Tube Replacement Research Articles

Simplified technique in total pancreatectomy with islet cell autotransplantation after Frey’s procedure: a case report

BackgroundThe selection of the surgical approach for chronic pancreatitis (CP) is determined by various factors including inflammatory location, presence of pancreatic duct dilatation, or possibility of cancer. Total pancreatectomy (TP), with or without islet cell autotransplantation, is considered for patients with refractory CP after the failure of other surgical treatments. Considering the increasing incidence of CP requiring surgical treatment, the number of cases in which TP is performed after previous surgical treatment is expected to increase.Case presentationWe reported a case of TPIAT in a patient with alcoholic CP who had previously undergone Frey’s procedure. During the operation, the sufficient length of the elevated jejunal loop for pancreaticojejunostomy in Frey’s procedure allowed it to be used directly for biliary jejunostomy during TP. In addition, jejunojejunostomy from the previous operation could be used, and these methods contributed to simplifying the operative procedure. We need open hemostasis on post-operative day (POD) 1and a percutaneous drainage tube replacement for an intraperitoneal abscess on POD 24. The patient was discharged from the hospital on POD 37 with normal serum C-peptide level, which suggests favorable insulin secretion from transplanted islets, and the epigastric pain that suffered her preoperatively resulted in a dramatic improvement.ConclusionsWhen performing the Frey’s procedure, the elevated jejunal loop and Y-anastomosis jejunal loop with sufficient length allow them to be used directly for the reconstructions in the possible subsequent TP.

A case study on the effect of contaminated inlet tubes on the accuracy of mid-cost optical particle counters for the ambient air monitoring of fine particles

This study investigates the impact of the long-term use of inlet-heated tubes on the performance of mid-cost optical particle counters (OPCs) for ambient air monitoring of fine particles (PM2.5). Two OPCs, equipped with inlet-heated tubes, were deployed over a 6-month period, with a beta attenuation monitor (BAM) serving as the reference device. The performance of the OPCs using the same inlet tubes for the first 3 months was compared to their performance after the frequent replacement of clean tubes during the final 3 months. The correlation coefficients (r2) for the 1 h and 24 h average PM2.5 concentrations between the OPCs and the BAM were lower with long-term contaminated tubes (0.82 < r2 < 0.93) compared to clean tubes (r2 > 0.93). The relative mean errors and biases significantly increased over time with contaminated tubes. Temperature, humidity, precipitation, and wind speed were found to have an insignificant effect (r2 < 0.1) on the performance of the two OPCs with inlet-heated tubes over the 6-month period. The relative average PM2.5 error when using clean tubes was less than 4%. These findings highlight the importance of inlet-heated tubes in improving OPC performance, particularly for mitigating humidity effects.Graphical

Evaluating the Impact of Elective Endotracheal Tube Replacement on Postoperative Outcomes in Esophageal Atresia: A STROBE-guided Study.

Elective ventilation and paralysis have been shown to decrease the anastomosis-related complications following primary repair of esophageal atresia (EA). Repeated endotracheal tube (ETT) block and replacement can increase these complications. We evaluated the results of our strategy of electively changing the ETT just before shifting the patient to the postoperative ward for elective ventilation. A retrospective study was conducted using the case records of patients from July 2015 to February 2024 including all the patients of EA with tracheoesophageal fistula who underwent primary repair with end-to-end esophageal anastomosis. The patients were divided into two groups Group A: ETT was changed and Group B: ETT was not changed immediately before shifting. The groups were compared for anastomotic leak and ETT tube block in the first 48 h. Ninety-one patients were included in the study, 36 in Group A and 55 in Group B. Elective replacement of ETT decreased the tube block rates in the first 48 h following surgery (P = 0.032). Tension in the anastomosis was associated with a higher leak rate. The leak was present in 58.3% and 3.6% in cases with and without tension in the anastomosis (P = 0.001). Overall, the anastomotic leak was similar in both groups. In the subgroup of patients with anastomosis under tension, the rate of anastomotic leak was higher in patients with ETT block (P = 0.028). Elective replacement of EET decreases the tube block rates and anastomotic leak rates in cases with anastomosis under tension.

