Right Femoral Vein Research Articles

Early preclinical experience of a mixed reality ultrasound system with active GUIDance for NEedle-based interventions: The GUIDE study

BackgroundUse of ultrasound (US) to facilitate vascular access has increased compared to landmark-based procedures despite ergonomic challenges and need for extrapolation of 2-dimensional images to understand needle position. The MantUS™ system (Sentiar, Inc.,) uses a mixed reality (MxR) interface to display US images and integrate real-time needle tracking.ObjectiveThe purpose of this prospective preclinical study was to evaluate the feasibility and usability of MantUS in a simulated environment.MethodsParticipants were recruited from pediatric cardiology and critical care. Access was obtained in 2 vascular access training models: a femoral access model and a head and neck model for a total of 4 vascular access sites under 2 conditions—conventional US and MantUS. Participants were randomized for order of completion. Videos were obtained, and quality of access including time required, repositions, number of attempts, and angle of approach were quantified.ResultsUse of MantUS resulted in an overall reduction in number of needle repositions (P = .03) and improvement in quality of access as measured by distance (P <.0001) and angle of elevation (P = .006). These findings were even more evident in the right femoral vein (RFV) access site, which was a simulated anatomic variant with a deeper more oblique vascular course. Use of MantUS resulted in faster time to access (P = .04), fewer number of both access attempts (P = .02), and number of needle repositions (P <.0001) compared to conventional US. Postparticipant survey showed high levels of usability (87%) and a belief that MantUS may decrease adverse outcomes (73%) and failed access attempts (83%).ConclusionUse of MantUS improved vascular access among all comers, including the quality of access. This improvement was even more notable in the vascular variant (RFV). MantUS readily benefited users by providing improved spatial understanding. Further development of MantUS will focus on improving user interface and experience, with larger clinical usage and in-human studies.

Abstract 199: Use Of Hybrid Veno-venous-pulmonary Artery ECMO In A Patient With Respiratory Failure Secondary To COVID-19

Background: Extracorporeal membrane oxygenation (ECMO) is a form of cardio-pulmonary life support used for patients with respiratory and/or cardiac failure. Hybrid ECMO is a sophisticated circuit to match the exact hemodynamic demands in patients who are refractory to traditional ECMO settings. Case: A 43-year-old male presented with dyspnea for four days. On physical examination, he exhibited increased work of breathing and decreased breath sounds bilaterally. Pulse oximetry was 70% on room air, minimally improved to 75% on maximum high flow nasal cannula. He was found to be COVID-19 positive and demonstrated diffuse bilateral lung consolidation on CT chest consistent with severe acute respiratory distress syndrome. Patient was intubated but continued to show poor oxygenation with P/F ratio of 71 (Normal: &gt;400). Veno-Venous (VV) ECMO was started with cannulations into the right femoral vein (RFV) and right internal jugular vein (RIJV); this resulted in an initial improvement of partial pressure of oxygen (pO2) in arterial blood gas. However, within a few days, pO2 started to decrease with visual evidence of recirculation of oxygenated blood into the venous drainage line. A transthoracic echocardiography revealed severe pulmonary artery (PA) hypertension secondary to respiratory failure with PA pressure of 116mmHg (Normal: 18-25mmHg). This prompted a revision of the ECMO circuit to offload the right ventricle. Revised circuit included a cannula in the RFV for venous drainage and oxygenated venous return through two pathways: cannula in the RIJV (approximately 1 liter return), and a third cannula inserted through the left subclavian vein terminating into the main PA (approximately 4 liters return). Hereon, patient was able to maintain adequate pO2 for the remainder of his hospital stay until he was transferred to a lung transplant center. Conclusion: Our case illustrates the clinical sophistication of hybrid VV-PA ECMO - especially in patients with PA hypertension and impending right-sided heart failure. As respiratory failure secondary to COVID-19 becomes more prevalent, hybrid ECMO may provide a practical solution to protect the right heart in the journey to lung transplant.

Catheter inversion: a technique to complete isthmus ablation and cure atrial flutter.

Cure of typical atrial flutter (AFL) by catheter ablation to produce bidirectional block across the tricuspid annulus-inferior vena cava isthmus (IS) is highly effective, but failures may occur. We describe a technique that may allow creation of bidirectional block where a conventional strategy has failed. AFL ablation was performed using the conventional approach with a mapping/ablation (ablation) catheter introduced via the right femoral vein (RFV) to create a line of bidirectional block across the IS. If this was not achieved after five passes of the ablation catheter from the tricuspid annulus to the inferior vena cava (IVC) a catheter inversion technique was used. This allowed stable positioning of the ablation catheter at the IVC end of the isthmus. In 11 patients, a mean of 17 (range 3 to 45) radiofrequency (RF) applications was given before the catheter inversion technique was applied. Following catheter inversion a mean of 4 (1 to 14) further RF applications achieved bidirectional isthmus block in every patient. No complications occurred. Catheter inversion provides a simple, safe, and effective means of achieving bidirectional isthmus conduction block in cases where a conventional ablation strategy might have failed.