients. Patients in the TEE probe group received right IJV catheterization using the TEE probe, while the vascular probe group used the vascular probe for catheterization. The puncture time, first-attempt success rate, quality of the imaging with needle tip positioning, wire positioning, and catheter positioning were recorded. The incidence of complication or any adverse event also was observed. Adult patients: In the vascular probe group, the success rate for first attempt IJV catheterization was 24/25 (96%), while in the TEE probe group, the success rate for first attempt IJV catheterization was 25/25 (100%). There was no statistical difference in the puncture time, image quality, needle tip positioning, wire positioning, and catheter positioning between groups (p > 0.05). Pediatric patients: The success rate for first-attempt IJV catheterization was 100% in both groups, and there were no statistical differences in the puncture time, image quality, and positioning between the 2 groups (p > 0.05). No complications or adverse events were observed in either group. The TEE probe, used as a surface probe, can be used to guide IJV puncturing and catheterization in cardiac surgery patients with favorable feasibility and safety.

Plasma transfusions prior to lumbar punctures and epidural catheters for people with abnormal coagulation.

The insertion of a lumbar puncture needle or epidural catheter may be associated with peri- and post-procedural bleeding. People who require this procedure may have disorders of coagulation as a result of their underlying illness, co-morbidities or the effects of treatment. Clinical practice in some institutions is to mitigate the risk of bleeding in these patients by prophylactically transfusing plasma in order to correct clotting factor deficiencies prior to the procedure. However, plasma transfusion is not without risk, and it remains unclear whether this intervention is associated with reduced rates of bleeding or other clinically-meaningful outcomes. To assess the effect of different prophylactic plasma transfusion regimens prior to insertion of a lumbar puncture needle or epidural catheter in people with abnormal coagulation. We searched for randomised controlled trials (RCTs), non-randomised controlled trials (non-RCT) and controlled before-after studies (CBAs) in CENTRAL (the Cochrane Library 2016, Issue 11), MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1937), the Transfusion Evidence Library (from 1950), and five other electronic databases as well as ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform (ICTRP) for ongoing trials to 9 January 2017. We planned to include RCTs, non-RCTs, and CBAs involving transfusions of plasma given to prevent bleeding in people of any age with a coagulopathy requiring insertion of a lumbar puncture needle or epidural catheter. If identified, we would have excluded uncontrolled studies, cross-sectional studies and case-control studies. We would only have included cluster-RCTs, non-randomised cluster trials, and CBAs with at least two intervention sites and two control sites. In studies with only one intervention or control site, the intervention (or comparison) is completely confounded by study site making it difficult to attribute any observed differences to the intervention rather than to other site-specific variables.We planned to exclude people with haemophilia as they should be treated with the appropriate factor concentrate. We also planned to exclude people on warfarin as guidelines recommend the use of prothrombin complex concentrate for emergency reversal of warfarin. We used standard methodological procedures expected by Cochrane. We identified no completed or ongoing RCTs, non-RCTs, or CBAs. There is no evidence from RCTs, non-RCTs, and CBAs to determine whether plasma transfusions are required prior to insertion of a lumbar puncture needle or epidural catheter, and, if plasma transfusions are required, what is the degree of coagulopathy at which they should be given. We would need to design a study with at least 47,030 participants to be able to detect an increase in the number of people who had bleeding after lumbar puncture or epidural anaesthetic from 1 in 1000 to 2 in 1000.

370 The Relationship Between Adult Body Mass Index and Anticipated Failure Rate of Needle Decompression Using a 5 cm Needle for Tension Pneumothorax

Tension pneumothorax is traumatic injury that can lead to rapid circulatory collapse and death. Emergent needle thoracostomy can quickly treat tension pneumothorax, but the best anatomic location and catheter length necessary to perform the intervention has been questioned in the recent years given the increasing rates of obesity in our population. We conducted a retrospective review of a convenience sample of all trauma patients admitted to our level 1 trauma center in Minneapolis, MN who underwent chest computed tomography (CT) during their admission between 2011 and 2012. Using these CT radiographs, chest wall thickness was measured bilaterally at the 2nd intercostal space (ICS) at the midclavicular line, and at the 4th and 5th intercostal spaces at the anterior axillary line. Baseline demographic data including age, sex, BMI, ISS and associated chest wall trauma were collected from medical chart review. Needle thoracostomy failure was defined as chest wall thickness (CWT) of > 5cm, based on the length of commonly used needle decompression needles. 141 patients who met all inclusion criteria were identified. There were no significant differences in mean CWT at any of the anatomic sites. CWT was similar between males and females. BMI > 30 was associated with an adjusted odds ratio of 13.8 (confidence interval 4.8-39.8) for failure with a standard 5cm catheter needle decompression. In the increasingly obese general population, needle thoracostomy with a standard 5cm needle may be more prone to failure. Adult BMI > 30 is a significant risk factor for anticipated failure of needle tube decompression. Alternative anatomic sites for needle decompression did not appear to increase the anticipated success of the intervention.

