Saline Flush Research Articles

Power-Injectable Peripherally Inserted Central Catheter Tip Malposition After Power Injection of Intravenous Contrast Media for Computed Tomography Examinations

The aim of this study is to describe the incidence of peripherally inserted catheter tip (PICC) migration after power injection of intravenous contrast for computed tomography (CT) examinations. Retrospective review was conducted of all PICC power injections for CT examinations during the study period: October 16, 2017 through October 23, 2018. Review included evaluation of preinjection and postinjection topograms to assess PICC tip position. Chi-squared statistical analysis was applied. A total of 594 topograms were obtained of power-injectable PICCs during the study period in anticipation of power injection with iodinated contrast media. Of those, 550 patients had satisfactory preinjection topograms and available postinjection topograms; 43 (7.8%) demonstrated tip malposition attributable to power injection of contrast media. Anatomic side of PICC placement and subsequent malposition were independent variables by chi-square test (chi-square = .09, P = .76); 32 of 429 (7.5%) right-sided PICCs versus 11 of 121 (9.1%) left-sided PICCs demonstrated new malposition after contrast media power injection. No complications related to power injection of contrast media through these PICCs were observed. PICC tip malposition secondary to power injection of iodinated contrast media is common and readily identifiable. Obtaining both preinjection and postinjection topograms ensures appropriate catheter position during injection and upon patient departure. Rapid saline flush is a noninvasive maneuver that allows a high chance of successful repositioning of catheter tips. Power injection of contrast media through a power injectable PICC is safe.

V07-04 MUSCULOCUTANEOUS LATISSIMUS DORSI PHALLOPLASTY: TECHNIQUE AND TIPS

You have accessJournal of UrologySexual Dysfunction & Transgender (V07)1 Sep 2021V07-04 MUSCULOCUTANEOUS LATISSIMUS DORSI PHALLOPLASTY: TECHNIQUE AND TIPS Aditi Valada, Rajveer S. Purohit, and Miroslav L. Djordjevic Aditi ValadaAditi Valada More articles by this author , Rajveer S. PurohitRajveer S. Purohit More articles by this author , and Miroslav L. DjordjevicMiroslav L. Djordjevic More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002034.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Musculocutaneous latissimus dorsi (MLD) phalloplasty is a gender affirming surgical option for transmen which permits penile prosthesis, glansplasty, and urethral extension at later stages. This surgery allows for a neophallus of adequate length and girth, and minimal donor site morbidity, but is technically complex. This video demonstrates a step-by-step technique and tips to optimize outcomes and simplify the operation for the MLD phalloplasty. METHODS: A 33-year-old transmale who previously underwent metoidioplasty presented for a MLD phalloplasty. With the patient in a supine position, the superficial femoral artery (SFA) and saphenous vein (SV) are isolated at the recipient site. The patient is repositioned into a lateral flank position, the flap tubularized, and inferior aspects of the wound closed prior to harvesting the thoracodorsal artery (TDA) and vein (TDV) to minimize cold ischemia time. The thoracodorsal artery and vein are dissected to their root at the subscapular artery and vein and removed with a patch of the subscapular artery. After the neophallus is harvested, the TDA and TDV are isolated and irrigated with a heparinized saline flush. The phallus is attached to the previously created recipient site and an end-to-side anastomosis is created between the SFA and TDA and an end-to-end anastomosis between the SV and the TDV. If the patient has a thick latissimus dorsi muscle or subcutaneous fat, a split-thickness skin graft can be used to close the ventral phallus to minimize tension on the tubularized neophallus. Positioning and close post-op monitoring of the neophallus are critical. RESULTS: A neophallus of adequate length and girth is created with the option for future urethral extension and penile prosthesis placement. CONCLUSIONS: Our video demonstrates the technique for a gender affirming MLD phalloplasty in a transman and tips to optimize outcomes and simplify the operation. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e552-e552 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aditi Valada More articles by this author Rajveer S. Purohit More articles by this author Miroslav L. Djordjevic More articles by this author Expand All Advertisement Loading ...

