Technique For Catheter Placement Research Articles

Gelatin Thoracic Paravertebral Teaching Model for Placement of a Continuous Infusion Catheter in the Extrathoracic Paravertebral Space

Our aim was to develop an ultrasound-guided training curriculum for continuous infusion catheter placement in the paravertebral space and to create a gelatin thoracic spine-rib model for use in this training. We sought to create a model that was inexpensive and reusable such that multiple participants could use one model during training. The model was prepared by embedding a firm foam thoracic spine replica with bilateral attached ribs into an opaque gelatin mixture. Once solidified, a preselected area was excised on each side, such that the model could be easily refilled with new gelatin blocks for use by each participant. This allowed for multiple participants to use the same model while eliminating confusion with prior tract marks. The Marcia and Eugene Applebaum Simulation Learning Institute, Beaumont Hospital, Royal Oak, MI; a private nonprofit tertiary care hospital associated with the OUWB School of Medicine, Rochester, MI. Fifty-two medical students and general surgery residents underwent a 30-minute didactic session on ultrasound technique for catheter placement followed by practice on the gelatin model. The texture and echogenicity of the model were subjectively comparable to those of tissue in vivo and the osseous elements of the spine in the model were clearly identified using ultrasound. The exchangeable catheter placement area provided an efficient and effective method to test accurate performance in catheter placement by multiple users. Participants increased their confidence in the use of ultrasound for this procedure. To date, this is the first gelatin thoracic spine-rib model that has been used to teach ultrasound-guided catheter insertion into the paravertebral space, with removable testing areas that can be used by multiple users. This model can provide an inexpensive training tool that can be used in a surgical simulation setting.

Infraclavicular versus axillary nerve catheters: A retrospective comparison of early catheter failure rate

Study objectivesContinuous brachial plexus catheters are often used to decrease pain following elbow surgery. This investigation aimed to assess the rate of early failure of infraclavicular (IC) and axillary (AX) nerve catheters following elbow surgery. DesignRetrospective study. SettingPostoperative recovery unit and inpatient hospital floor. Patients328 patients who received IC or AX nerve catheters and underwent elbow surgery were identified by retrospective query of our institution's database. MeasurementsData collected included unplanned catheter dislodgement, catheter replacement rate, postoperative pain scores, and opioid administration on postoperative day 1. Catheter failure was defined as unplanned dislodging within 24 h of placement or requirement for catheter replacement and evaluated using a covariate adjusted model. Main results119 IC catheters and 209 AX catheters were evaluated. There were 8 (6.7%) failed IC catheters versus 13 (6.2%) failed AX catheters. After adjusting for age, BMI, and gender there was no difference in catheter failure rate between IC and AX nerve catheters (p = 0.449). ConclusionsThese results suggest that IC and AX nerve catheters do not differ in the rate of early catheter failure, despite differences in anatomic location and catheter placement techniques. Both techniques provided effective postoperative analgesia with median pain scores < 3/10 for patients following elbow surgery. Reasons other than rate of early catheter failure should dictate which approach is performed.

Placement of baclofen pump catheter through a C1–2 puncture: technical note

Intrathecal baclofen has been suggested as an effective and safe treatment for intractable spasticity and dystonia. Techniques of lumbar and intraventricular catheter placement have been previously described. The purpose of this study was to describe a technique to implant catheters for intrathecal baclofen infusion through C1-2 puncture. Four of 5 consecutively treated patients underwent successful placement of catheters for intrathecal baclofen. There were no instances of infection, CSF leak, or catheter migration seen during a follow-up period of at least 6 months; furthermore, there were no occurrences of vertebral artery or spinal cord injury. All patients had an effective stabilization or reduction of their upper-extremity, lower-extremity, or trunk tone. There were no cases of worsening hypertonia. The authors' preliminary experience with C1-2 puncture for placement of the intrathecal baclofen catheter seems to indicate that this is a safe and efficacious technique. Lessons learned from the failed attempt at C1-2 puncture will be delineated.