Feculent Drainage from Percutaneous Endoscopic Gastrostomy Tube due to Gastrocolocutaneous Fistula Found in Emergency Department: A Case Report

Introduction Percutaneous endoscopic gastrostomy (PEG) placement is a common procedure for patients requiring non-oral feeding. One rare complication of PEG placement is the formation of a gastrocolocutaneous fistula that develops when bowel is caught between the stomach and abdominal wall during placement. This report explores an elderly patient's gastrocolocutaneous fistula development months post-PEG placement who presented with malodorous leakage from the gastrostomy tube to the Emergency Department (ED). Case Report A 73-year-old male on hospice presented to the ED with malodorous leakage from his PEG tube. He had received the PEG tube four months prior to this presentation and had it replaced once at an outside hospital due to blockages. In the ED, his PEG tube was found to have a deflated balloon stopper. The PEG tube was replaced, but the feculent discharge persisted. Imaging showed the tube's position in the transverse colon. The patient underwent non-surgical management, with PEG tube removal and nutritional support via nasogastric tube. He was discharged with improvement of PEG site. Conclusion Gastrocolocutaneous fistula should be considered in patients experiencing unexpected PEG tube drainage or feeding-related complications such as diarrhea. Careful replacement techniques after dislodgement or blockage are important. Radiologic confirmation should be considered after replacement of tubes with feculent drainage. The rarity of gastrocolocutaneous fistula cases in literature explains the lack of standardized management approaches. Clinical signs such as feculent leakage through PEG tube site should prompt recognition and diagnosis by the ED clinician.

Design and Optimization of Elliptical B-shaped Sleeve Configuration for Oil&Gas Pipeline

Abstract Affected by external loads or pipeline corrosion, oil &amp; gas transmission pipelines may encounter safety hazards during service. In terms of defect repair, both domestic and foreign standards currently stipulate that the permanent repair method is B-type sleeve or tube replacement. Compared to the costly tube replacement, B-type sleeves are undoubtedly the preferred choice for economy and safety. However, due to installation size limitations, conventional sleeves are difficult to repair large deformation defects such as wrinkles and buckling in oil and gas pipelines. This study aims at developing, designing, and optimizing a B-type sleeve for welding repair of irregular defects in oil and gas pipelines. By designing irregular B-shaped sleeves with different curve configurations, the stress levels and concentration coefficients of irregular sleeves at different defect heights and sleeve lengths are calculated. The optimal pumpkin shaped and elliptical curve sleeve configurations are selected as the repair solutions for irregular sleeves. Under the existing limitations of machining and detection accuracy, pumpkin shaped irregular sleeves can be prioritized for application in engineering, while elliptical curve sleeves are considered as alternative solutions.

Utilizing ultrasonography to determine the minimal transverse diameter of the subglottic airway for informed selection of reinforced cuffed endotracheal tube models in children.

We explored the use of ultrasonography in determining the minimal transverse diameter of the subglottic airway (MTDSA) for the purpose of choosing an appropriate model of reinforced cuffed endotracheal tube. A total of 110 pediatric patients who received general anesthesia and tracheal intubation for selective surgeries at the hospital from February 2019 to February 2022 were chosen. They were then randomly assigned to three groups: 39 in the MTDSA group, 35 in the age formula group, and 36 in the height formula group. We assessed how accurately the appropriate endotracheal tube model was predicted in each group and compared their predictive performance. The age range of the enrolled pediatric patients was 3-6 years old. The ultrasonic measurement method demonstrated a prediction accuracy of 87.18%, while the age formula method and height formula method exhibited lower accuracy rates of 54.29% and 47.22%, respectively. Notably, the ultrasonic measurement method outperformed the other two methods significantly (P < 0.05). In the MTDSA group, 2 patients had their catheters changed during anesthesia, and the proportion of patients who changed their catheters was 5.13%. In the MTDSA group, 6 catheters were replaced, and the frequency of catheter replacement was 15.38%. In contrast, these percentages were much higher in the age formula group, at 31.43% and 45.71%, and in the height formula group, at 36.11% and 52.78%. The latter two groups had significantly higher values than the MTDSA group (P < 0.05). Regarding complications such as hoarseness, laryngeal edema, aspiration, and laryngospasm, the MTDSA group experienced a notably lower total incidence of 7.69% compared to the 37.14% in the age formula group and 41.67% in the height formula group, demonstrating statistical significance (P < 0.05). The ultrasonic measurement technique employed in MTDSA exhibits impressive precision when it comes to forecasting the specific model of a reinforced cuffed endotracheal tube for pediatric patients. This enhanced accuracy contributes significantly to minimizing the need for tube replacements during anesthesia and the associated complications. It holds immense importance in assisting clinicians in selecting the most appropriate pediatric endotracheal tube model for anesthesia induction.