Rapid intraoperative perfusion assessment of parathyroid adenomas with ICG using a wide-field portable hand-held fluorescence imaging system

BackgroundFluorescence angiography (FA) using indocyanine green dye (ICG) has recently been introduced for real-time identification of parathyroid adenomas. However, time to peak fluorescence has not yet been critically evaluated. MethodsThis was a retrospective review of parathyroidectomies with ICG FA over a one-year period. ResultsThere were 66 patients with average age of 64 years. The average time to initial fluorescence was 26.7 s and to peak fluorescence was 38.0 s. The time to saline flush administration significantly correlated with times to initial and peak fluorescence (p < .0001). The rate of in-situ fluorescence was 97%. The rates of suspected adenoma detection were 69% for sestamibi scan, 71% for ultrasound, and 96% for CT scan. Imaging was discordant in 13 cases (20%), with the adenoma located on the opposite side of the neck in 4 cases. ConclusionsICG FA is a rapid and effective adjunct for the intraoperative identification of parathyroid adenomas.

Effect of Saline Flush on the Enhancement of Vascular and Liver via Saphenous Vein for Abdominal CT in Dogs

Effect of Saline Flush on the Enhancement of Vascular and Liver via Saphenous Vein for Abdominal CT in Dogs

Optimization Study of the Hemodynamics of Saline Flushing in Endoscopic Imaging of Chronic Total Occlusions (CTOs).

In this study, in vitro experiments and computational fluid dynamic (CFD) simulations are used to expand the understand of the physics of saline flushing of a blocked artery to enable optical imaging. This process involves saline injection, mixing with blood, and advection of the mixture away from the region of interest to provide a clear optical path for imaging. CFD simulations are used as a rapid turn-around tool for the evolutionary design process of an endovascular catheter that combines imaging forward-viewing element with saline flushing lumens. A novel design and control technique is developed that provides the method to regulate the pressure in a blocked artery during saline flushing, so only small deviations from physiological pressure values are exerted on the damaged artery wall at any time, minimizing risk of rupture. In vitro experiments demonstrate the optical clearing process in phantoms simulating chronic total occlusions (CTOs) in coronary arteries with an opaque blood surrogate being removed by saline flushing. With the CFD compared by the experiments, parametric analyses of artery diameter and curvature, and flushing lumen diameter size were conducted to understand their impact on flushing times and pressures. Different plaque morphologies were studied to explore the feasibility of saline flushing in different CTO conditions. A new catheter design is demonstrated to safely and effectively produce saline flushing, leading to a clear optical imaging field, and an improved technique is outlined that overcomes some practical challenges and limitations commonly encountered in angioscopy.

Determining an Appropriate To-Keep-Vein-Open (TKVO) Infusion Rate for Peripheral Intravenous Catheter Usage

Highlights Abstract Background: Evidence to support an optimum continuous to-keep-vein-open (TKVO) infusion rate for peripheral intravenous catheters (PIVCs) is lacking. The aim of this study was to simulate typical TKVO rates, in combination with flushing, to better understand TKVO in relation to PIVC patency. Methods: We simulated saline infusion through a 20-gauge PIVC in 2 forearm veins (3.3 and 2.2 mm) using computational fluid dynamics under various venous flow rates (velocities 3.7–22.1 cm/s), with a saline flush rate of 1 mL/s and TKVO infusion rates of 10, 20, and 40 mL/h. We determined TKVO efficacy using the stream of saline clearing the stasis region at the device tip and the shear stress acting on the vein. Results: At 10 mL/h TKVO rate, blood stasis occurs around the PIVC tip as saline is pulled into the faster-moving venous blood flow, creating the blood recirculation (stasis) zone at the device tip. When TKVO increases &amp;gt;20 mL/h, this stasis diminishes, and the likelihood of patency increases. Shear stress on the vein is negligible during TKVO but increases 10- to 19-fold when flushing the small and large veins investigated here. Conclusions: Low TKVO rates (10 mL/h) may not clear the PIVC tip and keep the device patent. Based on our simulations, we propose a TKVO rate of at least 20 mL/h could be used in practice; however, 30–40 mL/h appears most effective across different venous flow rates and peripheral vein sizes. However, this additional fluid load must be carefully considered based on the needs of each patient.

