Success Rate Of Catheterization Research Articles

Contrast medium free selective adrenal vein sampling in the management of primary aldosteronism

BackgroundTo analyze contrast free adrenal vein sampling (AVS) for differentiating unilateral from bilateral disease in patients diagnosed with hypertension due to primary aldosteronism (PA). MethodsConsecutive patients with PA and subsequent contrast medium free AVS between April 2015 and March 2020 were retrospectively included. Cross-sectional imaging (CSI), AVS and clinical data were analyzed regarding diagnostic performance. In addition, patients with lateralisation receiving adrenalectomy were compared to a control group treated with mineralocorticoid antagonists. ResultsIn total 186 patients with AVS were included. The success rate for bilateral catheterization was 88% (median effective dose 2.8 mSv). CSI had an accuracy of 60% (CI: 0.52–0.67) in the detection of lateralization compared to AVS. Patients with bilateral adrenal hyperplasia and those with aldosterone-producing adenoma did not differ in systolic blood pressure (sBP) (p = 0.63) or number of antihypertensive drugs (NAD) (p = 0.11). After adrenalectomy, 28 patients were cured (51%; sBP ≤130 mmHg, NAD = 0), 18 were improved (33%; decrease of sBP ≥20 mmHg and NAD), and 8 were unchanged (15%). Serum renin increased significantly after treatment (p < 0.01). ConclusionContrast medium free AVS is a reliable procedure in the diagnostic management of patients with PA with high technical success rate. The accordance between CSI and results from AVS was only moderate indicating the central role of AVS in the diagnostic work-up of patients with PA. Patients with predominant disease diagnosed with AVS had a high cure rate and/or significant improvement after adrenalectomy.

The effects of ultrasound guidance on first-attempt success for difficult peripheral intravenous catheterization: a systematic review and meta-analysis.

Identifying patients at risk of difficult intravenous access (DIVA) and increasing the success rates of peripheral intravenous catheterization (PIVC), preferably on the first catheterization attempt, is of clinical importance. The aim of this study was to compare the use of dynamic ultrasound guidance for PIVC with the traditional technique of visualization and palpation in patients with predicted DIVA. A systematic review and meta-analysis comparing ultrasound-guided PIVC with the traditional technique was performed. Data were systematically collected through MEDLINE and EMBASE databases from inception to March 2021. Eligibility criteria included randomized controlled trials performed on patients meeting criteria for difficult catheterization comprising either (a) no palpable or visible veins, (b) previous history of difficult venous catheterization, (c) patient age less than 4 years, (d) suspicion of difficult catheterization by operator, or (e) two or more unsuccessful attempts using the traditional technique before enrollment were included. For all outcomes, a random-effects meta-analysis using the DerSimonian and Laird method was performed. The primary outcome was the first-attempt success rate, and the secondary outcomes were the overall success rate and the number of attempts for successful intravenous catheterization. Bias was assessed using the Revised Cochrane Risk of Bias tool. Seven studies with a total of 994 patients were included. Patients comprised both children and adults and settings included operating rooms, emergency departments, and intensive care units. Ultrasound guidance was associated with a higher first-attempt success rate (OR, 3.07; 95% CI, 1.66-5.65; P < 0.001). For the secondary outcomes, ultrasound guidance was associated with a higher overall success rate (OR, 3.02; 95% CI, 1.04-8.79; P = 0.04); however, this finding did not meet statistical significance in a sensitivity analysis (OR, 2.90; 95% CI, 0.71-11.93; P = 0.14). Ultrasound was not associated with a significantly different number of attempts compared with the traditional technique (difference in means, 0.14; 95% CI, -0.32 to 0.05; P = 0.15). The use of ultrasound guidance resulted in a three-fold increase in odds for the first-attempt success rate in patients with predicted DIVA compared with the traditional technique of PIVC.

Ultrasound-Guided Infraclavicular Axillary Vein Versus Internal Jugular Vein Cannulation in Critically Ill Mechanically Ventilated Patients: A Randomized Trial.