Outcomes of fluoroscopic and ultrasound-guided placement versus laparoscopic placement of peritoneal dialysis catheters.

BackgroundSeveral peritoneal dialysis catheter (PDC) placement techniques have been described. The objective of this study was to compare the fluoroscopy and ultrasound guidance technique with the laparoscopic technique.MethodsWe retrospectively reviewed the medical records of 260 patients who had their first PDC placed between January 2005 and June 2016. We compared the outcomes of the fluoroscopic and ultrasound-guided catheter placement technique (radiologic group, n = 50) with the laparoscopic catheter placement technique (laparoscopic group, n = 190). The primary endpoint was complication-free catheter survival at 365 days. Secondary endpoints were complication-free catheter survival at 90 days, overall catheter survival at 90 and 365 days, median days to first complication and median days to catheter removal.ResultsIn the radiologic group, the complication-free catheter survival at 90 and 365 days was 64% and 48%, respectively, while in the laparoscopic group it was 71% (P = 0.374) and 53% (P = 0.494), respectively. Catheter malfunction was significantly higher in the laparoscopic group (30%) compared with the radiologic group (16%, P = 0.048). The overall catheter survival at 90 and 365 days was 76% and 52%, respectively, in the radiologic group, while in the laparoscopic group it was 88% (P = 0.0514) an 48% (P = 0.652), respectively. There was no significant difference in the median days to first complication and the median days to catheter removal between the two groups (P = 0.71).ConclusionThe technique of fluoroscopic and ultrasound-guided PDC placement is a clinically effective and safe alternative to laparoscopic catheter placement with similar survival and complication rates.

Tips and Tricks for Difficult Urethral Catheterization

Male urethral catheterization may be difficult in patients with enlarged prostate glands or other potentially obstructive conditions as urethral stenosis, after prostatic TUR undermining bladder neck, old and recent false passages, sphincteric spasm among others. Alternative techniques or tricks to surpass problematic urinary catheterization are usually known by experienced nurses and physicians. If repeated catheterization attempts are done, the risk of failing and complications appearing increase significantly. Improper insertion of catheters also may increase healthcare costs due to prolonged hospitalization, immediate and/or delayed surgical interventions transforming a minor technique into a huge problem for the patient, doctors, and healthcare system. Improved techniques for catheter placement are essential for all healthcare personnel involved in the management of the patient needing a urethral catheterization, including nurses and doctors from both primary and hospital medicine. The aim of this article is to show some tips and tricks that may be helpful for the blind placement of urethral catheters. The phrase primum non nocere acquires its maximum meaning in this context. Sanitary personal must be prudent in the number of attempts, have a clear strategy of what can be done in each moment and know how to stop or seek help in case of not being able to probe the patient in 2 or 3 attempts. If all these recommendations fail a urologist have to be required to place a catheter in a safe way including the use of endoscopic optic devices

Ultrasound-guided or landmark techniques for central venous catheter placement in critically ill children.