Effect of a Larger Flush Volume on Bioavailability and Efficacy of Umbilical Venous Epinephrine during Neonatal Resuscitation in Ovine Asphyxial Arrest.

The 7th edition of the Textbook of Neonatal Resuscitation recommends administration of epinephrine via an umbilical venous catheter (UVC) inserted 2–4 cm below the skin, followed by a 0.5-mL to 1-mL flush for severe bradycardia despite effective ventilation and chest compressions (CC). This volume of flush may not be adequate to push epinephrine to the right atrium in the absence of intrinsic cardiac activity during CC. The objective of our study was to evaluate the effect of 1-mL and 2.5-mL flush volumes after UVC epinephrine administration on the incidence and time to achieve return of spontaneous circulation (ROSC) in a near-term ovine model of perinatal asphyxia induced cardiac arrest. After 5 min of asystole, lambs were resuscitated per Neonatal Resuscitation Program (NRP) guidelines. During resuscitation, lambs received epinephrine through a UVC followed by 1-mL or 2.5-mL normal saline flush. Hemodynamics and plasma epinephrine concentrations were monitored. Three out of seven (43%) and 12/15 (80%) lambs achieved ROSC after the first dose of epinephrine with 1-mL and 2.5-mL flush respectively (p = 0.08). Median time to ROSC and cumulative epinephrine dose required were not different. Plasma epinephrine concentrations at 1 min after epinephrine administration were not different. From our pilot study, higher flush volume after first dose of epinephrine may be of benefit during neonatal resuscitation. More translational and clinical trials are needed.

Imaging the pediatric retina: An overview.

Recent decade has seen a shift in the causes of childhood blinding diseases from anterior segment to retinal disease in both developed and developing countries. The common retinal disorders are retinopathy of prematurity and vitreoretinal infections in neonates, congenital anomalies in infants, and vascular retinopathies including type 1 diabetes, tumors, and inherited retinal diseases in children (up to 12 years). Retinal imaging helps in diagnosis, management, follow up and prognostication in all these disorders. These imaging modalities include fundus photography, fluorescein angiography, ultrasonography, retinal vascular and structural studies, and electrodiagnosis. Over the decades there has been tremendous advances both in design (compact, multifunctional, tele-consult capable) and technology (wide- and ultra-wide field and noninvasive retinal angiography). These new advances have application in most of the pediatric retinal diseases though at most times the designs of new devices have remained confined to use in adults. Poor patient cooperation and insufficient attention span in children demand careful crafting of the devices. The newer attempts of hand-held retinal diagnostic devices are welcome additions in this direction. While much has been done, there is still much to do in the coming years. One of the compelling and immediate needs is the pediatric version of optical coherence tomography angiography. These needs and demands would increase many folds in future. A sound policy could be the simultaneous development of adult and pediatric version of all ophthalmic diagnostic devices, coupled with capacity building of trained medical personnel.

