Number Of Cannulation Attempts Research Articles

Central Venous Catheterization in the ICU: A Comparison of Anatomical Landmark and Ultrasound-Guided Techniques

Introduction: Central venous catheterization (CVC) is frequently required in intensive care units (ICUs) for administering medications, fluids, and monitoring central venous pressure. However, CVC insertion can lead to complications such as arterial puncture, hematoma formation, and pneumothorax. Ultrasound guidance has been advocated to reduce these complications, but its effectiveness in the ICU setting remains debated. This study compared the complication rates of anatomical landmark-guided versus ultrasound-guided CVC insertion in ICU patients. Methods: A prospective cohort study was conducted in the ICU of a tertiary care hospital. Patients requiring CVC were divided into two groups: anatomical landmark-guided and ultrasound-guided insertion. The primary outcome was the incidence of complications, including arterial puncture, hematoma, and pneumothorax. Secondary outcomes included cannulation time and the number of cannulation attempts. Results: A total of 39 patients were included in the study. The incidence of complications was significantly lower in the ultrasound-guided group (2 complications) compared to the anatomical landmark group (7 complications) (p=0.017). The most common complication was arterial puncture, occurring in 7 patients in the anatomical landmark group and 2 patients in the ultrasound-guided group. Conclusion: Ultrasound guidance significantly reduces the risk of complications during CVC insertion in the ICU. This technique should be considered the standard of care for CVC insertion in this setting.

The Impact of Difficult Biliary Cannulation on Post-ERCP Pancreatitis: A Secondary Analysis of the Stent versus Indomethacin Trial Dataset

Background and AimsDifficult biliary cannulation (DBC) is a known risk factor for developing post-ERCP pancreatitis (PEP). To better understand how DBC increases PEP risk, we examined the interplay between technical aspects of DBC and known PEP risk factors. MethodsThis was a secondary analysis of a multicenter, randomized controlled trial comparing rectal indomethacin alone with the combination of rectal indomethacin and prophylactic pancreatic duct (PD) stent placement for PEP prophylaxis in high-risk patients. Participants were categorized into 3 groups: 1) DBC with high pre-procedure risk for PEP, 2) DBC without high pre-procedure risk, and 3) non-DBC at high pre-procedure risk. ResultsIn all, 1601 (84.1%) participants experienced DBC, which required a mean of 12 (SD 10) cannulation attempts and mean duration of 14.7 minutes (SD 14.9). PEP rate was highest (20.7%) in DBC with high pre-procedure risk, followed by non-DBC with high pre-procedure risk (13.5%) and then DBC without high pre-procedure risk (8.8%). Increasing number of PD-wire passages (aOR:1.97, 95% CI:1.25-3.1) was associated with PEP in DBC, but PD injection, pancreatic sphincterotomy and number of cannulation attempts were not associated with PEP. Combining indomethacin with PD stenting lowered PEP risk (aOR:0.61, 95% CI:0.44-0.84) in DBCs. This protective effect was evident in up to at least 4 PD wire passages. ConclusionsDBC confers higher PEP risk in additive fashion to pre-procedural risk factors. PD wire passages appear to add the greatest PEP risk in DBCs, but combining indomethacin with PD stenting reduces this risk, even with increasing PD wire passages.

Comparing Male and Female Resident Physicians in Central Venous Catheter Insertion Self-confidence and Competency: A Retrospective Cohort Study.