This clinical trial aimed to compare the ultrasound-guided in-plane infraclavicular cannulation of the axillary vein (AXV) and the ultrasound-guided out-of-plane cannulation of the internal jugular vein (IJV). A prospective, single-blinded, open label, parallel-group, randomized trial. Two university-affiliated ICUs in Poland (Opole and Lublin). Mechanically ventilated intensive care patients with clinical indications for central venous line placement. Patients were randomly assigned into two groups: the IJV group ( n = 304) and AXV group ( n = 306). The primary outcome was to compare the IJV group and AXV group through the venipuncture and catheterization success rates. Secondary outcomes were catheter tip malposition and early mechanical complication rates. All catheterizations were performed by advanced residents and consultants in anesthesiology and intensive care. The IJV puncture rate was 100%, and the AXV was 99.7% (chi-square, p = 0.19). The catheterization success rate in the IJV group was 98.7% and 96.7% in the AXV group (chi-square, p = 0.11). The catheter tip malposition rate was 9.9% in the IJV group and 10.1% in the AXV group (chi-square, p = 0.67). The early mechanical complication rate in the IJV group was 3% (common carotid artery puncture-4 cases, perivascular hematoma-2 cases, vertebral artery puncture-1 case, pneumothorax-1 case) and 2.6% in the AXV group (axillary artery puncture-4 cases, perivascular hematoma-4 cases) (chi-square, p = 0.79). No difference was found between the real-time ultrasound-guided out-of-plane cannulation of the IJV and the infraclavicular real-time ultrasound-guided in-plane cannulation of the AXV. Both techniques are equally efficient and safe in mechanically ventilated critically ill patients.

Ultrasound to guided epicutaneo-caval catheter insertion in newborn infants.

Recently, ultrasound (US) has been increasingly used for epicutaneo-caval catheter (ECC) tip positioning; however, the selection of blood vessels for ECC still depends on the operator's subjective judgment. This study aimed to explore the value of US in decision-making regarding the great saphenous vein (GSV), tip navigation, and tip location of ECC. Catheterization through the GSV of the lower extremity was selected. The running condition of the GSV was assessed by using US, and the angle between the GSV and the femoral vein was observed and measured. We selected the GSV with a smaller angle to the femoral vein for ECC catheterization. ECC catheterization under ultrasound guidance increased the success rate at the time of catheterization from 82.5% to 100% (increased by 17.5%) and shortened the catheterization time from 56.1 ± 5.30 min to 31.5 ± 2.58 min on average (shortened by 44%). The incidence rate of catheter-related complications decreased by 58.2% catheter days from 6.80/1,000 to 2.84/1,000. ECC insertion under the guidance of US has numerous advantages, including significantly improving the success rate of one-time catheterization, shortening the time of catheterization, and reducing catheter-related complications.

The efficacy and safety of an improved percutaneous peritoneal dialysis catheter placement technique in urgent-start peritoneal dialysis patients: a retrospective cohort study.

Urgent-start peritoneal dialysis has high catheterization skill requirements and that early complications. The optimal catheter placement method remains debatable in urgent-start peritoneal dialysis patients. Safe and effective peritoneal dialysis catheterization is needed in clinical work. We retrospectively analyzed the data of 34 patients diagnosed with end-stage renal disease who opt for peritoneal dialysis, 19 males and 15 females, with an average age of 62.3±14.7 years, peritoneal dialysis catheter implantation was completed by the improved percutaneous catheterization technique. They were followed for 6 months, early and late complications were observed and the survival rate of the catheter technique was calculated. All 34 patients diagnosed with end-stage renal disease successfully underwent catheter placement using the improved percutaneous technique; the catheterization success rate was 100%. No severe organ injuries, such as intestinal perforation and bladder perforation, occurred intraoperatively. Peritoneal dialysis was started immediately after surgery. The early complications included one case of leakage, one case of omental wrapping, and six cases of rectus abdominis hemorrhage. The late complications included one case of pleuro-abdominal fistula and two cases of peritonitis. The 6-month technical survival rate for the catheter was 94.1% (32/34). Compared to previously reported studies, this technique may reduce leakage and early catheter dysfunction, and improve the technical survival of catheters. The improved percutaneous peritoneal dialysis catheter placement technique might be an effective and safe method for urgent‑start peritoneal dialysis patients.

