Time Of Catheter Placement Research Articles

The learning curve for retrograde intrarenal surgery: A prospective analysis.

retrograde intrarenal surgery (CRIR) is an evolving tool. Its learning curve is not well established, despite the common use of flexible ureteroscopes today. Our aim is to estimate the number of procedures needed for one to perform RIRS consistently. a urology resident had his first 80 RIRS for nephrolithiasis analyzed quantitatively and qualitatively. The procedures were divided into 4 groups containing 20 surgeries each (I to IV), according to their order, for comparison. there was no difference in stone sizes between groups. All qualitative variables varied significantly between groups (p<0.001), except between III and IV. In the quantitative analysis, there was a difference between groups I and IV in time for double-J catheter placement (p=0.012). There was an increasing difference in sheath placement time (p<0.001) and in total operative time (p=0.004). The time fot stone treatment (p=0.011) was significant only between groups I, II and III. There was difference in total sheath time only between groups I and III (p=0.023). Stone free status did not change between groups. the differences between the qualitative and quantitative variables show the relation between number of surgeries performed and proficiency in the procedure. Intergroup comparisons show sequential optimization of parameters. we found that 60 is a reasonable number of surgeries to be performed in order to reach the plateau of RIRSs learning curve.

An Information-Based Nursing Quality Evaluation Model of Daily PICC Work in Outpatient Clinics.

Our purpose of this study was to analyze the application value of the information-based nursing quality evaluation model in improving the daily work quality of the PICC room in the outpatient department. From January 2020 to December 2020, 465 patients who received PICC treatment were selected as the research objects and divided into the observation group (265 cases, July 2020–December 2020, information-based nursing quality evaluation model after implementation) and the control group (200 cases, January 2020–June 2020, before the implementation of the information-based nursing quality assessment model). Compared with the control group, the children and their families in the observation group had higher PICC health knowledge and compliance scores, longer mean time for catheter placement, lower overall complication rate, and higher overall satisfaction rate after the intervention. The information-based nursing quality evaluation model can improve the daily work quality of the PICC room in the outpatient clinic, improve the clinical efficacy of PICC in patients, and reduce the incidence of complications such as catheter shedding. It is worthy of clinical application.

Revisiting One-Stage Urethroplasties for Distal Urethral Strictures.

Background: Reconstructive approaches for distal urethral strictures range from simple meatotomy to utilizing grafts or flaps depending on the etiology, length and location. We describe a contemporary cohort of distal urethral strictures and report a surgical technique termed distal one-stage urethroplasty developed to address the majority of distal urethral strictures encountered. Methods: Thirty-four patients were included. The mean age was 56.7 years (range 15.7–84.9 years), the mean stricture length was 1.1 cm (0.5–1.5) and the mean follow-up was 42.5 months (28–61.3). Results: The vast majority of distal strictures (27/34 (79.4%)) were treated with our hybrid one-stage approach combining a distal urethral reconstruction with excision of the scar tissue without the need to use grafts or flaps. The average stricture length was 0.68 cm and average operative time was 24.43 min. Post-operative spraying was reported in a minority of patients (4/27 (14.8%)). The length of stricture and surgery were significantly longer in those 7/34 (20.6%) patients in whom grafts or flaps were used (2.88 cm and 154.8 min, respectively, p < 0.001 for both when compared to the hybrid one-stage approach). We noted 6/34 (17.6%) recurrences of distal urethral strictures, all of which were treated successfully with graft and flap repairs. Conclusions: The vast majority of distal urethral strictures are amenable to a distal one-stage urethroplasty, avoiding the use of grafts and/or flaps while achieving reasonable outcomes. This limited approach, at least initially, is associated with shorter operative time and time of catheter placement and avoids morbidity associated with graft or flap harvesting. Spraying of urine is seldomly encountered and comparable to other approaches addressing distal urethral strictures.

COMPARATIVE STUDY OF PRE-PROCEDURE AND REAL TIME ULTRASOUNDGUIDED EPIDURALANAESTHESIA IN OBESE PATIENT.