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OPINION Reactions ShareShare onFacebookTwitterWechatLinked InRedditEmail C&EN, 2021, 99 (9), p 3March 15, 2021Cite this:C&EN 99, 9, 3Letters to the editorCOVID-19 special issueI was blown away by the Jan. 18/25, 2021, edition on COVID-19. The entire issue was extremely thorough, well written, well edited, and incredibly informative. This is the most standout issue I have come across in my 30 years as a member. It was true journalistic excellence, and hopefully all those involved will be nominated for awards in journalism. Kudos to all involved.Brad SavallSan DiegoACS and death penaltyThe recently appointed editor in chief (EIC) of the distinguished Journal of Medicinal Chemistry, who is also the interim EIC of ACS Pharmacology and Translational Science and formerly the EIC of ACS Chemical Neuroscience, was one of two medical experts consulted by the US Department of Justice in 2017 regarding the constitutionality of an execution protocol for federal prisoners convicted of capital crimes and sentenced to death. According to publicly available documents, this protocol involves administration of 2 × 2.5 g of pentobarbital sodium in 50 mL of diluent followed by 60 mL of saline flush, after which the “inmate will be examined by a specified qualified person . . . to ensure that death has occurred.”Under a letterhead that included his position as EIC of ACS Chemical Neuroscience, the EIC advised in a publicly available document, “In my expert opinion, based on deep knowledge of the pharmacology of pentobarbital sodium, the protocol as drafted will produce a humane death with limited suffering and pain.”According to records at the Death Penalty Information Center, this protocol was used to execute 13 federal prisoners during the final weeks of the Trump administration—6 Black men, 1 Native American man, 1 White woman, and 5 White men.These are not the pages in which the constitutionality of the death penalty should be debated. However, these are the pages in which it is right to question the association of the American Chemical Society and its journals with this debate. The constitution of our society declares that our purpose is to “be concerned with the worldwide application of chemistry to the needs of humanity.” In my opinion, our constitution is a moral compass, pointing toward a world in which our society and our chemistry must focus on how to improve human life, not how to end it.David W. ChristiansonPhiladelphia CorrectionsFeb. 1, 2021, page 12: In the news story on the US plan to join a treaty on hydrofluorocarbons, the last word of the caption is cut off. It should read “Joe Biden’s executive order on climate includes provisions on environmental justice.”March 8, 2021, page 23: The feature story on nonanimal leathers incorrectly identifies the mushroom leather sample shown in a photo. The product is called Mylea, not Mylo.

Randomised trial of epinephrine dose and flush volume in term newborn lambs

ObjectivesNeonatal resuscitation guidelines recommend 0.5–1 mL saline flush following 0.01–0.03 mg/kg of epinephrine via low umbilical venous catheter for persistent bradycardia despite effective positive pressure ventilation (PPV) and chest compressions...

Differences Between CT-Perfusion and Biphasic Contrast-enhanced CT for Detection and Characterization of Hepatocellular Carcinoma: Potential Explanations for Discrepant Cases.

To compare the diagnostic value of liver perfusion computed tomography (PCT) and biphasic contrast-enhanced CT (bpCECT) for detection and characterization of hepatocellular carcinoma (HCC), and to identify potential causes for inter-modal discrepancies. In this retrospective study, 162 cases with a total of 325 HCC-typical lesions were evaluated using both PCT and bpCECT (mean time between examinations=15 days, range=0-13 days). HCC diagnosis was performed by multi-modality imaging including lesion growth at follow-up. For PCT, a total acquisition time of 40 s (26 measurements) each 1.5 s using 80 kV and 100 mAs, as well as 50 ml iodine contrast agent (at 5 ml/s) covering the entire liver was used. Mean arterial liver perfusion (ALP), portal venous perfusion (PVP) and hepatic arterial index (HPI) for both tumor and non-involved liver parenchyma; mean blood flow, blood volume and k-trans for tumor were quantified. Tumor localization, and size were registered. bpCECT consisted of unenhanced, arterial (30-33 s delay), and portal-venous (70-75 s) phases performed using 120 kV, 200-250 mAs, thin-slice reformates (<1 mm), 100 ml contrast agent (at 3 ml/s) followed by 50 ml saline flush. Finally, we divided the results according to detection by PCT only (i.e. missed by pbCECT), and by both PCT and pbCECT. PCT detected 272 lesions compared to 217 with bpCECT only. HCCs in liver segments 4 and 5 were significantly better detected by PCT (p<0.005). Furthermore, PCT detected significantly smaller HCCs than did bpCECT (p<0.001). Lesions detected by both methods had significantly higher mean ALP (p=0.03) and HPI (p=0.02), and lower mean PVP (p=0.01). Tumor blood flow, blood volume and k-trans proved not to be significant for lesion detection. The mean ALP, HPI, and PVP in inconspicuous cirrhotic liver were also not significant for lesion detection. The PVP(tumor)/HPI(liver) ratio of detected lesions was significantly higher for PCT alone (p=0.04). Pretreated, still vital lesions were better detected by bpCECT. Detection of smaller HCC lesions, lesions located in liver segments 4 and 5, as well as lesions presenting lower ALP and HPI, and higher PVP(tumor)/HPI(liver) ratio was better using both methods, emphasizing the important role of PCT.