Real Time Ultrasound-Guided Thoracic Epidural Catheterization with Patients in the Lateral Decubitus Position without Flexion of Knees and Neck: A Preliminary Investigation.

Objectives: For some patients, such as pregnant women, it can be difficult to maintain the ideal "forehead to knees" position for several minutes for epidural catheter placement. We conducted this study to investigate the feasibility of real-time ultrasound-guided (US) epidural catheterization under a comfortable lateral position without flexion of knees and neck. Materials and Methods: 60 patients aged 18-80 years with a body mass index of 18-30 kg/m2 after general surgery were included. In a comfortable left lateral position, thoracic epidural catheterization was performed under real-time US for postoperative analgesia. The visibility of the neuraxial structures, procedural time from needle insertion to loss of resistance in the epidural space, the number of needle redirections, success rate of epidural catheter placement and postoperative analgesic effect were recorded. Results: In the paramedian oblique sagittal view, the well visible of vertebral lamina, intervertebral space and posterior complex under ultrasound were as high as 93.33%, 81.67% and 70.00%, respectively. The success rate of thoracic epidural catheterization was as high as 91.67%, and the satisfactory postoperative analgesic effect was 98.2% for patients without nausea, pruritus and other discomfort. Discussion: Thoracic epidural catheterization with patients in the lateral position without flexion of knees and neck under real time ultrasound guidance has a high success rate and strong feasibility. This visual manipulation makes epidural catheterization not only "easier" to perform, but also reduces the requirements of the procedure.

Monitoring the Infusion Rate During Cough: A New Method to Position the PICC and Outcome Evaluation

With the wide application of peripherally inserted central catheter (PICC) in clinic, the associated complications are gaining more attention. Among them, catheter misplacement is the common one and the main cause for unplanned extubation. It is reported that rate of catheter misplacement during catheterization is 12.5%-25%, which makes determination of PICC tip location the focus of operator. Coughing could instantly and indirectly change the pleural cavity pressure and thus alter the inner pressure of superior vena cava, which further changes the dripping speed, so by observing the dripping speed, the PICC tip location can be determined, and thus adjustment can be made to improve the success rate of one-time catheterization. By comparing rate of catheter misplacement between two groups, the present study assessed the method of determining the PICC tip location by observing the dripping speed when coughing. Results shows that the method is effective in reducing the rate of catheter misplacement, with 1 out of 252 cases experienced catheter misplacement in experimental group, which only accounted for 0.4%. This method is not only convenient to use, but also effective in determining catheter misplacement both during and after the catheterization, which is worthy of clinical application. This is a brand new method for determining the PICC tip location, which has never been reported.

Single and double developing lines improve ultrasound-guided radial artery catheterization in obese patients: A randomized controlled trial

BackgroundArterial catheterization is challenging in obese patients. The present study tested the hypothesis that ultrasound guidance with acoustic shadowing improves the success rate of radial artery catheterization in obese patients. Methods240 obese patients were enrolled and were randomly assigned to three groups: control group, single developing line group, or double developing lines group. Patients underwent radial artery catheterization guided by acoustic shadowing ultrasound with none, single or double developing lines. The primary outcome was the first-attempt success rate. The secondary outcomes included the procedure time and complication rate. ResultsIn the single or double developing lines group, the success rate of radial artery catheterization at the first attempt was higher than in the control group (control vs. single vs. double, 71% vs. 90% vs. 91%, P = 0.001). Besides, the single and double developing lines groups had a shorter procedure time to success at the first attempt and a lower overall complication (vasospasm and hematoma) rate than the control group (procedure time: control vs. single vs. double, 63 s vs. 54 s vs. 40 s, P < 0.001; overall complication rate: control vs. single vs. double, 29% vs. 10% vs. 9%, P = 0.001). There was no significant difference in the first-attempt success rate, the procedure time to success within the first attempt, or overall complications’ rate between the single and double developing lines groups. ConclusionSingle and double developing lines improve first-attempt success rate and reduced the overall complications’ rate of ultrasound-guided radial artery catheterization in obese patients.

