Selective Catheterization Research Articles

Effect of topical application of black pepper essential oil on peripheral intravenous catheter insertion: A randomized controlled study

ObjectiveThe literature describes many techniques to increase vein visibility and palpability that facilitate peripheral intravenous catheter insertion. However, there is only one study examining the effect of topical essential black pepper oil on veins. We aimed to determine the effects of topical application of black pepper essential oil on peripheral intravenous catheter insertion success. MethodsThis randomized controlled trial was carried out on 60 patients randomly assigned to either the experimental group (n=30) or the control group (n=30) reporting to the endoscopy unit of the clinic between May 2019 and October 2019. The study results were evaluated using an information form, a catheter insertion form, and a visual analog scale (VAS). In the experimental group, black pepper essential oil was used to increase vein degree before the procedure, while in the control group, no extra interventions were applied. The time taken in determining an appropriate vein, time taken for successful catheter insertion, and the patient's and nurse's satisfaction after the process were recorded. ResultsSignificant improvements in vein degree were detected after the experimental group's oil application (p1<0.001). The period of appropriate vein selection and successful catheter insertion showed a statistically significant decrease in the experimental group (p<0.05). The satisfaction levels of patients and nurses in the control group were significantly lower than those of the patients from the experimental group (p<0.05). ConclusionTopical black pepper oil application can increase the vein degree and the success of the procedure.

Percutaneous Trans-Hepatic Embolization of an Iatrogenic Extra-Hepatic Pseudoaneurysm of the Right Hepatic Artery in a Patient With Previous Occlusion of the Proper Hepatic Artery: An Endovascular Procedure to Avoid a Difficult Surgical Repair

We report a case of successful percutaneous transhepatic, embolization of an iatrogenic extra-hepatic pseudoaneurysm (PsA) of the right hepatic artery (RHA) under combined fluoroscopic and ultrasonographic guidance. A 73-year-old man underwent percutaneous transhepatic biliary drainage placement in another hospital, complicated by haemobilia and development of a RHA PsA. Endovascular embolization was attempted, resulting in coil embolization of the proper hepatic artery, and persistence of the PsA. At this point, the patient was referred to our hospital. Computed tomography and direct angiography confirmed the iatrogenic extra-hepatic PsA of the RHA, refilled by small collaterals from the accessory left hepatic artery (LHA) and coil occlusion of the proper hepatic artery. Attempted selective catheterization of these vessels was unsuccessful due to the tortuosity and very small caliber of the intra-hepatic collaterals, the latter precluding endovascular treatment of the PsA. Percutaneous trans-hepatic combined fluoroscopic and ultrasound-guided embolization of the PsA was performed with Lipiodol® and cyanoacrylate-based glue (Glubran®2). Real time fluoroscopic images and computed tomography confirmed complete occlusion of the pseudoaneurysm. Surgical repair, although feasible, was considered at high risk. In our patient, we decided to perform a percutaneous trans-hepatic combined fluoroscopic and ultrasound-guided embolization of the PsA using a mix of Lipiodol® and Glubran®2 because of the fast polymerization time of the glue allowing the complete occlusion of the PsA in few seconds, thus eliminating the risk of coil migration, reducing the risk of PsA rupture and avoid a difficult surgical repair.

Kardiyovasküler Girişimler için Kullanılan Santral Venöz Kateterlerden İzole Edilen Patojenlerin Değerlendirilmesi

Objective: To evaluate the isolated pathogens in patients who underwent central venous catheterization due to cardiovascular procedures. Materials and Methods: Patients were monitored daily for the development of catheter related infections. Between April 2017 and July 2019, patients who exhibited infection symptoms like discharge, fever, pain, lymphadenopathy and itching after the catheterization were included in this retrospective study. Patients’ catheter types, catheter insertion sites, total catheterization durations, culture results, sensitivities and resistances of pathogens against antimicrobial drugs were recorded and analyzed. Results: Eighty-six patients who underwent central venous catheterization due to various indications were included. Mean age of patients was 52.70±17.82 years. Bacterial growth was found in 62.79% of patients. The most common catheter insertion sites were right subclavian vein, right jugular vein and right femoral vein. The most commonly isolated microorganism was S. aureus by 25.58% followed by E.coli (6.98%), S. haemolyticus (5.81%) and K.pneumonia (5.81%). S. aureus was detected to be sensitive to vancomycin and linezolid. Conclusion: Factors affecting incidence of these infections include catheter insertion site, catheterization duration, catheter selection and skills of the practitioners. Data in literature about the pathogens isolated in catheter-related infections and their sensitivity and resistance to antimicrobial agents are mostly old. Further comprehensive, multicenter studies are needed on this issue.