Efficacy of Ethanol Ablation for Benign Thyroid Cysts and Predominantly Cystic Nodules: A Systematic Review and Meta-Analysis.

BackgroundUltrasound-guided minimally invasive procedures are widely used to treat thyroid diseases. The objective of this study was to assess the efficacy and safety of ethanol ablation (EA) in comparison with other non-surgical options in the treatment of benign thyroid cystic nodules.MethodsWe conducted a systematic search of studies on EA for thyroid cystic nodules, mainly in the Ovid-MEDLINE and Embase, Web of Science, and Cochrane databases. The standardized mean difference (SMD) of the volume reduction ratio (VRR) after EA versus other non-surgical treatments comprised the primary outcome, whereas the odds ratio (OR) of therapeutic success rates between the two groups comprised the secondary outcome.ResultsThe meta-analysis included 19 studies (four randomized controlled trials and 15 non-randomized studies) with 1,514 participants. The cumulative VRR of EA was 83.908% (95% confidence interval [CI], 79.358% to 88.457%). EA had a significantly higher pooled VRR (SMD, 0.381; 95% CI, 0.028 to 0.734; P=0.030), but not a significantly higher pooled therapeutic success rate (OR, 0.867; 95% CI, 0.132 to 5.689; P=0.880), than other forms of non-surgical management including radiofrequency ablation (RFA), polidocanol sclerotherapy, and simple aspiration with or without saline flush. However, the VRR and therapeutic success rate were not significantly different between EA and RFA. Major complications were recorded only in six patients (0.53%) with self-limiting dysphonia.ConclusionThe role of EA as the first-line treatment for benign thyroid cysts and predominantly cystic nodules is supported by its high effectiveness and good safety profile compared to other currently available non-surgical options.

A development study of drain fluid gastrografin as a biomarker of anastomotic leak.

PurposeAnastomotic leakage (AL) is the anathema of colorectal surgery. Its occurrence leads to increased morbidity and mortality and a prolonged hospital stay. Much work has gone into studying various biomarkers in drain fluid to facilitate early detection of AL. This stage 2a development study aims to assess the safety and feasibility of reliably detecting the iodine in Gastrografin (GG; Bayer Australia Ltd.) in drain fluid and stool samples by dual-energy computed tomography (DECT).MethodsThis is a prospective, observational, controlled, consecutive cohort study establishing the safety and feasibility of the detection of GG in surgical drain fluid and stool as a biomarker of AL when patients with a low pelvic colorectal anastomosis undergo luminal flushing of the rectal tube with GG.ResultsTen consecutive patients were allocated to the saline flush group and the following 10 to the GG flush group. Three patients in the saline flush group developed an AL. One patient in the GG flush group developed an AL. An elevation in the drain fluid GG was detected using DECT on the day of clinical deterioration. None of the patients in the control group were found to have a positive result on DECT.ConclusionThis study demonstrates the safety of a novel approach to the early detection of AL from extraperitoneal colorectal anastomoses. The technique requires validation in a larger cohort and a multicenter study is planned to investigate the efficacy of GG rectal tube flushes as an early biomarker of AL in low pelvic anastomoses.

Functional assessment of intermediate coronary artery stenosis with 4-Fr catheters.