Use the right kidney contour as a landmark in adrenal vein sampling.

Adrenal Vein Sampling (AVS) is the gold standard for categorizing primary aldosteronism (PA). However, catheterization of the right adrenal vein (RAV) is challenging due the small size and variable location. This study aims to explore the relationship between the RAV orifice and the right kidney contour (RKC) on fluoroscopy, thus evaluating the potential of use the RKC as an anatomic marker for localizing RAV. Imaging data of 107 PA patients with successful bilateral AVS were retrospectively analyzed. Based on the body mass index (BMI), all patients were divided into the Normal Group (BMI < 24 kg/m2), Overweight Group (24 kg/m2 ≤ BMI < 28 kg/m2) and Obese Group (BMI ≥ 28 kg/m2). At the anterior view, the height level of RAV orifice was determined relative to vertebral bodies and disks. The distance from the RAV orifice to the upper edge of RKC was measured manually. The RAV orifice height level was mainly distributed from vertebral T11 to T12 (90.6%), and tended to be higher in patients with a larger BMI. The mean distance from the RAV orifice to the upper edge of RKC was 13.9±7.8mm, and had no difference among Normal group (n = 53, 14.1±8.2mm), Overweight group (n = 39, 13.7±8.0mm), and Obese group (n = 15, 13.9±5.5mm) (p = 0.981). Based on these findings, the RKC might be used as a landmark for localizing RAV on fluoroscopy, which is conductive to narrow down the exploration range and increase the success rate of RAV catheterization.

Effects of Compression of the Ulnar Artery on the Radial Artery Catheterization.

Background: The study was designed to evaluate the effects of compression of the ulnar artery on blood flow (BF) and internal cross-sectional area (CSAi) of the radial artery. We also evaluated the success rate and time of successful ultrasound-guided radial artery catheterization at the first attempt with or without compression of the ulnar artery. Methods: Patients were randomly allocated to the Compression group or Standard group to be treated with or without the application of ulnar artery compression, respectively. Hemodynamic stability was confirmed, and ultrasound-guided radial artery catheterization was performed. In the Compression group, an assistant compressed the ulnar artery at 5 cm above the wrist crease and the catheterization was performed after the loss of the distal ulnar artery BF. In the Standard group, the catheterization was performed without compression of the ulnar artery. Before and after the catheterization, BF and CSAi of the radial artery were evaluated. Success rate and time to successful catheterization at the first attempt were recorded. Results: BF and CSAi of the radial artery were similar in the two groups (37.5 [19.3–66] vs. 37.0 [20.6–53.7] mL/min, respectively, p = 0.63; 4.0 [4.0–6.0] vs. 4.0 [3.0–5.0] mm2, respectively, p = 0.095). In the Compression group, BF and CSAi were changed to 80.9 [35.9–128.5] mL/min (p < 0.001) and 5.0 [4.0–7.0] mm2 (p < 0.001), respectively, after compression of the ulnar artery. There was a trend that the success rate of ultrasound-guided radial artery catheterization at the first attempt was higher in the Compression group than in the Standard group (58/59 vs. 53/59, respectively, p = 0.05), although the difference was not statistically significant. However, the time to successful ultrasound-guided radial artery catheterization at the first attempt was significantly shorter in the Compression group than in the Standard group (34 [27–41] s vs. 46 [36–60] s, p < 0.001). Conclusion: Compression of the ulnar artery augmented BF and CSAi of the radial artery. It resulted in a significantly shorter success time for ultrasound-guided radial artery catheterization at the first attempt.

Retrospective Study of the Application Value Analysis of Ultrasound-Guided Technology in Peripheral Deep Venous Catheterization of Neonates.