Alcoholization of pyogenichepatic abscess with absolute alcohol in Bama minipigs.

Pyogenic hepatic abscess (PHA) is a rare, but potentially serious disease. At present, ultrasound-guided or computed tomography-guided percutaneous needle aspiration or catheter drainage is appropriate as a first-line treatment. However, it is difficult to aspirate or drain pus and to select the appropriate antibiotic therapy if the abscess consists of thick pus and polymicrobial confections, or its pathogenic bacterium is multidrug resistant and cryptogenic. Case studies of alcoholization provide a novel method to manage PHA. However, the efficacy and safety of this treatment should be further evaluated. In the present study, the therapeutic efficacy and complications of alcoholization for PHAs in Bama minipigs were investigated. PHAs were prospectively treated by ultrasound-guided percutaneous instillation of absolute alcohol in the abscess cavity. The criteria for considering a successful intervention were met in all minipigs subsequent to alcoholization twice within 14 days. The procedures were well tolerated in all animals, and there were no alcoholic adverse effects or procedure-associated complications. In conclusion, ultrasound-guided percutaneous alcoholization is a safe and effective procedure to manage PHA. The problems of thick pus aspiration and selection of an appropriate antibiotic observed in other treatments were resolved effectively using alcoholization. This technique may reduce the treatment period and possibly become a novel strategy for the management of PHA.

Ultrasound Phantom Using Sodium Alginate as a Gelling Agent.

For medical workers, ultrasound phantoms for human soft tissue are used not only for accuracy management of ultrasound diagnosis but also to aid ultrasound-guided needle and blind catheter insertion training without risk to real patients. For the phantoms, ultrasound characteristics and a texture are required to mimic the human soft tissue. The proposed phantom was composed of sodium alginate, calcium sulfate dihydrate, trisodium phosphate 12-hydrate, glycerol, and water. The propagation speed, attenuation coefficient, acoustic impedance, and texture of the proposed phantom were almost the same as those of human soft tissue. Expensive chemicals and special equipment are not required.

Application of nursing project on reducing incidence rate of hospital-wide indwelling needle catheter blockage

Objective To reduce the incidence rate of hospital-wide indwelling needle catheter through a nursing project. Methods We set up a nursing project team, conducted a cross-sectional survey to know the using status of hospital-wide catheter, and analyzed the reasons of catheter by root cause analysis method. Reducing the incidence rate of hospital-wide indwelling needle catheter blockage was established as the theme; improvement activities of nursing project were planned and developed for six months; and improvement methods were developed and implemented. Results The incidence rate of hospital-wide indwelling needle catheter reduced to 3.6% from 8.1% (χ2=752.177, P<0.01) , which reaches the goal of controlling the incidence rate of catheter below 4%, and continuously decreases month by month. After implementation, the score of knowledge questionnaire about indwelling needle catheter of nurses in the wards increased from (78.23±7.14) to (96.4±1.48) (t=54.735, P<0.01) . Conclusions The nursing project obviously improves the degree of mastering the knowledge about preventing blockage, and reduces the incidence rate of hospital-wide indwelling needle catheter blockage. Key words: Nursing project; Indwelling needle; Catheter

Management of Refractory Sciatic Neuropathic Pain Using Ultrasound-Guided Pulsed Radiofrequency

Nowadays, pulsed radiofrequency (PRF) is being used to control several types of musculoskeletal pain. Herein, we report a successful application of ultrasound (US)-guided PRF for a patient with refractory sciatic neuropathic pain. Case report. We applied US-guided PRF to a 50-year-old man, suffering from refractory neuropathic pain on the left foot following sciatic neuropathy for a period of approximately 6 months. We performed PRF on the level of piriformis muscle because the lesion of the sciatic nerve was presented digitally from the level of piriformis muscle on the magnetic resonance images. Under US guidance, the catheter needle was placed close to the left sciatic nerve, and dysesthesia and tingling sensation were reported to be less than 0.2V. The PRF treatment was administered at 5Hz and 5ms pulsed width for 360 seconds at 45V. After PRF on the left sciatic nerve, pain intensity-based on a numeric rating scale-decreased from 8 to 2. The reduction of pain was sustained for at least 6 months after the PRF procedure. We concluded that the PRF treatment with guidance with US is a very useful treatment technique for patients with refractory sciatic neuropathy.