To assess whether ultrasound guidance improves central venous catheter placement outcomes compared to the landmark technique in critically ill children. A prospective multicentre observational study was carried out in 26 paediatric intensive care units over 6months. Children 0-18years old who received a temporary central venous catheter, inserted using either ultrasound or landmark techniques, were eligible. The primary outcome was the first-attempt success rate. Secondary outcomes included overall placement success, number of puncture attempts, number of procedures requiring multiple punctures (>3 punctures), number of procedures requiring punctures at more than one vein site and immediate mechanical complications. To account for potential confounding factors, we used propensity scores. Our primary analysis was based on 1:1 propensity score matching. The association between cannulation technique and outcomes in the matched cohort was estimated using generalized estimating equations and mixed-effects models to account for patient-level and hospital-level confounders. Five hundred central venous catheter-placement procedures involving 354 patients were included. Ultrasound was used for 323 procedures, and the landmark technique was used for 177. Two hundred and sixty-six procedures were matched (133 in the ultrasound group and 133 in the landmark group). Ultrasound was associated with an increase in the first-attempt success rate [46.6 vs. 30%, odds ratio 2.09 (1.26-3.46); p<0.001], a reduced number of puncture attempts [2 (1-3) vs. 2 (1-4), B coefficient -0.51 (95% confidence interval -1.01 to -0.03), p=0.035], and fewer overall mechanical complications [12 vs. 22.5%, odds ratio 0.47 (95% confidence interval 0.24-0.91), p=0.025] in the matched cohort. The number of puncture attempts was the main factor associated with overall complications. Compared with the landmark technique, ultrasound guidance was associated with an increased first-attempt success rate, a reduced number of puncture attempts, and fewer complications during central venous catheter placement in critically ill children.

Adjustable Ghajar Guide Technique for Accurate Placement of Ventricular Catheters: A Pilot Study.

ObjectiveAn adjustable Ghajar guide is presented to improve the accuracy of the original Ghajar guide technique. The accuracy of the adjustable Ghajar guide technique is also investigated.MethodsThe coronal adjustment angle from the orthogonal catheter trajectory at Kocher’s point is determined based on coronal head images using an electronic picture archiving and communication system. For the adjustable Ghajar guide, a protractor is mounted on a C-shaped basal plate that is placed in contact with the margin of a burrhole, keeping the central 0° line of the protractor orthogonal to the calvarial surface. A catheter guide, which is moved along the protractor and fixed at the pre-determined adjustment angle, is then used to guide the ventricular catheter into the frontal horn adjacent to the foramen of Monro. The adjustable Ghajar guide technique was applied to 20 patients, while a freehand technique based on the surface anatomy of the head was applied to another 47 patients. The accuracy of the ventricular catheter placement was then evaluated using postoperative computed tomography scans.ResultsFor the adjustable Ghajar guide technique (AGT) patients, the bicaudate index ranged from 0.23 to 0.33 (mean±standard deviation [SD]: 0.27±0.03) and the adjustment angle ranged from 0° to 10° (mean±SD: 5.2°±3.2°). All the AGT patients experienced successful cerebrospinal fluid diversion with only one pass of the catheter. Optimal placement of the ventricular catheter in the ipsilateral frontal horn approximating the foramen of Monro (grade 1) was achieved in 19 patients (95.0%), while a suboptimal trajectory into a lateral corner of the frontal horn passing along a lateral wall of the frontal horn (grade 3) occurred in 1 patient (5.0%). Thus, the AGT patients experienced a significantly higher incidence of optimal catheter placement than the freehand catheterized patients (95.0% vs. 68.3%, p=0.024). Moreover, none of the AGT patients experienced any tract hemorrhages along the catheter or procedure-related complications.ConclusionThe proposed adjustable Ghajar guide technique, using angular adjustment in the coronal plane from the orthogonal trajectory at Kocher’s point, facilitates accurate freehand placement of a ventricular catheter for hydrocephalic patients.

Peculiarities of post-operative analgesia after the extensive surgical interventions in children