Objective To investigate the application value analysis of ultrasound-guided technology in peripheral deep venous catheterization of neonates. Method A total of 94 neonates who underwent peripheral deep venous catheterization treatment from March 2020 to August 2021 in our hospital were selected and divided into the study group and the control group according to the simple randomized method, and each group had 47 cases. The control group was performed peripheral deep venous catheterization through X-ray examination, while the study group was performed peripheral deep venous catheterization through ultrasound-guided technology. The catheter placement, catheter retention time and adjustment times, the incidence of complications (limb swelling, pain, fluid leakage, and phlebitis), and the intervention satisfaction of family members were counted. Results The success rate of one-time catheterization in the study group was higher than that in the control group, the operation time was shorter than that in the control group, and the amount of bleeding was less than that in the control group. The indwelling time of catheter in the study group was longer than that in the control group, and the number of adjustments was less than that in the control group. The incidence of complications in the study group was lower than that in the control group. The intervention satisfaction of family members in the study group was higher than that in the control group. Conclusion Peripheral deep venous catheterization in neonates through ultrasound-guided technology can reduce operation time and blood loss and ensure the success rate of one-time catheterization, resulting in a long indwelling time of catheter, low number of adjustments, and low incidence of complications, which has safety and high intervention satisfaction of family members.

The optimized jugular vein catheterization reinforced cocaine self-administration addictive model for adult male Sprague–Dawley rats

The self-administration (SA) model represents one of the most important and classic methods for drug addiction, and jugular vein catheterization is one of the most critical techniques in this animal model. We aimed to explore an optimized scheme to improve the success rate of rat jugular vein catheterization and SA model. Our experiment provided an optimized scheme which including numerous details, materials, approaches, updated techniques and protocols. Our experimental group consisted of 120 adult male Sprague–Dawley rats, which were divided into the Traditional Operation group (TO group) and the Optimized Operation group (OO group) by the random number table method and then further individually divided into the Saline Training group and the Cocaine Training group for the following SA training. Our results showed that the success rate of the jugular vein catheterization in the OO group was significantly greater than that in the TO group (93.33% vs 46.67%, χ2 = 31.11, P < 0.001). The optimized jugular vein catheterization could make the SA model more stable, reliable and efficient than the traditional operation. Compared with traditional methods, our optimized scheme made numerous improvements in materials and techniques including uniformity, individualized variability of the S-type positioning nail, the length and connection matching, the shape of the end and low cost. Our optimized scheme could provide a more stable and efficient tool for basic research on drug addiction. Several subtle improvements under our personal experience are usually important for augmenting operational efficiency.

Effect of a thin-tipped short bevel needle for peripheral intravenous access on the compressive deformation and displacement of the vein: A preclinical study.

Peripheral intravenous catheter (PIVC) insertion often fails on the first attempt. Risk factors include small vein size and dehydration, causing vein deformation and displacement due to puncture resistance of the vessel. The authors developed a short, thin-tipped bevel needle and compared its puncture performance with needles of four available PIVCs using an ex vivo model. The PIVC with the thin-tipped short bevel needle was compared to four available PIVCs using an ex vivo model which simulated the cephalic vein of the human forearm. The ex vivo model consisted of a porcine shoulder and porcine internal jugular vein, and was used for evaluation of the rate of vein deformation and vessel displacement during needle insertion. An ex vivo model was created with a vessel diameter of 2.7-3.7 mm and a depth of 2-5 mm. The thin-tipped short bevel PIVC needle was associated with a significantly lower compressive deformation rate and venous displacement compared to the needles of the other four PIVCs. The thin-tipped short bevel needle induced lower compressive deformation and displacement of the vein than the conventional needles. This needle has the potential to improve the first-attempt success rate of peripheral intravenous catheterization in patients with difficult venous access.

Efficacy Assessment of Phentolamine Accompanied by Lidocaine Subcutaneously under Ultrasound Guidance on Radial Artery Catheterization in Pediatric Patients.