815. FREE JEJUNAL GRAFT (FJG) FOR COMPLEX RECONSTRUCTION AFTER PHARINGO-LARINGO-ESOPHAGECTOMY

Abstract Background Pharyngo-esophageal reconstruction using free jejunal grafts has been widely used for the treatment of locally advanced carcinomas of the hypopharynx and cervical esophagus. However, the procedure is technically demanding and requires complex recontractions. The aim of this study was to evaluate our institutional outcomes of reconstruction using a free jejunal graft with vascular reconstruction in patients undergoing pharyngo laryngo esophagectomy with a multidisciplinary surgical team. Material and methods Unicentric retrospective case series between 2014-2023 with 6 patients that require complex reconstruction with free jejunal graft. Information was obtained from institutional database. Quantitative variables are expressed with median and interquartile range (IQR), and qualitative variables with percentage and absolute number. Results In our sample, all patients were male with median age of 62 (7) years old and had previous history of squamous cell carcinoma (SCC) treated with radical Qt/Rt with maximum radiotherapy dose who developed local recurrence at hypopharynx involving the cervical esophagus. Patients demographics and characteristics are shown in table 1. FJG was the primary procedure in five cases after PLPE, of which three were done as curative procedure and the rest as a palliative procedure. In one patients FJG was considered after gastric tube reconstruction with transhiatal esophagectomy. JFG vessels were commonly anastomosed to the common superior thyroid artery (42,9%) and the external jugular vein (21%) and thyroid vein (21,2%). Operative time was 440 (359) minutes. After FJG procedure time to oral intake reintroduction was 7 (6-20) days and hospital stay length was 20,5 (16) days. Pneumonia was the most frequent complication in four patients (57,2%). Leakage rate after FJG was 33% (2). Three patients required reintervention, (1) mesenteric graft bleeding, (1) graft anastomoses dehiscence and (1) graft necrosis. FJG failure rate was 33%, one due complete graft ischemia secondary to arterial thrombosis at 2nd POD and other due to failed conversative management of dehiscence of both anastomoses with partial ischemia. After failed FJG only one patient underwent reconstruction by transhiatal esophagectomy and gastric tube replacement. Two patients were readmitted before 30 days and two patients before 12 months after discharge. BMI after JFG was 22.7 (13,1) kg/m2. According to late complication, dysphagia was the most common complication (42,7%) also one patient cannot feed orally due to severe stenosis after chronic fistula. In-patient mortality was 0%. Overall survival was 19 (37) months. One patient with FJG failure died due to septic complications after pharingostoma, and one patient due to disease progression. Conclusion Free jejunal graft with vessel reconstruction for patients undergoing pharyngo-laryngo-esophagectomy is a safe procedure but with high complications rate which enhance the priority of centralize this pathology in high volume centers.