Risk factors for ophthalmic artery stenosis and occlusion in patients with retinoblastoma treated with intra-arterial chemotherapy

PurposeTo explore the risk factors for ophthalmic artery (OA) stenosis and occlusion after intra-arterial chemotherapy (IAC) with selective ophthalmic artery catheterisation (OAC) in the treatment of retinoblastoma.DesignRetrospective, single centre case-control...

Catheter Selection and Angiographic Views for Anomalous Coronary Arteries: A Practical Guide.

Although congenital coronary artery anomalies are relatively rare, they are the second most common cause of sudden cardiac death among young athletes. When encountered in the cardiac catherization laboratory, they are often challenging to selectively engage, requiring multiple catheters, plus increased contrast volume and radiation exposure. In the setting of acute coronary syndromes, it is not infrequent that percutaneous intervention is delayed because of the inability to engage an anomalous coronary artery. The aim of this review is to provide a comprehensive and concise overview of coronary artery anomalies, with particular attention to diagnostic and guide catheter selection for each type of anomaly and recommendations on how to recognize the vessel course angiographically.

Abstract No. 182 Evaluation of adjunctive collimated C-arm computed tomography in adrenal venous sampling and its effect on successful selective catheterization

Evaluation of feasibility and effect of a novel approach to adrenal venous sampling (AVS) analysis by combination of established selective cortisol and aldosterone indices with acquisition of a collimated C-arm CT (CACTColl). Overall, 100 AVS procedures in 97 consecutive patients (38f, 59m; 53 ± 8 years), performed from January 2014 to February 2020 in a single institution, were included in this retrospective study. Sequential samples of cortisol and aldosterone levels of the suspected adrenal veins and the right iliac vein were obtained and selectivity indices (SI) for both hormones computed, by dividing the central plasma cortisol/aldosterone concentration in the adrenal vein by the peripheral value in the iliac vein. Successful AVS procedures were defined either by stand-alone SICortisol and/or SIAldosterone≥2.0 as well as SICortisol and/or SIAldosterone≥1.1 in combination with positive right-sided CACTColl of the adrenals (n = 79). Radiation exposure of CACT was measured via dose area product (DAP) and weighed against an age- and weight-matched cohort of 66 patients receiving liver-directed therapy at our center. The preliminary success rate measured by either a SICortisol and/or SIAldosterone≥ 2.0 lay at 99.3% on the left and 72.6% on the right side, corresponding to sensitivity rates of 0.99 and 0.73, respectively, and could be significantly improved by addition of a positive CACTColl, adding up to a 91% success rate on the right. Sensitivity for stand-alone collimated CACT (CACTColl) could be computed at 0.93, with a total of 74 of 79 acquired CACTColl confirming selective cannulation by adrenal vein opacification. Mean DAPColl_CACT measured 2400 ± 940 μGy × m2, while mean DAPFull-FOV_CACT in the matched cohort measured 8700 ± 1900 μGy × m2 (P< 0.001). Significantly increased success rates in (right-sided) selective cannulation of AVS procedures could be achieved by combining established hormone indices with collimated CACT. This offers a successful alternative to previously published AVS analysis algorithms with lower radiation exposure as compared to a full-FOV CACT. Significantly increased success rates in (right-sided) selective cannulation of AVS procedures could be achieved by combining established hormone indices with collimated CACT. This offers a successful alternative to previously published AVS analysis algorithms with lower radiation exposure as compared to a full-FOV CACT.

Transarterial management of advance lung cancer.