Objective Pediatric patients are facing greater difficulties in radial catheterization for anatomic variation and smaller diameter. This study is to investigate the efficacy of phentolamine accompanied by lidocaine subcutaneously under ultrasound guidance on radial catheterization in pediatric patients. Methods 66 pediatric patients were enrolled and randomly divided into saline group, phentolamine group, and phentolamine+lidocaine group. Baseline characteristics and surgical types were collected. Relevant solutions were subcutaneously injected, and catheterization was subsequently conducted under ultrasound guidance. Radial artery diameter and depth were measured, the success rate of catheterization and procedure time were calculated, and the complications were evaluated with ultrasonography. Results No significant differences were observed in age, sex, weight, American Society of Anesthesiologists' classification, systolic blood pressure, diastolic blood pressure, heart rate, hemoglobin, and surgical types among three groups. Subcutaneously, the diameter in phentolamine and phentolamine+lidocaine groups increased significantly compared with the saline group. Moreover, the diameter also increased significantly after injection compared with that before injection both in the phentolamine and phentolamine+lidocaine groups. The first-attempt success rates were significantly higher while the procedure times of cannulation were shorter in the phentolamine and phentolamine+lidocaine groups than that in the saline group. Kaplan–Meier analysis showed that the overall procedure time was shorter in the phentolamine and phentolamine+lidocaine groups than the saline group. Overall complications and vasospasm incidence were lower in the phentolamine and phentolamine+lidocaine groups than the saline group. Conclusion Phentolamine accompanied by lidocaine subcutaneous injection under ultrasound guidance improved the first-attempt success rate and reduced the complication of radial artery catheterization in pediatric patients.

Application of plan-do-check-act management to improve first-attempt insertion success rates of internal jugular vein catheterization for standardized training residents in an intensive care unit

BackgroundIn the intensive care unit (ICU), internal jugular vein puncture and catheterization are basic rescue operations that physicians need to complete quickly and independently. It is necessary to improve the first-attempt success rate of internal jugular vein catheterization, shorten the catheterization duration and reduce the incidence of complications for standardized training residents (STRs).ObjectiveTo improve first-attempt insertion success rates of internal jugular vein catheterization for STRs.MethodsBased on the PDCA cycle management method and current situation investigation, the PDCA management objectives were set, and the implementation content, monitoring items and continuous improvement plan were formulated. The data of residents who were trained in the ICU of Fangcun Hospital, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, from January 2016 to April 2016 and managed by the PDCA cycle (PDCA group), were compared with the data of residents trained in the same department from August 2015 to November 2015 before the implementation of PDCA (historic control group), the first-attempt success rate of puncture and catheterization, the duration of puncture and catheterization, and the incidence of complications were analysed.ResultsThirty-six cases of internal jugular vein catheterization were performed by the PDCA group, 21 cases (58%) were performed by residents in the third year of standardized training, and 15 cases (42%) were performed by residents in the second year of standardized training. Compared with the historic control group, there was no significant difference in the seniority of residents (X2 = 0.240, P = 0.625) or the ‘majors of the residents (X2 = 1.306, P = 0.835). The first-attempt success rate of puncture in the PDCA group was 94% (34/36), which was significantly higher than that of the historic control group (55% (11/20) (P = 0.001). In the PDCA group, the first-attempt success rate of puncture among third-year standardized training residents was 95% (20/21), and the first-attempt success rate in the second-year was 93% (14/15), which were significantly higher than the corresponding rates of 62% (8/13) and 43% (3/7) respectively, in the historic control group (all P = 0.021). The duration of catheterization was [4 (3,5)] min after PDCA, which was significantly shorter than that in the historic control group [9 (6.25,13.00)] min (Z = − 5.214, P < 0.001). The incidence rate of complications in the PDCA group was 0% (0 /36), which was significantly lower than the rate of 20% (4 / 20) in the historic control group (P < 0.013).ConclusionPDCA cycle management can help improve the first-attempt success rate of internal jugular vein puncture and catheterization, shorten the duration of puncture and catheterization, and reduce the incidence of complications. The idea and method of PDCA cycle management can be applied to other training and management protocols for STRs.