Female physicians often report lower self-confidence in their procedural and clinical competency compared to male physicians. There is limited data regarding self-reported confidence of female versus male trainees and any relation to objective competency in central venous catheter insertion. To analyze differences between male and female trainees in self-confidence and skill-based outcomes in placing central venous catheters. Using data from a central venous catheter simulation training program at a large tertiary medical center, we performed linear regressions to analyze confidence difference pre- and post-training, number of restarts, and number of cannulation attempts while controlling for baseline demographic characteristics of the sample. PGY-1 physician residents in all residency specialties who insert central venous catheters in the clinical setting at a tertiary academic center with a sample size of 281 residents. Confidence difference pre- and post-training measured on a Likert scale 1-5, number of restarts (novel global assessment variable), and number of cannulation attempts during the competency evaluation. Female trainees had both lower pre-program confidence (1.35 versus 1.74 out of 5, p < 0.001) and lower post-program confidence (3.77 versus 4.12 out of 5, p = 0.0021) as compared to male trainees. There was no statistically significant difference in number of restarts (95% CI - 0.073 to 0.368, p = 0.185) or cannulation attempts (95% CI - 0.039 to 0.342, p = 0.117) between sexes in linear regressions controlled for age, specialty designation, prior central venous catheter training, prior ultrasound guided vessel cannulation training, and pre-training confidence level. Female trainees rated their confidence significantly lower than their male counterparts both before and after the training program, despite no significant difference in skill-based outcomes. We discuss potential implications for trainees acquiring procedural skills during residency and for physician educators as they design training programs and delegate procedural opportunities.

A randomized controlled trial comparing ultrasound-guided versus traditional palpatory methods of posterior tibial artery cannulation in adult patients.

The palpation method of posterior tibial artery cannulation has not yet been compared to ultrasound-guided posterior tibial artery cannulation in adults. This research examined whether using ultrasound to cannulate the posterior tibial artery enhances first-pass cannulation success and lowers total procedure time. In this randomized controlled experiment, 76 adult patients were included who were undergoing surgery under general anesthesia and required artery cannulation. Cannulation of the posterior tibial artery was performed utilizing either an ultrasound-assisted method (group U) or a palpation method (group P). Data were analyzed for cannulation success on the first attempt, number of cannulation attempts, assessment time, cannulation time, and total procedure time. The P group had a considerably shorter mean assessment time than the U group [14.29 ± 2.79 s vs 20.89 ± 2.70 s; p < .001]. Moreover, cannulation time was substantially longer in the P (29.20 ± 12.60 s) than in the U group (15.90 ± 6.50 s) (p < .001). The total procedure time remained statistically more in the P group than in the U group (p = 0.007). The rate of successful posterior tibial artery cannulation on the first attempt was comparable between the two groups (63.2% in the U and 55.3% in the P group, respectively; p = .484)]. The posterior tibial artery may be a suitable alternative to arterial cannulation for individuals with multiple failed attempts or difficult access. The application of ultrasound during posterior tibial artery cannulation in adult patients is safe and feasible and accompanied by a reduction in cannulation and total procedure time. The rate of first-attempt successful posterior tibial artery cannulation was comparable between the two groups.

Ultrasound guidance versus landmark method for peripheral venous cannulation in adults.

Ultrasound guidance versus landmark method for peripheral venous cannulation in adults.

Factors associated with intraoperative intravenous catheter extravasation in children.

SummaryThis retrospective study aimed to determine the incidence of and factors associated with peripheral intravenous extravasation in paediatric patients in the intraoperative setting. We conducted a retrospective study of 56,777 patients who underwent general anaesthesia and had peripheral intravenous catheter placement at Cincinnati Children's Hospital between 1 January 2015 and 1 January 2017. Data collected included age, American Society of Anesthesiologists Physical Status Classification, catheter site, number of cannulation attempts, ultrasound use for cannulation, surgery duration, and surgery class. Primary outcome was peripheral intravenous extravasation using an extravasation assessment tool. Some 64,814 peripheral venous catheters were placed in patients undergoing general anaesthesia. Significant extravasation was documented in 40 catheters with an estimated incidence of 1 in 1620 venous catheters (0.06%). Of those 40 catheters, 47.5% (n = 19) were placed using ultrasound and 37.5% (n = 15) required more than one cannulation attempt. In multivariable analysis, peripheral intravenous catheter extravasation was associated with American Society of Anesthesiologists Physical Status Classification (3, 4, 5) versus (1, 2) (odds ratio 2.42 (95% CI 1.08 to 5.41)), inpatient versus outpatient surgeries (odds ratio 2.99 (95% CI 1.31 to 6.81)), and intravenous catheters placed with ultrasound guidance (odds ratio 8.01 (95% CI 4.12 to 15.57)). Our study identified factors associated with intraoperative peripheral intravenous extravasation, and will help develop mitigation strategies to minimise harm to patients.