Finite Element Analysis of CFFT and CFDTS Columns as a Replacement for CFST Columns in Composite Construction by Using ABAQUS

In the field of composite construction of steel and concrete, concrete filled steel tube CFST columns have been proven to be greater performance structural members. The properties of steel and concrete are used efficiently. But CSFT columns are prone to corrosion in outdoor structures as the outer encasing tube is made up of steel. The outdoor use of CFST column due to its high risk of corrosion requires frequent maintenance and may prove costly. Hence, the possible replacement of steel tubes with fiber-reinforced polymer (FRP) Tubes has to be investigated. FRPs are the most suitable material for encasing concrete columns due to its orthotropic behaviour. In solution to this, the paper is aimed at numerical study of CFST, CFFT and CFDTS short columns to study the axial compression behavior of these short columns analytically and examine the best suitable alternatives of CFST column. The concrete in-fill double tube section CFDTS with better axial compression, stiffness and ductility are also investigated as a suitable replacement of CFST columns. For these three different specimens of CFST columns of steel tube thickness 3mm, 4.5mm and 6mm, CFFT columns of GFRP tube thickness 3mm, 4.5mm and 6mm and CFDTS column with GFRP outer tube of thickness 3mm, 4.5mm and 6mm as well as inner steel tube of thickness 1.5mm, 2mm and 2.5mm are analyzed and compared. Consequently, CFDTS columns, with 1872 kN are proven to be superior to CFST columns with axial capacity 1653 kN and CFFT with axial capacity 689 kN columns. The confinement effect in CFDTS is more than CFST and CFFT column.

Enhancing heat exchanger performance with combined twisted tubes and twisted Tapes: Design and retrofit strategies

This study investigates the application of twisted tubes and twisted tapes as heat transfer enhancement tools in both new designs and revamping of shell-and-tube heat exchangers. This research introduces a new design approach based on published data of thermohydraulic performance of combined twisted tubes and twisted tapes. This work discusses general design considerations and proposes methodologies for the sizing of new heat exchangers and the incorporation of twisted tubes and twisted tapes into existing units. In design, surfaces with the best trade-off between heat transfer enhancement and pressure drop are simple twisted tubes and twisted tubes with triple-channel twisted tape (TT-3C) with a PEC of 3.06 and 2.59 respectively. It is found that for new designs, reductions in area relative to the original units are observed. With twisted tubes alone, the reduction is 19.11 %, while with the incorporation of TT-3C, it reaches 29.70 %. In revamping of existing heat exchangers, the replacement of smooth tubes by twisted tubes and TT-3C results in average thermal load increases of 26.32 % and 27.50 %, equivalent to 19,526 kW and 20,442 kW, respectively. The results reveal significant improvements in heat transfer efficiency without substantial pressure drop increments, making twisted tubes and twisted tapes valuable options for enhancing heat transfer.

Outcomes of Colonic and Gastric Tube Transplants after Caustic Esophageal Burn in Children: A 33-Year Review.

Introduction: Accidental caustic burns of the esophagus in children represent a significant global health challenge, often necessitating esophageal reconstruction. The aim of this study is to compare the efficacy and morbidity related to esophagus replacement with colonic and gastric tube transplants in a pediatric population followed for caustic stenosis. Methods: This retrospective study was conducted at a tertiary pediatric surgery unit for children treated from January 1989 to December 2022. We compared colonic and gastric tube esophageal replacement. Short term (within 30 days) and mid-term outcomes and complications were reviewed. Statistical evaluation was considered using a Chi-square test for categorical data analysis. Results: A total of 124 children with caustic esophageal burns were included. Among them, 23 (18.5%) had a gastric tube transplant for esophagus replacement and 101 (81.5%) a colonic transplant. During surgical intervention, we found a significantly higher risk of complications when using a colonic transplant (34%, p < 0.001). There was no significant statistical difference in postoperative short term and mid-term complications between the two techniques. Twenty-six (26%) of the children required a reoperation, with a higher risk in the gastric tube transplant group (p < 0.001). Endoscopic dilatation after surgery was also performed on a higher number of children who had received a gastric tube transplant (p = 0.005). Overall, 97.6% recovered full normal oral feeding. Conclusions: We found that colonic and gastric tube replacement are both good options for pediatric esophageal replacement after a caustic injury and show effectiveness over time. Gastric tube transplants carried a slightly higher risk of reoperations and a higher number of dilatations post-surgery. However, our groups are not really comparable, due to the much higher number of colonic transplants. Both surgical options have to be considered during surgery, and the choice depends on the anatomy of the patient. Our future research will focus on assessing long term quality of life and the potential risk of neoplastic complications.