Modified suture-assisted canaloplasty in Asians with primary open-angle glaucoma: a prospective study with 12-month follow-up

BackgroundTo evaluate the efficacy and safety of modified suture-assisted canaloplasty in Asians with primary open-angle glaucoma (POAG).MethodsA prospective, consecutive cases study, evaluating a modified canaloplasty by twisted 6/0 suture was performed on Asian POAG patients. Three modifications of this canaloplasty included opening the Schlemm’s canal by viscocanalostomy, circumferential probing by a twisted 6/0 suture and loose suture of the superficial scleral flap. The twisted 6/0 suture was selected as a prober based on characteristical analysis of size and contact measurement as well as chemical composition conducted among 5/0, twisted 6/0 polypropylene sutures and the microcatheter. Success criteria were defined as intraocular pressure (IOP) ≤ 21 mmHg, 18 mmHg, 15 mmHg, and ≥ 20% reduction without (complete success) or with medications (qualified success). Efficacy was assessed by the success rate of circumferential catheterization, IOP values, the success rate of the surgery, the number of IOP-lowering medications, best-corrected vision acuity (BCVA), cup-to-disc ratio (C/D), and mean deviation (MD). Safety was evaluated by adverse events.ResultsForty eyes from 40 consecutive patients were included with a mean follow-up of 14.8 ± 3.0 months. Circumferential catheterization was successfully conducted in 36 eyes (90%). Mean IOP decreased from 26.2 ± 6.9 mmHg to 14.5 ± 2.7 mmHg at 12 months postoperatively. While medication numbers were reduced from 3.2 ± 0.6 to 0.5 ± 0.8 at month 12 (both p < 0.001). Qualified success rate was 97.2% [95% confidence interval (CI) 0.92–1.03], 86.1% (95% CI 0.74–0.98) and 66.7% (95% CI 0.51–0.83) at 12 months with three criteria. BCVA, C/D and MD did not show progression at 1-year follow-up (p > 0.05). Age, baseline IOP, and spherical equivalent negatively influenced the success rate significantly (all p < 0.05). Adverse events included hyphema (30.6%), IOP spike > 25 mmHg (8.3%), and peripheral synechia to the trabecular-Descemet’s membrane (2.7%).ConclusionTwisted 6/0 suture can be an ideal material for cannulation. Modified suture-assisted canaloplasty is an effective, safe alternative with a cost-efficient feature for patients with POAG, especially in developing countries.Trial registrationThis trial was registered in the Chinese Clinical Trial Registry (ChiCTR1900028618, 29/12/2019).

Ultrasound-guided short-axis out-of-plane vs. long-axis in-plane technique for radial artery catheterization: an updated meta-analysis of randomized controlled trials.

Short-axis out-of-plane (SA-OOP) and long-axis in-plane (LA-IP) are the two major approaches used in ultrasound (US)-guided radial arterial catheterization. Nevertheless, their efficacy and safety remain controversial. Therefore, this meta-analysis aimed at comparing the two approaches for radial arterial catheterization. The PubMed, Embase, and Cochrane Library databases were searched for relevant articles published from database inception until December 2020. We selected randomized controlled trials comparing the short- and long-axis methods for US-guided radial artery catheterization. The results were analyzed using RevMan software to determine the adequacy and conclusiveness of the available evidence. Six studies (725 patients) ultimately met the inclusion criteria. No significant difference was observed between the SA-OOP and LA-IP approaches for US-guided radial artery catheterization (relative risk [RR], 0.99; 95% confidence interval [CI], 0.96-1.03; p =0.61; I2=0%). The first-attempt success rate was similar between the two groups (relative risk [RR], 1.02; 95% CI, 0.79-1.32; p =0.90; I2=87%). The incidence of hematoma formation was similar between the two groups (RR, 1.91; 95% CI, 0.66-5.56; p =0.24; I2=77%). The SA-OOP approach does not increase the total or first-attempt success rate of radial artery catheterization using the LA-IP approach. More highly powered well-designed trials are needed to evaluate additional outcomes.

A Comparison of Puncture and Continuous Pump Analgesia With Two Different Approaches to Thoracic Paravertebral Block for Thoracic Surgery.