Study of patients undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP) at Tishreen University Hospital in Lattakia – Syria

Objective: The aim of this study is to evaluate the indications, findings, and complications of performing Endoscopic Retrograde Cholangiopancreatography (ERCP). Patients and Methods: A Prospective Observational Descriptive study conducted for the period from January 2020 to January 2021, 167 consecutive ERCP were performed at Tishreen University Hospital in Lattakia-Syria. Results: The median age was 58 years, 59.30% of patients were female. The most common indications for ERCP were common bile duct stones (44.9%) and obstructive jaundice (44.3%). The median number of attempts for cannulation was 2 counts, and 74.3% of the procedures were graded as with difficulty grade 1. The most common abnormal findings were common bile duct dilation (50.3%) and bile duct stones (43.7%). The most therapeutic endoscopic interventions were sphincterotomy (64.7%) and stone extraction balloons (68.9%). The therapeutic success rate was 93.5% with repeated the procedure and complications occurred in (10.8%) of patients. The most frequent complication was mild pancreatitis (6%). Death was reported in five cases (3%), one of them (0.6%) was due to ERCP. Conclusion: ERCP is a potential risk for complications, so physicians should be adept at recognizing and treating any complications as soon as they arise.

A Comparison between Ultrasound-guided Short-axis Approach and Oblique Axis Approach for Internal Jugular Venous Cannulation in the Emergency Department.

Background:Central venous catheter (CVC) placement is a frequently performed procedure in the emergency department (ED). We aim to compare two different ultrasound (US)-guided techniques, the short-axis (SAX) approach and the oblique axis (OAX) approach for the insertion of internal jugular vein (IJV) catheters in an ED setting.Methods:This prospective, observational study was conducted in the ED of a single tertiary care teaching hospital on patients requiring IJV cannulation. CVC placement was done using both the SAX and OAX approaches as per the ED physician's discretion. Outcome measures included acute complications, successful insertion of an IJV catheter, number of attempts, and access times. The Chi-square test was used to compare the study variables (acute complications, number of cannulation attempts, and successful cannulation) between the two approaches. Mann–Whitney U-test was applied to compare the mean differences of flash time and cannulation time.Results:Sixty patients were enrolled, of which 30 underwent IJV cannulation by the SAX technique and 30 by the OAX technique. We noted a total of 22 acute complications, 56.7% in the SAX group and 16.7% in the OAX group. A significant incidence of posterior venous wall puncture was noted in the SAX group (50.0%). No significant statistical differences were noted on analysis of other outcome measures.Conclusion:The OAX approach is a useful alternative technique to IJV cannulation in the ED setting. Further multicentric studies in this domain will be required to consider this technique as the primary approach to US-guided IJV cannulation in the ED setting.

Impact of laparoscopic cholecystectomy on the complexity of endoscopic retrograde cholangiopancreatography.