The 4-Fr catheter system is not recommended for invasive functional assessment of coronary artery stenosis, because it tends to distort the aortic waveform. This study aimed to identify the incidence of aortic waveform distortion and a feasible method for correct diagnosis of coronary artery stenosis with a 4-Fr catheter. We retrospectively investigated 178 lesions with intermediate coronary artery stenosis. Non-hyperemic distal coronary artery pressure (Pd) and aortic pressure (Pa) were measured with a 4-Fr diagnostic or 6-Fr guiding catheter before and after saline flush. The mean Pd/mean Pa (Pd/Pa) and instantaneous wave-free ratio (iFR) were calculated before and after flushing. We compared the effect of flushing on the changes in Pd/Pa and iFR between the 4-Fr diagnostic and 6-Fr guiding catheters. Using the 4-Fr diagnostic catheter, there was a significant decrease in incidence of aortic waveform distortion from 42.0% (47 lesions) before flushing to 1.8% (2 lesions) after flushing (p < 0.001); the incidence was only 3.0% before saline flush and decreased to 0% after saline flush when using the 6-Fr guiding catheter. The presence of aortic waveform distortion influenced the iFR when the 4-Fr system was used. Functional measurements with the 4-Fr diagnostic catheter require adequate saline flush to remove the influence of aortic waveform distortion.

T1 mapping and late gadolinium enhancement for the diagnosis of dilated cardiomyopathy

To explore the role of T1 mapping and late gadolinium enhancement (LGE) for detection of dilated cardiomyopathy (DCM). Thirty-two DCM patients detected by ultrasonic testing with unknown origin heart failure from April 2018 to November 2019 were involved. In addition, they were compared with 18 physical examiner under cardiac magnetic resonance imaging (CMRI) in the same period. Phillip's Ingenia 3.0T MRI was used to examine heart function, plain scan included cine, T2 weighted imaging (T2WI) and pre-contrast native T1 mapping. The enhancement scan included perfusion weighted imaging, LGE imaging and post-contrast post T1 mapping. Using gadolinium injection, a bolus of 0.1 mL/kg of gadolinium-based contrast followed by a 20 mL saline flush was administered. After a 7-minute later start scanning, delay enhance sequence was started, including 4 layers, 2 cavities and 4 cavities. LGE and T1 mapping results were observed, including cardiac function indexes [left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), valvular regurgitation], cardiac morphological indexes [left ventricular mass (LVM)], histological characteristics (T2WI myocardial signal, presence of perfusion defect and its position and scope, presence of delayed enhancement and its position, shape and scope, pre- and post-contrast T1 values), extracellular volume (ECV) and the accompanying signs (pericardial effusion and pleural effusion). The receiver-operating characteristic curve (ROC) was drawn, the diagnostic value of T1 value of pre-contrast T1 mapping for DCM was evaluated, and the occurrence of clinical endpoint events was observed. There were no statistically significant differences in DCM patients with gender, age, body mass index (BMI), blood pressure, heart rate (HR), hematocrit (HCT), creatinine (Cr), family history of hypertension or heart disease. In DCM group N-terminal brain natriuretic peptide precursor (NT-proBNP) level and proportion of patients with heart function level III, diabetes, smoking history, drinking history and medication history were significantly higher than those in control group. Compared with control group, LVEDV (mL/m2: 234.9±35.9 vs. 121.8±27.6), LVESV (mL/m2: 189.7±42.8 vs. 54.8±17.0), LVM (g: 197.6±56.3 vs. 110.5±22.9), pre-contrast T1 values (ms: 1 332.1±35.9 vs. 1 272.0±47.0), ECV [(45.7±4.9)% vs. (28.0±2.1)%] were significantly increased in the DCM group; LVEF (0.191±0.107 vs. 0.554±0.103), post-contrast T1 values (ms: 453.9±72.7 vs. 493.5±43.9) were significantly decreased (all P < 0.05). In DCM group, the proportions of valvular regurgitation, pericardial effusion and pleural effusion were 25.0%, 18.8% and 25.5%, respectively. ROC curve analysis showed that the cutoff value of pre-contrast T1 values was 1 220.22 ms, the area under ROC curve (AUC) was 0.84 (P = 0.015), the sensitivity and specificity were 77.8% and 88.9%, indicating that pre-contrast T1 values may be a certain prediction for diagnosis of DCM. In 32 patients with DCM, 22 cases (68.8%) had LGE in position wall, interventricular septum, inferior wall or under the epicardium, with local or multiple diffuse, 9 cases (28.1%) were both interventricular septum and inferior wall involved. During an average of 16 months follow-up, 3.1% patients appeared sudden cardiac death. One-stop CMRI can improve the diagnostic efficacy of DCM, and T1 mapping with LGE imaging can improve the diagnostic accuracy, which is very meaningful for diagnosis and follow-up of patients.

