Peripheral Catheter Placement Research Articles

Design and Evaluation of a Handheld Robotic Device for Peripheral Catheterization.

Medical robots provide enhanced dexterity, vision, and safety for a broad range of procedures. In this article, we present a handheld, robotic device capable of performing peripheral catheter insertions with high accuracy and repeatability. The device utilizes a combination of ultrasound imaging, miniaturized robotics, and machine learning to safely and efficiently introduce a catheter sheath into a peripheral blood vessel. Here, we present the mechanical design and experimental validation of the device, known as VeniBot. Additionally, we present results on our ultrasound deep learning algorithm for vessel segmentation, and performance on tissue-mimicking phantom models that simulate difficult peripheral catheter placement. Overall, the device achieved first-attempt success rates of 97 ± 4% for vessel punctures and 89 ± 7% for sheath cannulations on the tissue mimicking models (n = 240). The results from these studies demonstrate the viability of a handheld device for performing semi-automated peripheral catheterization. In the future, the use of this device has the potential to improve clinical workflow and reduce patient discomfort by assuring a safe and efficient procedure.

Decrease in behaviors associated with pain during catheter placement using a topical anesthetic formulation in cats.

In veterinary practice, peripheral catheter placement is very common. For some cats, this procedure can be painful and stressful. This study aimed to determine the effect of a topical anesthetic cream on pain reaction related to cephalic catheter placement in healthy, awake cats. 20 healthy cats, enrolled for ovariohysterectomy, were randomized to either a lidocaine 2.5%-prilocaine 2.5% cream or placebo cream group. In each group, the cream was applied for 30 minutes on a previously shaved skin overlying the cephalic vein and venipuncture was carried out using a 22-gauge catheter. The Cat Stress Score system was applied before venipuncture to ensure that the reaction observed was not associated with cat stress level. The behaviors associated with pain during venipuncture were also evaluated. All cats tolerated the application of the cream well. Cat Stress Score before venipuncture ranged from fully relaxed to very tense in both groups and no correlation was found between the behaviors associated with pain during venipuncture and cat stress level. 30 minutes of application time was effective in providing local anesthesia, with cats in the treatment group showing significantly fewer behaviors associated with pain than cats in the placebo group. The use of a topical anesthetic cream before peripheral catheter placement in non-emergency cases is feasible.

Application of implanted port systems during immunochemo- and infusion therapy in hematological patients