A scarce number of researches discussed the impact of cholecystectomies on the anatomy of common bile duct (CBD) and intern if this will affect the difficulty of endoscopic retrograde cholangiopancreatography (ERCP). The objective of present study was to assess the impact of complicated cholecystectomy on the complexity and safety of the ERCP procedure. A total of 100 patients were enrolled after meeting the following inclusion criteria - study group (group A): 50 patients with previous history of complicated laparoscopic cholecystectomy and control group (group B): 50 patients with previous noncomplicated laparoscopic cholecystectomy. ERCP was performed and complexity was judged by a number of cannulation attempts, ERCP time, pancreatic cannulation and post-ERCP pancreatitis. The study revealed prolonged ERCP procedure duration in noncomplicated cholecystectomy (24.2 ± 8.5 min) and it was significantly more prolonged in complicated cholecystectomy (39.6 ± 10.7 min; P = 0.03). The trials of cannulation attempts were significantly higher in the study group with complicated cholecystectomy (P = 0.009). Pancreatic duct cannulation was frequently higher in the complicated cholecystectomy group (P = 0.03). Difficult or failed stone extraction was significantly prevalent in the complicated cholecystectomy group and the occurrence of post-ERCP pancreatitis (PEP) was significantly higher than the control group. ERCP after complicated laparoscopic cholecystectomy is more complex with increased duration liability of complications.

Effect of Moist Heat Therapy on the Visibility and Palpability of Peripheral Veins Before Peripheral Venous Cannulation among Patients Undergoing Intravenous Cannulation- A Quasi Experimental Study

Hospitalization rate in India is increasing over years and treatment is given mostly via intravenous route.Moist heat therapy for identifying vein before cannulation will reduce number of attempts for cannulation,supply costs and will improve patient satisfaction. AIM: To assess the efficacy of moist heat therapy onvisibility and palpability of peripheral veins prior to intravenous cannulation. SETTINGS: Day care unit(chemotherapy ward), Medicine and Orthopaedic wards of GGS hospital, Faridkot. MATERIAL ANDMETHODS: Using Quasi experimental research design and convenient sampling 60 patients undergoingI.V.cannulation whose veins were not visible and palpable were randomly assigned to experimental (n=30)and conventional group (n=30). In experimental group moist heat therapy with conventional tourniquettechnique and in conventional group only tourniquet was used then post assessment was checked by VeinAssessment Scale in both the groups. RESULTS: In experimental group, the post intervention vein assessmentscore improved from pre intervention score 1-2 to 3-5 and in conventional group from score 1-2 to 1-4. Afterintervention, in experimental group majority of subjects had vein score 4(vein visible and palpable), whereasin conventional group majority scored vein score 3(vein barely visible and palpable). 7(23.3%) subjects ofexperimental group scored vein score 5(vein clearly visible and palpable) whereas in conventional group nosubject scored 5 vein score. Also, 2(6.7%) subjects of this group had vein score 1 that remained unchangeddespite of routine technique. Difference between post intervention scores of experimental and conventionalgroup was found to be significant (?2= 20.06 and p-value 0.00) at p-value <0.05. CONCLUSION: Moistheat with conventional tourniquet technique used in experimental group was significantly effective than onlyconventional technique used in conventional group

Comparison of Mill Suss™-guided radial artery catheterization with the long-axis in-plane ultrasound-guided method under general anesthesia: a randomized controlled trial.

Continuous arterial blood pressure measurement is an effective perioperative monitoring method in patients with high-risk comorbidities. Recently, ultrasound guidance has been reported to facilitate radial artery catheterization. A new device, Mill Suss™, has also been developed for visualization of the radial artery and superficial veins using near-infrared laser light. In this study, we hypothesized that the Mill Suss-guided method might reduce the time and the number of attempts required for radial artery catheterization under general anesthesia, as compared to the long-axis in-plane ultrasound-guided method. Seventy-two adult patients aged 20-80years, ASA physical status I or II, were randomly assigned to the Mill Suss-guided group (Group M: n = 36) or ultrasound-guided group (Group U: n = 36). Primary outcomes were the time required for successful radial artery catheterization and the number of cannulation attempts. There were no significant differences in the characteristics of patients between the two groups. The time required for successful radial artery catheterization was significantly shorter in Group M than in Group U. The number of attempts for successful cannulation was not statistically significantly different between the two groups. However, the results might be different among anesthesiologists well experienced in the ultrasound-guided method.

Difficult Biliary Cannulation from the Perspective of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: Identifying the Optimal Timing for the Rescue Cannulation Technique.