Risk Factors for Replacement of Tympanostomy Tubes After Surgical Removal for Pediatric Patients.

Ear tube removal and patch myringoplasty are frequently performed. The indication and timing for surgery varies among otolaryngologists. This study identifies risk factors associated with the need for the replacement of tympanostomy tubes after tube removal and myringoplasty. Case series with chart review. Single institution academic otolaryngology practice. Patients younger than 12 years of age who underwent tympanostomy tube removal and myringoplasty at the University of Rochester Medical Center from March 2011 to September 2019. Patients with tympanostomy tube removal due to chronic otorrhea were excluded. One hundred sixty-one patients (230 ears) met inclusion criteria and had sufficient follow-up. Myringoplasty success after tube removal was 94.8%. Successful myringoplasty was associated with shorter tube duration (32 months) versus unsuccessful myringoplasty (40 months) (P = .02). Replacement tympanostomy tubes after myringoplasty occurred in 9.6% of ears. There was no difference in average patient age (P = .96) or duration of tubes (P = .74) in patients who required replacement of tympanostomy tubes versus patients who did not require tube replacement. Patients with a cleft abnormality were more likely to require tympanostomy tube replacement (P < .001). Most children do not need tubes replaced after removal. This study identified cleft abnormality as a factor that increased the need for replacement tubes. Longer tube durations of over 3 years negatively impacted myringoplasty success. Tympanostomy tube removal should be considered 2 to 3 years after placement in most patients with longer tube durations considered in children with a repaired cleft palate.

Lightweight bobbin yarn detection model for auto-coner with yarn bank

The automated replacement of empty tubes in the yarn bank is a critical step in the process of automatic winding machines with yarn banks, as the real-time detection of depleted yarn on spools and accurate positioning of empty tubes directly impact the production efficiency of winding machines. Addressing the shortcomings of traditional methods, such as poor adaptability and low sensitivity in optical and visual tube detection, and aiming to reduce the computational and detection time costs introduced by neural networks, this paper proposes a lightweight yarn spool detection model based on YOLOv8. The model utilizes Darknet-53 as the backbone network, and due to the dense spatial distribution of yarn spool targets, it incorporates large selective kernel units to enhance the recognition and positioning of dense targets. To address the issue of excessive focus on local features by convolutional neural networks, a bi-level routing attention mechanism is introduced to capture long-distance dependencies dynamically. Furthermore, to balance accuracy and detection speed, a FasterNeck is constructed as the neck network, replacing the original convolutional blocks with Ghost convolutions and integrating with FasterNet. This design minimizes the sacrifice of detection accuracy while achieving a significant improvement in inference speed. Lastly, the model employs weighted IoU with a dynamic focusing mechanism as the bounding box loss function. Experimental results on a custom yarn spool dataset demonstrate a notable improvement over the baseline model, with a high-confidence mAP of 94.2% and a compact weight size of only 4.9 MB. The detection speed reaches 223FPS, meeting the requirements for industrial deployment and real-time detection.

The impact of musical intervention on pain and anxiety levels during percutaneous nephrostomy tube replacement: a randomized controlled trial

Objective: Percutaneous nephrostomy tube replacement (PNTR) is a significant and frequently performed outpatient urological procedure. Patients undergoing this procedure often experience pain and anxiety. Various non-pharmacological methods are currently utilized to alleviate pain and anxiety. The objective of this study is to investigate the effects of music on pain and anxiety during PNTR . Materials and Methods: A prospective randomized controlled trial was conducted in patients undergoing PNTR at Loei Hospital from May 1, 2023, to September 30, 2023. A total of 104 patients were randomly assigned to two groups: group 1, where patients did not listen to music during the procedure, and group 2, where patients listened to their preferred choice of music. Demographic data, vital signs, Visual Analog Scale (VAS) pain levels, State-Trait Anxiety Inventory-State Anxiety (STAI-SA), and willingness to repeat procedures were compared. Results: The VAS pain scores in the music group were significantly lower than in the non-music group during and after PNTR (2.5 vs 5, p &lt; 0.005 and 0 vs 3, p &lt; 0.001, respectively). Moreover, the STAI-SA levels in the music group were significantly lower post-procedure (32.98±5.61 vs 39.98±6.18, p &lt; 0.001), and the willingness to repeat the procedure was significantly higher (41 vs 22, p &lt; 0.001). Conclusion: The results of this study indicate that listening to a preferred choice of music during PNTR has the potential to reduce pain, and anxiety, and increase the willingness of patients to repeat procedure. The intervention of music serves as a cost-effective, safe, and side effect-free non-pharmacological approach to facilitate patient outcome in PNTR.