Previous reports on transarterial treatment for lung cancer were reviewed. The bronchial arterial infusion therapy has a long history since 1964. Better local control with less doses of anti-neoplastic agents was warranted by trying transarterial administration to lung and mediastinal tumors. It is reported that both primary and metastatic tumors are fed by bronchial or other systemic arteries. The bronchial arterial embolization for hemoptysis has been introduced for clinical practice since 1973. Hemoptysis by not only benign but also malignant diseases has been well controlled by embolization. In recent decades, the technical elements for transarterial treatments have markedly improved. They make it possible to carry out precise procedures of selective catheter insertion to the tumor relating arteries. Current concepts of transarterial treatment, technical aspects and treatment outcomes are summarized. Tentative result from chemo-embolization for advanced lung cancer using recent catheter techniques was also described. It provides favorable local control and survival merits. It is considered that a population of lung cancer patients can benefit from transarterial management using small doses of anti-neoplastic agents, with less complications and less medical costs.

Choosing the Right Catheter for Pediatric Procedures: Patient Considerations and Preference.

Determining the need for bladder decompression and urinary diversion in the perioperative pediatric surgical patient can cause a clinical conundrum for the surgical team. Add in the several different types of urinary diversion devices possible, and the various materials associated therein and the process can suddenly seem unnecessarily daunting given the lack of concise recommendations and broad consensus. The decision to divert urine, though seemingly trivial, is associated with inherent risks. Managing and mitigating certain risks are best approached through proper education, selection, and technique. We provide a broad overview of pediatric catheter selection, indications, and pitfalls to streamline the process so that energy and attention can best be focused on the planned intervention at hand.

The Michigan Appropriateness Guide for Intravenous Catheters in children with congenital heart disease: miniMAGIC-CHD.

The approach to vascular access in children with CHD is a complex decision-making process that may have long-term implications. To date, evidence-based recommendations have not been established to inform this process. The RAND/UCLA Appropriateness Method was used to develop miniMAGIC, including sequential phases: definition of scope and key terms; information synthesis and literature review; expert multidisciplinary panel selection and engagement; case scenario development; and appropriateness ratings by expert panel via two rounds. Specific recommendations were made for children with CHD. Recommendations were established for the appropriateness of the selection, characteristics, and insertion technique of intravenous catheters in children with CHD with both univentricular and biventricular physiology. miniMAGIC-CHD provides evidence-based criteria for intravenous catheter selection for children with CHD.

An Enhanced Algorithm for Image Processing Based Catheter Selection During Right Coronary Angiography

Background: Image processing based catheter selection is a newly developed procedure in which a catheter is selected based onpatient's image data, acquired prior to the intervention. In this technique, the arteries are extracted from the data followed by thecomputation of geometric parameters for all available catheters.Objectives: To propose an improved algorithm for estimating geometric parameters such as coronary artery curve angle andlength of the coronary artery curve.Material&amp; Methods: We propose a new framework to compute the geometric parameters from the patient magnetic resonance /computed tomography images. In order to meet the clinical time constraint, we calculate CACA and CACL in 3D MR cardiacimages of the patients.Results: The method has been tested on seven MR cardiac images provided by Unieklinikum Wrzburg. The results show moreaccuracy and less computation time as compared to the already developed method.Conclusion: The proposed algorithm uses an enhanced method for extracting 3D curve to calculate the angle and there by greatlyreduces the computation time and improves the accuracy.Keywords: Optimal catheter; Right coronary angiography; Catheter selection; Landmarks; Geometricparameter

An Enhanced Algorithm for Image Processing Based Catheter Selection During Right Coronary Angiography

An Enhanced Algorithm for Image Processing Based Catheter Selection During Right Coronary Angiography

Charcot-Bouchard Aneurysm Diagnosed with CTA and MRA

Hemorrhage in the basal ganglia resulting to lenticulostriate artery aneurysm rupture is extremely rare. This distal micro-aneurysm of the perforating lenticulostriate arteries is called Charcot-Bouchard aneurysm. We wish to report a case of an hematoma in the basal ganglia due to a Charcot-Bouchard aneurysm demonstrated by Computed Tomography Angiograpy (CTA) and Magnetic Resonance Angiography (MRA) and confirmed by selective catheter angiography.Teaching Point:Charcot-Bouchard aneurysm is a very rare distal micro-aneurysm of the perforating lenticulostriate arteries. Young patients who experience basal ganglia hemorrhage should have contrast-enhanced CT, especially if they don’t have arterial hypertension and if subarachnoid hemorrhage is associated.