Background/AimsRecently, the European Society of Gastrointestinal Endoscopy (ESGE) proposed criteria for “difficult biliary cannulation” during endoscopic retrograde cholangiopancreatography (ERCP). This study aimed to investigate the clinical relevance of the ESGE criteria from the perspective of post-ERCP pancreatitis (PEP).MethodsAn ERCP database was prospectively maintained between November 2014 and December 2015 across six teaching hospitals in South Korea. The ESGE criteria (biliary cannulation time, the number of cannulation attempts, and inadvertent pancreatic duct [PD] manipulation) were recorded in this database as well as other technical factors. Logistic regression analysis was used to identify risk factors for PEP. Then, the PEP prediction model was investigated using decision tree analysis.ResultsWe analyzed 1,067 consecutive patients with naïve papilla. The overall rate of PEP was 6.6%. Multivariate analysis revealed that female sex (odds ratio [OR], 1.860; 95% confidence interval [CI], 1.124 to 3.078), a selective biliary cannulation duration >5 minutes (OR, 3.282; 95% CI, 1.641 to 6.566), and inadvertent PD manipulation (OR, 2.614; 95% CI, 1.480 to 4.617) were significant factors affecting PEP. Decision tree analysis revealed that biliary cannulation time (χ2=49.857, p<0.001) and inadvertent PD manipulation (χ2=8.556, p=0.010) were decisive factors. PEP occurred in 3.9%, 11.8%, and 16.2% of patients with biliary cannulation duration lasting 3 to 5 minutes, >5 minutes, and >5 minutes with inadvertent PD manipulation, respectively.ConclusionsBiliary cannulation time and inadvertent PD manipulation could be relevant indicators of PEP, and 5 minutes might be used as a cutoff value for the implementation of the rescue cannulation technique. (Gut Liver 2021;15-465)

Use of vein-viewing device to assist intravenous cannulation decreases the time and number of attempts for successful cannulation in pediatric patients.

Every child who contacts a healthcare setting has a potential for intravenous cannulation (IV) procedure and related pain, fear, and distress. Many of the healthcare professionals recognize that there is a lack of intervention to prevent multiple cannulation attempts and to reduce pain and distress inflicted to children during IV cannulation. A quasi‐experimental study was undertaken in pediatric patients to study the effect of a vein‐viewing device (VTorch) on IV cannulation procedure. The number of cannulation attempts and time taken for successful cannulation were assessed with the use of this device (experimental group, n = 159) and compared it with the standard procedure (control group, n = 159). The effect of this device in cannulation associated pain, fear, and behavioral distress were also evaluated among these children. Using Vein‐viewing device as an aid for IV cannulation significantly reduced the time taken for cannulation (P = .003) and the number of cannulation attempts (P = .03). In addition, there was a significant increase in the first‐attempt cannulation success rate with the use of this device (P = .04). The use of vein‐viewing device did not have any direct effect on cannulation associated pain, fear, or behavioral distress among the study participants. The results of this study may aid in improving the quality of intravenous access procedure in pediatric patients.

Comparative evaluation of safety and efficacy of radial arterial cannulation using conventional blind palpation technique with ultrasound guided Technique perioperatively - Raccuet study