Lacrimal duct Surgery: Different Techniques and Long-Term Postoperative Results

Pre-saccal obstructions of the lacrimal duct can be solved with a conjunctivodacryocystorhinostomy while saccal or post-saccal obstructions are restored with an external, endoscopic or laser dacryocystorhinostomy (DCR). The aim of the present study is to review the indications for each technique and to compare the results achieved. Retrospective review of 335 patients in whom 440 surgeries of the lacrimal duct were performed, with at least 4 months of follow-up. Outcomes in terms of symptoms and endoscopic findings during follow-up were considered. Successful results understood as resolution of symptoms were observed in 85% of cases treated with endoscopic DCR and in 62% of cases after laser DCR (p < 0.001). Among patients with recurrence of epiphora after surgery, 32% showed a visible ostium during endoscopy. Sixty-eight conjunctivodacryocystorhinostomies were performed, 68% of which required a tube replacement due to obstruction or extrusion. The mean duration of the tubes replaced was 10 months (range 3 days – 95 months). Endoscopic DCR shows better success rates than laser DCR. A considerable percentage of failures after DCR surgery present a visible ostium on endoscopic examination. This fact should lead to reconsider the initial diagnosis, ruling out functional problems or canalicular obstructions.

The laser-electron source of X-ray radiation (from the opening statement at workshop dedicated to the 85th anniversary of B.S. Ishkhanov in SINP MSU on October 26, 2023)

The work, as well as the seminar at which it was reported, is devoted to the memory of the outstanding physicist-nuclear scientist, professor of Moscow State University B.S. Ishkhanov, namely his contribution to the research and development of LEXG — laser-electronic X-ray generators. Relevance and prospects of this direction are connected with «gap» between two existing types of X-ray sources: on the one hand — X-ray tubes, and on the other - electronic accelerators, storage rings and free electrons lasers. It’s about a huge difference in their bundle characteristics, cost, scale, energy consumption, etc. The history of modern projects abroad, as well as the LEXG project of MSU–Jilin University, led by Prof. B.S. Ishkhanov, are briefly presented. From the point of view of their applications, the LEXG designs can be divided into two types with different scale of the devices. The first is the replacement of serial X-ray tubes and the second is radiation medicine, nuclear technology and nuclear physics research. International conferences on LEXG have been held since 2008. The list of these is given in the Annex to the article.

Profound Alkalosis and Prolonged QT Interval Due to Inappropriate Gastrostomy Tube Loss: A Case Report.

Severe metabolic alkaloses are relatively rare but can carry a high mortality rate. Treatment involves supportive care and treatment of underlying causes. A 55-year-old male dependent on a gastrojejunostomy tube presented to the emergency department for altered mental status. The patient had metabolic alkalosis, electrolyte abnormalities, and prolonged QT interval on electrocardiogram. Examination and history revealed that chronic drainage of gastric fluid via malfunctioning a gastrojejunostomy tube resulted in profound alkalosis. The patient recovered with supportive care, electrolyte repletion, and gastrojejunostomy tube replacement. This case highlights the importance of gastrointestinal acid-base pathophysiology.