Background. Modern immunochemotherapy (ICT) and infusion therapy (IT) in the treatment of malignant lymphomas, further supportive and concomitant therapy require constant and reliable vascular access. Today, the hematology clinic uses both short-term and minimally invasive methods of vascular access (venipuncture, peripheral catheters) and long-term options (peripherally inserted central catheter, subclavian vein catheterization). The choice of the optimal method of access to vessels, its preservation and care, and the avoidance of complications associated with the functioning of such access require the joint efforts of many specialists.
 Objective. To outline the indications for the establishment, advantages and disadvantages of the use of implanted port systems (IPS) in hematological patients.
 Materials and methods. 8 patients with newly diagnosed malignant lymphomas and established IPS who received volumetric and long-term IT during antilymphoma treatment were observed. 7 patients were diagnosed with primary mediastinal large B-cell lymphoma (PMBCL), and 1 patient was diagnosed with Hodgkin’s lymphoma (HL). Gender distribution was the following: 7 women and 1 man. Age of patients ranged from 26 to 48 years (median – 29.8 years). Patients were implanted with one of the two IPS available on the Ukrainian market (U-port 6.6/8.4 Fr or B-Braun Celsite® ST301 6.5/8.5 Fr). Catheterization of the right or left subclavian vein was performed in the operating room using local anesthesia and under X-ray control. IPS began to be used immediately after implantation.
 Results and discussion. Patients who were scheduled for long-term and volumetric infusions for the treatment of malignant lymphomas, or who had problems with short-term vascular access, were suggested to have IPS. As a result 7 patients with PMBCL received ICT, which involved a continuous 96-hour infusion of antilymphoma drugs and concomitant IT, the total volume of which was 5.0-6.5 liters per day. In 2 patients before the initiation of ICT there were significant obstacles to the establishment of short-term vascular access (phlebitis, postphlebotic changes in peripheral veins), another 1 patient had similar problems after the second course of ICT. The patient with HL at the time of chemotherapy had a poor condition of peripheral veins, which did not allow their frequent and prolonged catheterization, and the mode of application of antilymphoma drugs (every 2 weeks, 12 injections) made it inexpedient to catheterize the subclavian vein. Eventually, the presence of IPS has greatly simplified the permanent vascular access and care for the port system itself. In all of our patients, IPS ensured the continuity of the infusion and the planned volume. In the intercourse period, IPS did not require special care: patients followed their normal lifestyle, including taking a shower. Subsequently, in the long term (up to 24 months) IPS appeared to be functionally complete and with regular care (every 2-4 weeks) allowed for maintenance and concomitant therapy. One patient had a hematoma in the pocket area of the reservoir of the port system, which resolved spontaneously. No infection around the port area and no cases of catheter induced sepsis were observed. To date, IPS has been removed without complications in 5 patients, one continues ICT, and in another one IPS was decided not to be removed.
 Conclusions. The use of IPS in hematological patients has shown its benefits in long-term and large-scale ICT and IT regimens to ensure persistent, multiple and safe access to blood vessels. The use of IPS is also indicated for patients with vascular lesions, venous diseases or their unsatisfactory condition. The medical staff avoids the constant search for “working vessels” for the placement of peripheral catheters or special care for the central catheter. IPS provides the opportunity to conduct initial, supportive and concomitant therapy for months with minimal care for vascular access. Complications during the installation and operation of IPS are extremely rare and minor. IPS placement can be considered an integral part of ICT and IT in the hematological practice.

Survey of Techniques to Induce Vasodilation Performed by Clinical Nurses During Short Peripheral Catheter Placement

Survey of Techniques to Induce Vasodilation Performed by Clinical Nurses During Short Peripheral Catheter Placement

A simple diagnostic test to confirm correct intravascular placement of peripheral catheters in order to avoid extravasation

BackgroundIntravenous catheters are ubiquitous among modern medical management of patients, yet misplaced or tissued cannulas can result in serious iatrogenic injury due to infiltration or extravasation of injectate. Prevention is difficult, and currently few reliable tests exist to confirm intravascular placement of catheters in awake spontaneously breathing patients. MethodsTwenty conscious spontaneously breathing healthy volunteers were injected with 50 mL normal saline and 50 mL 4.2%, or 50 mL 2.1%, or 20 mL 4.2% sodium bicarbonate in a random order. A blinded anesthetist observed continuous sampling of exhaled carbon dioxide and was asked to differentiate between the sodium bicarbonate and saline injections. Peak increase in measured exhaled carbon dioxide was also calculated. ResultsExhaled carbon dioxide increased significantly in participants injected with intravenous sodium bicarbonate. Mean peak increase was 7.4 mm Hg (±2.1 mm Hg) for 50 mL 4.2% sodium bicarbonate, 4.7 mm Hg (±2.5 mm Hg) for 20 mL 4.2% sodium bicarbonate, and 3.5 mm Hg (±1. 8 mm Hg) for 50 mL 2.1% sodium bicarbonate. The blinded observer correctly identified the injection as sodium bicarbonate or normal saline in every instance. DiscussionIntravenous injection of dilute sodium bicarbonate with exhaled carbon dioxide monitoring reliably confirms correct intravascular placement of a catheter. A transient increase of exhaled carbon dioxide by 10% or more is an objective and reliable confirmation of intravascular location of the catheter. We recommend using 20 mL of 4.2% sodium bicarbonate to minimize the mEq dose of sodium bicarbonate required.