Introduction: Radial cannulation is needed in perioperative management of many patients requiring invasive hemodynamic monitoring during surgery and may be not only time consuming and at times difficult to attain in untrained centers. Objectives: Comparative evaluation of safety and efficacy of Radial Arterial Cannulation using Conventional blind palpation technique with Ultrasound guided Technique perioperatively – Raccuet Study. Materials and Methods: This randomized controlled, prospective, single blind comparative study was conducted on 142 adult ASA I to IV patients of either sex, scheduled for elective major surgery requiring general anesthesia of which 71 patients underwent radial cannulation by classical palpatory method (group P) and the other 71 underwent radial cannulation under ultrasound guidance (Group U). All procedures were evaluated using Siemens Acuson X500 ultrasound machine with 5-13Hz linear array transducer. All patients were evaluated for efficacy by measuring time to cannulation (TTC), mean time to first attempt cannulation (mTFA), and number of attempts for cannulation (NA). Safety was assessed by evaluating incidence of hematoma and spasm in both the groups. Statistical analysis was done using (SPSS) Version 22.0. Independent t test and Mann Whitney test have been used for carrying out significant P value. Results: Patients were demographically similar in both the groups. TTC in group U (37.97±18.14sec) was significantly less than that in Group P (58.38±21.45sec) (P =0.007).mTFA was 34.81±15.77 seconds in group U compared with 55.58±19.29 seconds with group P (P=0.01). There was trend towards lower NA in group U as compared to group P (P=0.06).Incidence of hematoma formation and vasospasm were similar amongst both groups but study was underpowered to evaluate the same. Conclusion: Ultrasound guided radial artery cannulation improves the success rate of cannulation in lesser time with similar complication rates as compared to clas

Risk Factors for Post-ERCP Pancreatitis in High-Risk Patients Receiving Post-procedure Rectal Indomethacin

BackgroundPost-ERCP pancreatitis (PEP) is the most common adverse event of ERCP. Rectal indomethacin has been widely administered to decrease the incidence of PEP in high-risk patients. However, it cannot completely prevent the occurrence of PEP. The purpose of the study was to evaluate the risk factors for PEP in high-risk patients receiving post-ERCP indomethacin. MethodsFrom June 2012 to July 2015, patients undergoing ERCP and at high risk for PEP in three tertiary hospitals in China were enrolled. All patients received indomethacin after the procedure. Patient-related and procedure-related risk factors for PEP were collected. Logistic regression analysis was used to investigate the risk factors. ResultsSeven hundred ninety patients at high risk for PEP received post-ERCP indomethacin. The incidence of overall PEP and moderate-to-severe PEP was 8.0 and 1.5%, respectively. In multivariate analysis, suspected sphincter of Oddi dysfunction (SOD) (OR 2.73; 95%CI 1.38–5.43; p = 0.004), the presence of hilar obstruction (OR 4.53; 95%CI 1.60–12.81; p = 0.004), number of cannulation attempts ≥ 13 (OR 2.00; 95%CI 1.07–3.77; p = 0.030), inadvertent pancreatic duct (PD) cannulation ≥ 1 (OR 2.26; 95%CI 1.04–4.90; p = 0.040), and pancreatic contrast injections ≥ 1 (OR 2.30; 95%CI 1.02–5.23; p = 0.046) were high risk factors for overall PEP. For moderate-to-severe PEP, suspected SOD (OR 4.67; 1.19–18.35; p = 0.027), the presence of hilar obstruction (OR 7.95; 1.39–44.97; p = 0.010), and more cannulation attempts (OR 3.71; 1.09–12.65; p = 0.036) were three independent risk factors. ConclusionsA substantial number of high-risk patients had PEP even receiving post-ERCP rectal indomethacin. The independent risk factors included suspected SOD, hilar stricture, more cannulation attempts, inadvertent PD cannulation, and PD contrast injections. Trial RegistrationNCT02709421