The glucose error in arterial sampling: assessing staff awareness and the effect of sampling technique*

Using a dextrose-containing solution, instead of normal saline, to maintain the patency of an arterial cannula results in the admixture of glucose in line samples. This can misguide the clinician down an inappropriate treatment pathway for hyperglycaemia. Following a near-miss and subsequent educational and training efforts at our institution, we conducted two simulations: (1) to observe whether 20 staff would identify a 5% dextrose/0.9% saline flush solution as the cause for a patient's refractory hyperglycaemia, and (2) to compare different arterial line sampling techniques for glucose contamination. (1) Only 2/20 participants identified the incorrect dextrose-containing flush solution, with the remainder choosing to escalate insulin therapy to levels likely to risk fatality, and (2) glucose contamination occurred regardless of sampling technique. Despite national guidance and local educational efforts, this is still an under-recognised error. Operator-focussed preventative strategies have not been effective and an engineered solution is needed.

Diagnosis of Breast Micro calcifications with Contrast Enhanced Digital Mammography and Histopathological Correlation

Abstract Backgroud: Microcalcificaitons constitute up to 31% of lesions detected at screening mammography. Ductal carcinoma in situ (DCIS) often presents with microcalcificaitons on mammography. Of all mammographically detected DCIS lesions, up to 79% manifest with microcalcifications only. However, not all microcalficications are associated with in situ or malignant disease. Aim of Study: To evaluate diagnostic value of contrast enhanced digital mammography in breast microcalcificaations. Methods: A retrospective study of 30 patients having mammographic suspicious breast calcifications under BIRADS 4, 5 and 6 categories. A high-energy and a low-energy digital mammograms were obtained and then images were subtracted, isolating the iodine signal in the region of angiogenesis. 1.5mg/kg of the contrast agent was injected by hand over a period of 1 minute at a rate of 3mL per second, followed by a saline solution flush. Breast compression was applied to reduce the thickness of the breast and images obtained exactly 2 min after contrast administration. Image acquisitions: Cranio-caudal and the medio-lateral oblique projections for the abnormal breast were obtained exactly 2 minutes after contrast injection followed by cranio-caudal and medio-lateral oblique projections of the normal breast. The lesions were analyzed by specialized radiologist for the presence, morphology, and pattern of enhancement. Finally, Correlation with histopatho-logical findings was done. Results: The sensitivity of CEDM in detecting malignant pathology with contrast uptake was 96%. Compared to sensi-tivity of 86.7% in FFDM. There were lesions of IDC in (69.2%), lesion of DCIS in (11.5%), lesion of IDCS & IDC in (11.5%) and lesions of ILC in (3.8%). Enhancement was also observed in 3/4 (75%) of the benign lesions. Conclusion: Dual-energy contrast-enhanced digital mam-mography is a useful technique in the diagnosis of underlying disease in mammographically detected breast microcalcifica-tions.

Time to peak enhancement of malignant hypervascular hepatic tumors versus that of the aorta evaluating by test bolus sequence of magnetic resonance imaging

PurposeTo determine the relationship between time to peak enhancement (TPE) of malignant hypervascular hepatic tumors and that of the aorta. MethodSixty patients with malignant hypervascular hepatic tumors (48 with hepatocellular carcinoma and 12 with metastatic neuroendocrine tumor) who received abdominal MRI with test bolus sequence between January 2015 and May 2019 were enrolled. The test bolus images were monitored every 3 s after the injection of 2 mL gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) and 10 mL saline flush, to evaluate the TPE of the tumors and aorta. We used linear regression with a least squares approach to show the relationship between TPE of the malignant hypervascular hepatic tumors and that of the aorta. ResultsTPE of malignant hypervascular hepatic tumors and abdominal aorta were 43.4 ± 12.9 and 23.3 ± 7.4 s, respectively (mean ± standard deviation). In univariate regression analysis, the TPE of malignant hypervascular hepatic tumors have a positively linear correlation with that of the aorta by the following equation: (TPE of malignant hypervascular hepatic tumor) = 1.4 X (TPE of the aorta) + 10.6 s (r = 0.65, p < 0.005). ConclusionsTPE of malignant hypervascular hepatic tumors can be predicted by a simple linear transformation from that of the aorta.