Comparative utility of centrally versus peripherally transduced venous pressure monitoring in the perioperative period in spine surgery patients

Study ObjectiveTo compare central venous pressure (CVP) with peripheral venous pressure (PVP) monitoring during the intraoperative and postoperative periods in patients undergoing spine surgery. DesignProspective observational study. SettingUniversity-affiliated teaching hospital. Patients35 ASA physical status 1, 2, and 3 patients. InterventionsA peripheral catheter in the forearm or hand and a central catheter into the internal jugular vein were placed for PVP and CVP monitoring, respectively. MeasurementsCVP and PVP values were collected simultaneously and recorded electronically at 5-minute intervals throughout surgery and in the recovery room. The number of attempts for catheter placement, ease of use, maintenance, and interpretation were recorded. Patient comfort, frequency of complications, and cost were analyzed. Main resultsThe correlation coefficient between CVP and PVP was 0.650 in the operating room (P < 0.0001) and 0.388 in the recovery room (P < 0.0001). There was no difference between groups in number of attempts to place either catheter, maintenance, and interpretation with respect to PVP and CVP monitoring in the operating room. In the recovery room, the nurses reported a higher level of difficulty in interpretation of PVP than CVP, but no differences were noted in ease of maintenance. There were no complications related to either central or peripheral catheter placement. Patient comfort and cost efficiency were higher with a peripheral than a central catheter. ConclusionDuring clinically relevant conditions, there was limited correlation between PVP and CVP in the prone position during surgery and postoperatively in the recovery room.

Ultrasound‐guided peripheral catheter placement for upper limb amputation in a 12‐year‐old boy: possible phantom limb pain prevention?

Pediatric AnesthesiaVolume 18, Issue 4 p. 335-337 Ultrasound-guided peripheral catheter placement for upper limb amputation in a 12-year-old boy: possible phantom limb pain prevention? Giorgio Ivani md , Giorgio Ivani md Department of Anesthesiology and Intensive CareSearch for more papers by this authorValeria Mossetti md , Valeria Mossetti md Department of Anesthesiology and Intensive CareSearch for more papers by this authorAntonio Andreacchio md , Antonio Andreacchio md Division Pediatric Othopedic Surgery, Regina Margherita Children’s Hospital, Turin, Italy (email: gioivani@libero.it)Search for more papers by this author Giorgio Ivani md , Giorgio Ivani md Department of Anesthesiology and Intensive CareSearch for more papers by this authorValeria Mossetti md , Valeria Mossetti md Department of Anesthesiology and Intensive CareSearch for more papers by this authorAntonio Andreacchio md , Antonio Andreacchio md Division Pediatric Othopedic Surgery, Regina Margherita Children’s Hospital, Turin, Italy (email: gioivani@libero.it)Search for more papers by this author First published: 29 February 2008 https://doi.org/10.1111/j.1460-9592.2008.02444.xCitations: 8Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume18, Issue4April 2008Pages 335-337 RelatedInformation

Einsatz von niederosmolarem Gadolinium zur angiographischen Darstellung und bei interventionell-radiologischen Eingriffen bei niereninsuffizienten Patienten

To evaluate the benefit and feasibility of gadolinium contrast agents for intra-arterial use in diagnostic and therapeutic angiography in patients with renal insufficiency. In 15 patients with planned peripheral or renal vascular interventions digital subtraction angiography with intra-arterial administration of gadolinium (gadodiamide n = 14, gadolinium-DTPA n = 1) was performed. Gadolinium was used selectively after peripheral catheter placement, mainly as an adjunct to CO2 (n = 12), to assess the distal run-off vessels or to characterize stenotic lesions. In 14 cases gadolinium yielded good or satisfactory results that were superior to those of CO2 angiography in the femoropopliteal region and calf, but also to the aorto-iliac vessels and the renal arteries. A small amount of iodinated contrast media was administered due to insufficient contrast of gadolinium in one patient. Mean serum creatinine level after angiography (295 +/- 167 micromol/l; range 125 - 764 micromol/l) was not significantly different (p >/= 0,37) from the initial level (279 +/- 149 micromol/l; range 143 - 728 micromol/l). Gadolinium is a viable alternative contrast agent for digital subtraction angiography and percutaneous transluminal angioplasty in patients with renal insufficiency. It enhances the diagnostic evaluation of stenosis and run-off vessels.