INTRODUCTION. Postoperative pain syndrome remains a serious problem in pediatric surgery and anesthesiology. Epidural analgesia is considered to be effective in the early postoperative period, as it provides better pain control compared with the use of opioids.PURPOSE OF THE WORK. To evaluate the the effectiveness and safety of epidural analgesia after extensive surgical interventions on abdominal organs in children. MATERIALS AND METHODS. The study included 22 children from 1 year to 17 years. They were divided into two groups: 1 group included children who received opioid analgesics parenterally as a postoperative analgesia (n = 10), in group 2 there were patients in whom a prolonged epidural anesthesia was carried out (n = 12).RESULTS AND DISCUSSION. When studying the variability of blood pressure and heart rate during the day, as a marker of pain, it was found that in children of the first group, these fluctuations were much more expressed than in the second group. Peristalsis appeared in 54.61 ± 9.66 hours after surgery in patients of the first group and in 14.22 ± 6.89 hours – in the second group. Diluting the 0.25% solution of anesthetic to a concentration of 0.125% gave an opportunity to increase the rate of solution delivery to cover more dermatomes and expand the analgesia zone.CONCLUSIONS: 1. Prolonged epidural analgesia has advantages over the use of opioids, providing more reliable and effective analgesia in children. 2. Prolonged epidural anesthesia, with the correct technique of catheter placement and strict dosing of local anesthetic, does not have clinically significant side effects in children, and can be recommended for postoperative analgesia after extensive surgical interventions on abdominal organs in children.

Needle-guided ultrasound technique for axillary artery catheter placement in critically ill patients: A case series and technique description

PurposeAxillary arterial cannulation for blood pressure monitoring has been reported in adults since 1973. Reported failure rates using palpation landmarks are high. This report describes a needle-guided ultrasound technique for axillary arterial line placement in critically ill patients. MethodsA retrospective review of all patients requiring axillary arterial cannulation attempts with ultrasound-assisted needle guidance for hemodynamic monitoring was performed from July 2010 to June 2016 at a single institution. ResultsOne hundred fifty nine (159) cannulation attempts were performed in 155 patients. The overall success rate was 97%, with a first pass success rate of 84%. Inexperienced operators performed 49% of procedures under direct faculty supervision, and had a 99% success rate, which was not different from experienced operators. Almost 20% of patients had moderate-to-severe coagulopathy (platelets<50k/uL, INR>2.0 or PTT>60s). Complications reported included the following: nonfunctioning of catheter (6%) and hematoma (6%). Ischemia was noted in 2 patients (1%), but only one was attributed to the arterial catheter. ConclusionsUse of the needle-guided ultrasound assisted approach for axillary arterial line placement is easily teachable and can be used to promote safe and successful placement of axillary arterial lines for novice learners.

Modified laparoscopic placement of peritoneal dialysis catheter with intra-abdominal fixation.

Peritoneal dialysis (PD) is a commonly accepted method of treating end-stage renal disease (ESRD). Various laparoscopic techniques for the placement of PD catheter have been described. In this study, we developed a novel modified laparoscopic technique for PD catheter placement and evaluated the early results. A straight Tenckhoff PD catheter was placed employing the modified technique in 39 consecutive patients with ESRD from May 2013 to April 2016. The technique is laparoscopically guided intra-abdominal fixation of the PD catheter tip at one point by using suture passer hernia forceps. Individual information including sex, age, primary disease etiology, complications, surgical duration, morbidity, mortality and catheter survival was collected and analyzed. The modified laparoscopic procedure was effectively performed in all patients with a mean operative time of 45±7min. No conversions from laparoscopy to open surgery of catheter placement occurred. There was one case showing early pericatheter leakage. There were no serious complications, such as bleeding, abdominal wall hernias, distal catheter cuff extrusion and infections of the exit site or tunnel during surgery or the postoperative duration. No mortality was observed in this group of patients. The 6-month follow-up study showed 100% catheter-related complication-free survival. Our modified laparoscopic intra-abdominal fixation technique using suture passer hernia forceps is a simple and safe method for PD catheter placement and is effective in minimizing the risk of catheter migration.