Effect of video-based education on percutaneous endoscopic gastrostomy tube use duration: A case report

Percutaneous endoscopic gastrostomy (PEG) is a safe, practical, and effective method for enteral nutrition. Minor and major complications may occur after the placement of a PEG tube. In the content of the education provided to caregivers, information should be given about the potential complications and the importance of communicating with the nutrition support team when these issues arise. In this case, we present a patient who was fed through a PEG tube and experienced infections and hypergranulation tissue processes during a thirty-seven-month follow-up, which included one tube replacement. Through this case, we aim to demonstrate that minor complications associated with the PEG tube can be addressed without hospitalization, through collaboration between the patient and the nutrition support team, allowing for an extended period of PEG tube usage.

Single-step, non-surgical placement of permanent low-profile cystostomy tubes in dogs: 10 cases (2018-2023).

Low-profile cystostomy tubes provide an alternative to conventional cystostomy tubes with external tubing. Previously, these have been placed surgically involving coeliotomy, cystotomy and cystopexy, or have been used as replacement tubes in existing stoma sites. The purpose of this study is to describe a technique for, and the outcomes of, single-step, non-surgical low-profile cystostomy tube placement. All cases that had single-step, non-surgical placement of low-profile cystotomy tube attempted at the authors' institutions were included in this study. Data, including success rates, outcomes and complications, were extracted from the medicalrecords. Ten client-owned dogs were inclided. Single-step, non-surgical placement was successful in eight out of 10 dogs, with placement being unsuccessful in two thus necessitating coeliotomy. The median duration that low-profile cystostomy tubes were in place was 7.0 months (range 4 days to 38 months). Seven of the eight dogs required replacement of their cystostomy tube. Mean time until first tube replacement was 103 days (range 13 to 363 days). Single-step, non-surgical placement of a low-profile cystostomy tube is a viable alternative to surgical placement. Lack of cystopexy does not appear to result in complications. Conversion to coeliotomy might be required if tube placement is not successful with this technique. Complications seen with non-surgical tube placement such as inadvertent tube removal were similar to those previously reported for surgically placed tubes.

Power Plant Maintenance Investment Decision Making Based on Reliability, Availability, Maintainability and Risk Cost Case Study: Replacement Tube HRSG 1.2 Combine Cycle Power Plant Belawan

This study analyzes the feasibility of investing in the HRSG 1.2 replacement tube as a guide in making decisions based on reliability, availability, maintainability as an operational aspect, and risk cost as a risk aspect and analyzes the financial aspect. This feasibility analysis was carried out on 3 alternative options, namely just replacing the leaking HRSG 1.2 tube or corrective maintenance, doing the HRSG 1.2 tube replacement as a whole and doing the HRSG 1.2 tube replacement partially. In the analysis of operational aspects, it was obtained an increase in the reliability value of HRSG 1.2 by 0.137, an increase in the availability of HRSG 1.2 by 0.016 and an increase in the maintainability of HRSG 1.2 by 0.0006, so that it could increase operational performance combine cycle power plant block I. In the financial aspect analysis, capital budgeting was calculated which resulted in a net present value of IDR 360.419.186.184 and an internal rate of return of 7,51%. Meanwhile, in the risk aspect analysis, the risk cost value is below the risk appetite statement and in the moderate category. So that the investment work to maintain the HRSG 1.2 CCPP Belawan replacement tube is feasible to increase company value.

Evaluation of community nurse-led traumatic tube displacements.

Home enteral tube feeding (HEF) has many benefits and is largely safe practice. Some complications have historically required intervention in the acute setting, including traumatic displacement of feeding tubes (i.e. internal bumper/balloon removed intact), and evidence to support the safe replacement of these tubes in the community is lacking. To address this, a service enabling community homecare nurses (CHN) to replace traumatically displaced feeding tubes was designed and evaluated. Adult patients presenting with a traumatically displaced feeding tube over 29 months were included in the service evaluation. Baseline characteristics and outcomes at day 1, 7 and 6 months post-replacement were recorded. A total of 71 tube replacements were performed by CHNs in 60 patients. No clinical complications were recorded at any follow-up points. A simple cost analysis estimated savings of £235 754.40. These results suggest that nurse-led replacement of traumatically displaced feeding tubes in adults in the community is low-risk and offers potential cost savings.