Agitated saline contrast to delineate central venous catheter position in neonates.

Central venous catheter (CVC) insertion is required for the management of sick neonates. Ultrasonography/targeted neonatal echocardiography (TNE) with/without normal saline (NS) flush is used to identify CVC position. The present study compared the visibility and safety of agitated saline (AS) with normal saline (NS) flush. This prospective interventional study included 110 CVC insertions, both umbilical venous catheterization (UVC) and peripherally inserted central catheterization (PICC). Catheter position was monitored by real-time TNE. Overall visibility of catheter tip (combined UVC and PICC) was significantly better in AS (n = 55) compared with NS group (n = 55) [48/55 (87.2%) vs. 28/55 (50.9%); p < 0.0001]. Time to detect catheter tip by AS push was significantly less than that of NS push. There was no difference in the amount of saline flush required with either method. No major adverse effect was observed. AS push can be used as a safe method to delineate CVC position in neonates.

Heparin Flush Use in Transfemoral Cerebral Angiography Survey

The drug concentration of heparinized saline used for transfemoral catheter angiography flush during different types of cerebral angiogram procedures varies among providers and centers worldwide. Although heparin is recommended for use during cerebral angiograms to minimize the risk of thromboembolic events associated with the utilization of multiple endovascular devices and lengthy procedures, there is a paucity of information available regarding protocols for administration of heparin and heparinized saline. Higher concentrations of heparinized saline flush may benefit patients undergoing elective nonruptured intracranial aneurysm embolization procedures by decreasing the risk of thromboembolism. However, it could potentially place patients undergoing revascularization procedures for acute ischemic stroke at higher risk of symptomatic intracerebral hemorrhage, particularly if they received intravenous tissue plasminogen activator immediately before endovascular thrombectomy. After obtaining permission from the Association for Radiologic and Imaging Nursing (ARIN) Board of Directors, a survey was presented in English and electronically distributed by the ARIN to all current and past ARIN members with valid e-mail addresses. The survey was preceded by an introductory letter explaining the study purpose and its voluntary nature. Response to the survey was identified as consent to participate. Subjects were asked to participate if they were currently involved in the management of patients undergoing cerebral angiography with a variety of interventions including management of acute ischemic and hemorrhagic stroke. There is a paucity of evidence supporting use of a specific concentration of heparinized saline solution. It ranges from no heparin added to concentrations exceeding 5 units/mL for transfemoral flush. The most frequently used concentration is 2 units/mL (32.8–34.8% of respondents depending on endovascular intervention), and the least frequently utilized concentrations are 3 units/mL and higher than 5 units/mL (4.3–5.7% of respondents depending on endovascular intervention). Mixing and labeling bags with heparinized saline flush was noted to be the responsibility of interventional radiology registered nurse (39%, n = 46), pharmacy (26.3%, n = 31), or the angiography technologist (8.5%, n = 10). More than quarter (26.5%) of respondents noted not having readily available premixed heparinized saline flush. Twenty-four (20.3%) of survey participants claimed using only premixed bags of heparinized saline solution. Despite the Institute for Healthcare Improvement, Institute for Safe Medication Practices and Joint Commission recommendations, there are no standard protocols across stroke centers identifying optimal heparinized saline flush solution concentration, preparation, and documentation. Replication of this survey among members of the American Society of Neuroradiology is recommended to validate the findings from the present study. If confirmed, a consensus on safety of heparinized saline flush use during neuroradiology interventions is strongly advised.