Simultaneous needle catheter selection and dwell time optimization for preplanning of high-dose-rate brachytherapy of prostate cancer

Purpose. Needle catheter positions critically affect the quality of treatment plans in prostate cancer high-dose-rate (HDR) brachytherapy. The current standard needle positioning approach is based on human intuition, which cannot guarantee a high-quality plan. This study proposed a method to simultaneously select needle catheter positions and determine dwell time for preplanning of HDR brachytherapy of prostate cancer. Methods. We formulated the needle catheter selection problem and inverse dwell time optimization problem in a unified framework. In addition to the dose objectives of the planning target volume (PTV) and organs at risk (OARs), the objective function incorporated a group-sparsity term with a needle-specific adaptive weighting scheme to generate high-quality plans with the minimal number of needle catheters. The optimization problem was solved by a fast-iterative shrinkage-thresholding algorithm. For validation purposes, we tested the proposed algorithm on 10 patient cases previously treated at our institution and compared the resulting plans with plans generated using needle catheters selected manually. Results. Compared to the plan with manually selected needle catheters, when normalizing both plans to the same PTV coverage V 100% = 95%, the plans generated by the proposed algorithm reduced median V 125% from 65% to 64%, but increased median V 150% from 35% to 38%, and V 200% from 14% to 16%. All planning objectives were met. All clinically important dosimetric parameters of OARs were reduced. D 1cc of bladder and rectum were reduced from 8.57 Gy to 8.50 Gy and from 7.24 Gy to 6.80 Gy, respectively. D max of urethra was reduced from 15.85 Gy to 15.77 Gy. The median number of selected needle catheters was reduced by two. The computational time for solving the proposed optimization problem was ∼90 s using MATLAB. Conclusion. The proposed algorithm was able to generate plans for prostate cancer HDR brachytherapy preplanning with increased median conformity index (0.73–0.77) and slightly lower median homogeneity index (0.64–0.62) with the number of selected needles reduced by two compared to the manual needle selection approach.

National expert consensus on the operation and management of deep vein catheterization in severe burn patients (2020 version)

Deep vein catheterization is an important method to prevent and treat burn shock in severe burn patients, monitor hemodynamic changes and provide venous nutritional support. Although deep vein catheterization has been applied widely, there is no standard operation and management process. In order to guide the operation and management of deep vein catheterization in severe burn patients in a more scientific and standard manner, the consensus writing group organized domestic experts in burn field, most of whom are members of the 10th Committee of Chinese Burn Association to discuss and reach a consensus mainly in selection of deep vein catheter and the catheterization site, the method of catheterization operation, catheter maintenance, and prevention and treatment of catheter-related complications. This consensus aims to provide practical basis and guidance for the operation and management of deep vein catheterization in severe burn patients.

Truncus Bicaroticus With Arteria Lusoria: A Rare Combination of Aortic Root Anatomy Complicating Cardiac Catheterization.

While most patients with arteria lusoria and common carotid trunk conditions are asymptomatic, discovery of such anomalies periprocedurally may affect the cardiac catheterization access site, catheter selection, and additional imaging.

A Novel Endovascular Therapy for CSF Hypotension Secondary to CSF-Venous Fistulas.

We report a consecutive case series of patients who underwent transvenous embolization of the paraspinal vein, which was draining the CSF-venous fistula, for treatment of spontaneous intracranial hypotension. These are the first-ever reported cases of this treatment for CSF-venous fistulas. All patients underwent spinal venography following catheterization of the azygous vein and then selective catheterization of the paraspinal vein followed by embolization of the vein with Onyx. All patients had improvement of clinical and radiologic findings with 4 patients having complete resolution of headaches and 1 patient having 50% reduction in headache symptoms. Pachymeningeal enhancement resolved in 4 patients and improved but did not resolve in 1 patient. Brain sag resolved in 4 patients and improved but did not resolve in 1 patient. There were no cases of permanent neurologic complications. All patients were discharged home on the day of the procedure.

Evaluation of 3D printing in planning, practicing, and training for endovascular lower extremity arterial interventions.