BackgroundThis study aims to compare the success rate of thoracic paravertebral block (TPVB) and the effect of postoperative analgesia between two approaches.MethodsA total of 34 patients with American Society of Anesthesiology (ASA) physical status score II–III, undergoing an optional thoracoscopic surgery, were randomly assigned to a parasagittal approach group (group P, n = 17) and a transverse intercostal approach group (group T, n = 17). The catheterization time, success rate of the puncture and catheterization, block plane and effect at the surgical site were compared between two groups. The mean arterial pressure and heart rate were recorded, as well as the cold tactile block plane and numeric rating scale (NRS) at 0.5, 2, 4, 8, 12, 24, and 48 h after surgery. The study was registered at http://www.chictr.org.cn/showproj.aspx?proj=9624 (Registration number: ChiCTR2100054642).ResultsThe catheterization time in group P was significantly longer than that in group T (P < 0.05). The success rate of catheterization in group P was lower than that in group T, but no statistical significance (P = 0.085). There was no significant difference in the success rate of Puncture and blocking effect of the surgical site at 30 min post-injection between two groups (P > 0.05). There was no significant difference in the cold tactile block plane and NRS scores during coughing between two groups at 0.5, 2, 4, 8, 12, 24, and 48 h postoperatively (P > 0.05).ConclusionThis study suggests that there is no significant difference in postoperative block level or pain score during coughing for thoracoscopic surgery between ultrasound-guided parasagittal and transverse intercostal approach, but the parasagittal approach takes longer and has a higher failure rate.

Recent Advances in the Clinical Application of Adrenal Vein Sampling.

We reviewed clinical research investigating the applications of adrenal vein sampling (AVS). AVS could be applied not only to primary aldosteronism (PA) but also to other endocrine diseases, such as adrenocorticotropic hormone (ACTH) independent Cushing syndrome (AICS) and hyperandrogenemia (HA). However, the AVS protocol requires improvements to increase its success rate. Using the computed tomography image fusion, coaxial guidewire technique, and fast intraprocedural cortisol testing (CCF) technique could improve the success rate of catheterization in AVS for PA. ACTH loading could be considered in medical centers with a low selectivity of AVS for PA but is not essential in those with mature AVS technology. The continuous infusion method should be recommended for ACTH stimulation in AVS for PA to reduce adverse events. AVS has not been routinely recommended before management decisions in AICS, but several studies verified that AVS was useful in finding out the source of excess cortisol, especially for distinguishing unilateral from bilateral disease. However, it is necessary to reassess the results of AVS in AICS with the use of reference hormones to fully normalize cortisol levels. In addition, it is essential to determine the optimal model that combines AVS results and mass size to guide the selection of surgical plans, including identifying the dominant gland and presenting the option of staged adrenalectomy, to minimize the impact of bilateral resection. For HA, AVS combined with ovarian intravenous sampling to locate excess androgens could be considered when imaging results are equivocal.

Modified Long-Axis In-plane Technique for Radial Artery Cannulation in Children: A Randomized Controlled Trial

BackgroundRadial artery catheterization is a challenge for anesthetists in the pediatric population. The purpose of this study was to determine whether the modified long-axis in-plane (MLAX-IP) technique increased the success rate of radial artery catheterization in children.MethodsThis study involved 80 children who required arterial catheterization and were randomly divided into the MLAX-IP group and dynamic needle tip positioning (DNTP) group (40 cases in each group). Radial artery catheterization was performed using either the MLAX-IP technique or the DNTP technique.ResultsThe first-attempt cannulation success rate was higher in the MLAX-IP group than in the DNTP group (95 vs. 80%, P = 0.043). The imaging time of the artery in the MLAX-IP group was longer than in the DNTP group (19.1 ± 3.1 vs. 9.6 ± 2.4 s, P < 0.001). While the total catheterization time was similar between the 2 groups (88.1 ± 23 vs. 86.9 ± 46.1 s, P = 0.475).ConclusionThe first-attempt cannulation success rate with the MLAX-IP technique is increased, while the total catheterization time is similar between the 2 groups and puncture-related complications are fewer.