Sa1691 - Perils and Promises of Pharyngeal and Striated Esophageal High-Resolution Manometry: The Need for Purposeful Catheter Placement and Analysis Technique

Sa1691 - Perils and Promises of Pharyngeal and Striated Esophageal High-Resolution Manometry: The Need for Purposeful Catheter Placement and Analysis Technique

Introduction of novel 3D-printed superficial applicators for high-dose-rate skin brachytherapy

PurposeCustom-made surface mold applicators often allow more flexibility when carrying out skin brachytherapy, particularly for small treatment areas with high surface obliquity. They can, however, be difficult to manufacture, particularly if there is a lack of experience in superficial high-dose-rate brachytherapy techniques or with limited resources. Methods and MaterialsWe present a novel method of manufacturing superficial brachytherapy applicators utilizing three-dimensional (3D)–printing techniques. We describe the treatment planning process and the process of applicator manufacture. ResultsThe treatment planning process, with the introduction of a pre-plan, allows for an “ideal” catheter arrangement within an applicator to be determined, exploiting varying catheter orientations, heights, and curvatures if required. The pre-plan arrangement is then 3D printed to the exact specifications of the pre-plan applicator design. This results in improved target volume coverage and improved sparing of organs at risk. ConclusionsUsing a pre-plan technique for ideal catheter placement followed by automated 3D-printed applicator manufacture has greatly improved the entire process of superficial high-dose-rate brachytherapy treatment. We are able to design and manufacture flexible, well-fitting, superior quality applicators resulting in a more efficient and improved patient pathway and patient experience.

Laser Interstitial Thermal Therapy Technology, Physics of Magnetic Resonance Imaging Thermometry, and Technical Considerations for Proper Catheter Placement During Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy.

MRg-LITT, magnetic resonance-guided laser-induced thermal therapyPAD, precision aiming device.

Urinary Catheterization: a Paradigm Shift in Difficult Urinary Catheterization.

The urinary catheter is an ancient device for urinary drainage in patients. Placement of a urethral catheter is a common medical procedure that may have led to morbidity and mortality. Urethral catheterization is commonly performed by a nurse. Difficult catheter placement generates urology consultation. Difficult catheterization with a vision-guided urinary catheter may provide expedited and successful catheter placement by nursing personnel. A PubMed.gov and Ovid Medline search for articles on history of urinary catheter, difficult urinary catheterization, iatrogenic urethral injury, iatrogenic urethral injury and CAUTI, management of iatrogenic urethral injury, and techniques for urinary catheter placement was performed. The history of urinary catheters is reviewed. Technical advances in the last century are discussed. Indications for catheter placement are included. Outcomes and cost of complications of urinary catheters are discussed relative to present practice quality standards. Review of difficult urinary catheterization management algorithms developed with urological catheter improvements during the last decade is analyzed. Educational and technological advances to improve outcomes of urinary catheter use are addressed. Provider attention to issues of urinary catheterization is enhanced by education and additional skills for catheterization. Physician and nurse providers can use current technology with preparation to improve the catheterization care of patients.

Evaluation of a modified in-plane ultrasound technique for routine arterial catheterisation

Evaluation of a modified in-plane ultrasound technique for routine arterial catheterisation

Current practices and attitudes regarding central venous catheter placement technique at a large teaching hospital in Guatemala

Current practices and attitudes regarding central venous catheter placement technique at a large teaching hospital in Guatemala

Surgical versus percutaneous techniques for peritoneal dialysis catheter placement: A meta-analysis of the outcomes

BackgroundPeritoneal dialysis (PD) is an effective method of renal replacement therapy for end-stage renal disease patients. The PD catheter could be inserted by surgical (open surgery/laparoscopic-assisted) or percutaneous techniques. However, the efficacy of the techniques, including catheter survival and catheter related complications, is still controversial.MethodThe dataset was defined by searching PubMed, EMBASE, Google Scholar and the Cochrane database that had been published until July 2014. The meta-analysis was performed using Review Manager Software version 5.2.6.ResultThe final analysis was conducted on 10 studies (2 randomized controlled studies (RCTs) and 8 retrospective studies), including 1626 patients. The pooled data demonstrate no significant difference in 1-year catheter survival (OR = 1.04, 95% CI = 0.52–2.10, P = 0.90) between surgical and percutaneous groups. However, the sensitivity analysis of the RCTs demonstrated that the incidence of overall infectious (OR = 0.26, 95% CI = 0.11–0.64, P = 0.003) and overall mechanical complications (OR = 0.32, 95% CI = 0.15–0.68, P = 0.003) were significantly lower in the percutaneous groups than the surgical groups. Furthermore, the subgroup analyses revealed no significant difference in the rates of peritonitis, tunnel and exit site infection, leakage, inflow-outflow obstruction, bleeding and hernia by comparing the methods.ConclusionThe results showed that the placement modality did not affect 1-year catheter survival. Percutaneous catheter placement is as safe and effective as surgical technique.