СРАВНЕНИЕ ДВУХ МЕТОДИК КАТЕТЕРИЗАЦИИ ЛУЧЕВОЙ АРТЕРИИ: ПАЛЬПАТОРНОЙ И С УЛЬТРАЗВУКОВЫМ КОНТРОЛЕМ

Anatomical landmarks and palpation are traditionally used for radial arterial catheterization in emergency units. Despite the successful use of ultrasound monitoring for central venous access, there is a lack of evidence about the benefits of the ultrasound guidance for peripheral arterial cannulation. The objective: to compare two methods of radial arterial catheterization (the traditional one based on palpation and the method under ultrasound guidance) in the patients undergoing planned surgery. Subjects and methods. 40 patients participated in the prospective cohort study, all of them had planned surgeries. In Group 1, the traditional method was used for arterial catheterization (the palpation group), and in Group 2 it was done under ultrasound guidance (the ultrasound group). The following parameters were recorded for both groups: number of attempts, number of puncture sites, complications and their type, time of catheterization. The number of cannulation attempts was taken as a primary endpoint. Results. The statistically significant correlation was found between the method of catheterization and the number of attempts (Pearson's ch i-s quared test = 29.562, df = 6, p < 0.001), places of puncture (Pearson's ch i-s quared test = 10.365, df = 3, p = 0.015). In the ultrasound group, the first attempt of cannulation was a success in 19 cases (95%; CI 73−99%), while in the palpation group, the first attempt was a success in 2 cases (10%; CI 2−33%). The one catheterization site was used in 95% of cases in the ultrasound group ( CI 73−99%; 1 observation). While in Group 2 (the palpation group), two sites of cannulation and more were required in 50% of patients ( CI 30−17%; 10 observations). Among complications there were hematomas, and no statistically significant correlations were found between the method of puncture and their number in the groups (Pearson's ch i-s quared test = 2.7706, df = 1, p = 0.09601). The time spent on catheterization in the ultrasound group was shorter versus the palpation group (W = 344, p < 0.001) and it made 101 sec. (51; 144) and 194 sec. (153; 311) respectively. Conclusion: Compared to the traditional (palpation) method, the radial arterial catheterization guided by ultrasound possesses such benefits as high chances of successful cannulation with the first attempt, fewer sites required to provide arterial access and total time required for the manipulation.

Coronal mode ultrasound guided hemodialysis cannulation: A pilot randomized comparison with standard cannulation technique.

Infiltrations from cannulation result in significant morbidity including loss of hemodialysis (HD) vascular access (VA). Cannulation is dependent on personnel skill and VA characteristics. Surface marking of VA lacks real-time information and traditional ultrasound (US) devices are large, expensive, requiring skilled operators. Sonic Window© (Analogic Ultrasound, Peabody, MA, USA) is a coronal mode ultrasound device (CMUD) approved for VA cannulation. Single center randomized, prospective pilot study comparing handheld US-guided cannulation of new arteriovenous fistula (AVF) to standard cannulation practices. Patients with end stage renal disease (ESRD) on in-center HD who had a new AVF cleared for cannulation and dialysis were enrolled. Patients with new AVF received either standard cannulation (control group) or image guidance using CMUD (study group) for 3 weeks. Ultrasound characteristics of VA, cannulation practices and complications end points were obtained. An infiltration rate of 9.7% was noted during the study. Slightly lower odds ratio (OR) of infiltration was observed in the study group (OR 0.94, 95% CI: 0.26-3.41, P value = 0.93). Study group yielded longer time for assessment (101.8 ± 80.2 vs. 22.3 ± 22.5 seconds, P = < 0.001), increased cannulation time (41.1 ± 70.6 vs. 25.0 ± 27.9 seconds, P = 0.04), and increased patient satisfaction (94.6% vs. 82%, P = 0.04) compared to control group. Number of cannulation attempts, needle size, arterial or venous needle insertion, and tourniquet usage between groups were not statistically different. Handheld ultrasound is a safe and useful aid in cannulation of dialysis access.

El método buttonhole como técnica de punción de la fístula arteriovenosa en hemodiálisis: Una revisión de la literatura