Background In this study, we aimed to investigate the potential role of 3D-printed physical and digital anatomical models in pre-procedural planning, practice and training in lower extremity arterial interventions. Methods A total of 16 patients (9 males, 7 females; mean age: 72.1±1.5 years; range, 69 to 75 years) who underwent superficial femoral artery balloon angioplasty between February 2016 and April 2019 were retrospectively reviewed for vascular access site preference and balloon sizing. Pre-procedural computed tomography volumetric images used for diagnosis were analyzed and modeled with 3D printing. Procedural and 3D-based data regarding the size of the balloon and deployment sites and the severity of the stenosis were compared. Results Measurements obtained from 3D models manually and segmentation images from software were similar (p>0.05). Both were smaller than the actual size of balloons used (p<0.001). Stenosis severity was similar with manual and software methods and both were significantly lower than the reported quantitative angiographic measurements (p<0.001). Vascular access site preference was changed in five (31.2%) patients, when the model was simulated by a non-sterile practice on 3D-printed physical models. The wire and catheter selection differed in eight patients, while practicing with models. Conclusion The planning and practicing of lower extremity arterial procedures with 3D models may reduce operator-dependent variables, avoid unnecessary interventions, reduce endothelial damage, and increase procedural success. The 3D-printed models may be used for educational purposes for medical professionals.

Safety and efficacy of prostatic artery embolization for large benign prostatic hyperplasia in elderly patients.

ObjectiveTo assess the safety and efficacy of prostatic arterial embolization (PAE) for elderly patients with lower urinary tract symptoms secondary to large benign prostatic hyperplasia.MethodsTwenty-eight patients (>80 years of age) with prostate volume >80 mL were enrolled from October 2016 to October 2019. PAE was performed using microspheres and functional results were evaluated at 1, 3, 6, and 12 months postoperatively. The following data were recorded: International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urine flow rate (Qmax), post-void residual urine volume, prostate volume and total prostate-specific antigen level.ResultsSelective prostatic arterial catheterization and embolization were achieved in 27 of 28 patients. Follow-up data were available for those 27 patients until 12 months postoperatively. Significant improvements were found at all postoperative time points in terms of the mean IPSS, mean QoL score, mean Qmax, mean post-void residual urine volume, mean total prostate-specific antigen level, and mean prostate volume. The overall complication rate was 46.4%.ConclusionsPAE is an efficacious and safe treatment for elderly patients with large prostate volume; it may offer an effective approach for patients who are not candidates for open or endoscopic surgical procedures because of comorbidities.

A giant spontaneous dural arteriovenous fistula of the spheno-parietal sinus clinically masquerading as carotico-cavernous fistula: A case report

Dural arteriovenous fistulas (DAVF) are abnormal connections between the feeding arteries and veins within the dural leaflets and constitute 10%–15% of all intracranial arteriovenous malformations. DAVF draining into sphenoparietal sinus is a rare pathologic entity that is fed by the middle meningeal artery and is associated with a history of prior trauma. We report a unique case of DAVF of sphenoparietal sinus that had developed spontaneously. Being giant in morphology, it had eroded into the orbit and presented with proptosis, chemosis and restriction of eye movement. Although the clinical findings pointed towards caroticocavernous fistula, the real pathomorphology was unveiled by the six-vessel catheter angiography with selective catheterisation of smaller feeding vessels. All the feeding vessels were meticulously mapped out, and the fistulous connection was vividly identified and subsequently obliterated using detachable coils and n-butyl cyanoacrylate.

Pelvic Venous Congestion Secondary to a Circumaortic Renal Collar in an Adolescent Female: Report of a Case

We report a 13-year-old girl who presented with a recurrent abdominal pain that started after her menarche. The abdominal palpation revealed tenderness over the left ovarian point. The laboratory study, ultrasonography, and abdominal X-ray were normal. The computed tomography and magnetic resonance imaging showed a double left renal vein with a retroaortic component, an increased left parauterine circulation, and ipsilateral ovarian vein engorgement. A diagnostic and therapeutic phlebography allowed a selective catheterization of a group of pelvic varicose veins draining to the left ovarian and to the internal iliac veins. There were no complications during the procedure and the symptoms disappeared 2 days later. Circumaortic left renal vein may cause hematuria, proteinuria, pelvic congestion syndrome, and massive hemorrhage during surgery. A conservative treatment is recommended for patients without gynecourological/renal symptoms or with mild hematuria. The endovascular treatment by gonadal venous embolization is safe and effective.