Percutaneous radiologic gastrostomy catheter placement without gastropexy: a co-axial balloon technique and evaluation of safety and efficacy.

The purpose of this study is to evaluate the short-term safety and efficacy of a co-axial angioplasty balloon technique for percutaneous radiologic gastrostomy catheter placement (PRG). A total of 65 percutaneous radiologic gastrostomy tube placements were performed with the co-axial angioplasty balloon technique from 10/1999 to 1/2014. This included 19 females and 46 males between the ages of 20-83. Without the use of T-fasteners for gastropexy, the gastrostomy tube was placed over a catheter-shaft angioplasty balloon as a co-axial system. The angioplasty balloon was used to sequentially approximate the stomach wall to the abdominal wall, dilate the tract, and was then used as a dilator to aid gastrostomy tube advancement into the gastric lumen. Technical success, complications, and dislodgements were evaluated by means of retrospective review of patient medical records and imaging. There was no procedural failure in any of the 65 placements. 30-day follow-up was available for 56 patients. 7 patients died within 30 days; none of the deaths were recorded as procedure-related. There was 1 major complication (1.5%) consisting of a colocutaneous fistula. There were 4 minor complications (6.2%). There was no occurrence of bleeding or skin infection while using this technique. PRG with the co-axial angioplasty-balloon technique is a safe and effective technique for gastrostomy placement.

Method for Blind Catheter Placement in the Equine Pulmonary Artery

The navigation behavior of catheters within the equine pulmonary artery (PA) was investigated using en bloc heart and lung preparations for the purpose of developing a method of blind catheter placement. An equine ex vivo heart and lung perfusion system with controlled perfusate pulsatile flow, pressure, and temperature was used to evaluate a blind navigation technique for placement of balloon-tipped catheters into the distal main stem of the PA. Catheter performance was observed with an intravascular endoscope. Three balloon catheters were selected for navigation trials: a 4 mm diameter × 1.2 cm, 2.7Fr, 142 cm angioplasty catheter (C4mm); a 10 mm diameter × 4 cm, 5Fr, 150-cm angioplasty catheter (C10mm); and a 16-mm diameter, 7Fr, 200-cm pancreatic duct sphincteroplasty catheter (C16mm). Successful catheter placement was defined as insertion within a left or right main stem of the PA to a distance greater than 20 cm beyond the bifurcation. A method of blind catheter placement into the distal main stem of the equine PA using balloon-tipped catheters was successfully developed. The 16-mm catheter was superior with an average proportion of successful insertions (PSIavg) of 93.6%; an average insertion distance in the main stem (IDMavg) of 30.1 ± 5.7 cm; and an average insertion distance anywhere in the PA (IDAavg) of 29.3 ± 6.4 cm versus the 10 mm (PSIavg 25%, IDMavg 39.3 ± 11.4 cm, IDAavg 19.3 ± 15.1 cm) and 4 mm (PSIavg 11%, IDMavg 40.0 ± 11.0 cm, IDAavg 12.8 ± 13.2 cm), respectively.

Peer review report 2 on “Surgical versus percutaneous techniques for peritoneal dialysis catheter placement: A meta-analysis of the outcomes”

Peer review report 2 on “Surgical versus percutaneous techniques for peritoneal dialysis catheter placement: A meta-analysis of the outcomes”