Introducción: La hemodiálisis es el tratamiento de elección en los pacientes con insuficiencia renal crónica. La clave para un tratamiento adecuado es tener un buen acceso vascular. Por ello, las fístulas arteriovenosas son consideradas la mejor opción. Uno de los principales factores que influyen en la supervivencia de estas es la técnica de punción realizada. El objetivo principal del estudio fue conocer el método buttonhole como técnica de punción de la fístula arteriovenosa en la hemodiálisis. &lt;br /&gt;&lt;br /&gt;Metodología: Se realizó una revisión de la literatura científica a través de las siguientes bases de datos: PubMed/Medline, Scopus, Cinahl y Cuiden Plus, desde 2011 hasta 2016. Además, se realizó una búsqueda secundaría manual.&lt;br /&gt;&lt;br /&gt;Resultados: Las estrategias iniciales de búsquedas identificaron un total de 84 resultados, siendo finalmente seleccionados 7 estudios. Los resultados encontrados han sido muy diversos, encontrándose resultados para el dolor, tasas de infección, tiempo de hemostasia, dilataciones aneurismáticas, flujo sanguíneo, presión venosa, número de intentos de canulación, seguridad, estética del brazo portador de la fístula y calidad de vida del paciente.&lt;br /&gt;&lt;br /&gt;Conclusiones: El método buttonhole parece ser una buena alternativa de punción, ya que está prácticamente exenta de las complicaciones habituales existentes en otras técnicas, como extravasaciones, hematomas, aneurismas, entre otras. Además, facilita la auto-punción en los domicilios. Por otro lado, es necesario un buen aprendizaje previo a la incorporación de esta técnica y un periodo de adaptación por parte de los profesionales, requiriendo implicación por parte de los mismos y del centro. &lt;br /&gt;&lt;br /&gt;

PTU-022 Needleknife Assisted Cannulation in a UK Tertiary Referral Centre – Utilisation and Complications in Standard Practice

Introduction Needleknife assisted cannulation has been shown to be effective in ERCPs where standard techniques have failed. Concerns regarding risk of complication, particularly pancreatitis and perforation, have led to it being used only as a last resort. We evaluated the current practice and safety profile in a regional tertiary referral centre. Methods We performed a prospective observational study of ERCP outcomes in patients with intact ampullae. Experienced endoscopists with HPB expertise performed all ERCPs, and were asked to follow their standard practice. We used three ampulla classifications; non-prominent, prominent and distorted by tumour. The number of attempts at cannulation was recorded, as were the techniques used. Primary outcome measures were cannulation success and complication rates. Results Over a period of 8 months, 222 procedures were performed on patients who had not had previous ERCP. Successful cannulation in this group was achieved in 91.7%. Needleknife assisted cannulation was performed in 37 cases (17%). All needleknife cuts were started at the ampullary orifice. Needleknife use varied between different ampulla types (p = 0.44). Needleknife cannulation was most frequently attempted in ampullae involving tumour (33% attempted) but often unsuccessful (60% failure), compared to non-distorted (16.7% attempted, 22% failure rate). There was a wide range in the number of cannulation attempts made in both the needleknife and non needleknife groups (range 1–25) but there was a significant difference between the number of cannulation attempts in the standard cannulation and needleknife groups (p Conclusion Needleknife assisted cannulation is more likely to be used where the ampulla is involved with tumour and where ERCP is indicated for malignant disease. However, in this context, needleknife assisted cannulation is more likely to fail. Reassuringly despite being used after failed attempts at cannulation using standard techniques, the complication rate for needleknife-assisted cannulation is not statistically different. The likelihood of progression to needleknife use may be predicted by ERCP indication and ampullary characteristics. This may facilitate consideration of an early conversion to needleknife-assisted cannulation, but also early abandonment of procedure for alternative methods (percutaneous or surgical) in these groups. Disclosure of Interest None Declared

Prophylaxe der Post-ERCP-Pankreatitis: Update der Leitlinie der Europäischen Gesellschaft für Gastrointestinale Endoskopie (ESGE) – Juni 2014

Diese Leitlinie ist ein offizielles Statement der Europaischen Gesellschaft fur Gastrointestinale Endoskopie (ESGE). Sie behandelt die Prophylaxe der durch eine endoskopische retrograde Cholangiopankreatikografie verursachten akuten Pankreatitis (Post-ERCP-Pankreatitis). Hauptempfehlungen