Background And Aims: Epidural anaesthesia is widely performed using a landmark-guided midline approach. The indistinct or distorted landmark is associated with obesity, previous spinal surgeries, deformities, or degenerative changes due to ageing. In the present study, we compared the efcacy of real-time ultrasound (RUS)-guided paramedian approach, and pre-procedure ultrasound (PUS) landmark-guided paramedian approach in obese patients. Methods: Sixty patients with body mass index (BMI) &gt;30 kg/m2 were included in the study. The participants were randomly assigned to two groups : PUS and RUS group . The primary end point was to attain a successful placement of epidural catheter. Variables like the number of attempts, the number of passes, the time taken for identifying epidural space(s), and time taken for successful epidural catheter placement(s) were secondary end points and were recorded in both the groups. Results: The median number of attempts were 4 (IQR 2-4) and 2 (IQR 1-2), respectively, in the PUS and RUS group (P-value &lt; 0.001). The median number of passes, the median time for identifying space, and the time for successful epidural catheter placement was statistically signicantly less in the RUS group, than the PUS group. Conclusion:The time taken for the identication of the space, the number of attempts, number of passes, and the time taken for successful epidural catheter placement was more in the PUS group as compared to the RUS group.

Timing of intervention and complications of tunneled peritoneal catheter placement for recurrent malignant ascites in ovarian cancer patients

Objectives: In ovarian cancer patients, recurrent malignant ascites reduces quality of life and is associated with a poor prognosis. There is a lack of guidance in the literature regarding the placement of a tunneled peritoneal catheter in this patient population. We evaluated the outcomes of ovarian cancer patients who underwent tunneled peritoneal catheter placement for recurrent malignant ascites. Methods: We queried the institutional interventional radiology records from 5/2009 to 5/2020 for female patients with ovarian cancer who had a tunneled peritoneal catheter placed for malignant ascites. We evaluated patient characteristics, number of paracentesis procedures recorded prior to placement, complications, and the time between placement and death. Descriptive statistics were performed. Results: 30 patients were identified. The mean age was 68 (range, 42-88). 77% of patients were White and the average BMI was 26. 56.7% of patients had stage IIIC ovarian cancer and the 83.3% had papillary serous adenocarcinoma. Patients had a mean of four lines (range, 0-11) of chemotherapy before undergoing tunneled peritoneal catheter placement. The mean number of paracentesis performed prior to peritoneal catheter placement was two (range, 0-6). There were six minor complications (20%), including two catheter-related infections requiring removal and four instances of catheter dysfunction requiring revision. The median time of catheter placement to death was 44 days (range, 3-151). Conclusions: The complication rate of tunneled peritoneal catheter placement is low, as evidenced by no major complications found in this patient population. The short period from catheter placement until patient death suggests that tunneled peritoneal catheters should be pursued earlier in the disease course if patients have symptomatic, recurrent ascites.

Optimization in treatment planning of high dose-rate brachytherapy - Review and analysis of mathematical models.

Treatment planning in high dose-rate brachytherapy has traditionally been conducted with manual forward planning, but inverse planning is today increasingly used in clinical practice. There is a large variety of proposed optimization models and algorithms to model and solve the treatment planning problem. Two major parts of inverse treatment planning for which mathematical optimization can be used are the decisions about catheter placement and dwell time distributions. Both these problems as well as integrated approaches are included in this review. The proposed models include linear penalty models, dose-volume models, mean-tail dose models, quadratic penalty models, radiobiological models, and multiobjective models. The aim of this survey is twofold: (i) to give a broad overview over mathematical optimization models used for treatment planning of brachytherapy and (ii) to provide mathematical analyses and comparisons between models. New technologies for brachytherapy treatments and methods for treatment planning are also discussed. Of particular interest for future research is a thorough comparison between optimization models and algorithms on the same dataset, and clinical validation of proposed optimization approaches with respect to patient outcome.

Effect of a Vein Imaging Device and of Fist Clenching on Determination of an Appropriate Vein and on Catheter Placement Time in Patients Receiving Chemotherapy

As the vein structure gets damaged in patients receiving chemotherapy treatment, placement of peripheral intravenous catheter becomes difficult. To increase the success of peripheral intravenous catheter placement, a vein imaging device and fist clenching can be used. The aim of this study was to determine the effect of using a vein imaging device or fist clenching on the determination of an appropriate vein and successful catheter placement time in adult patients receiving chemotherapy. One hundred thirty-five patients receiving chemotherapy were randomly assigned to either the vascular imaging device group (n = 45), the fist clenching group (n = 45), or the control group (n = 45). In the vascular imaging group, a vascular imaging device was used to determine the appropriate vein; in the fist clenching group, the patients were asked to open and close their palms to determine the appropriate vein; and in the control group, no interventions except for the process steps were applied and the same nurse carried out the catheter insertion. The durations of determining the appropriate vein and successful peripheral intravenous catheter insertion were shorter in the device group at a significant level (P < .05) compared with the control group. The satisfaction levels of the patients and the nurse were higher in the device group at a significant level (P < .05) compared with the control group. The vascular imaging device was effective in determining the proper vein and in successful intravenous catheter insertion time in patients who were receiving chemotherapy. The use of vein imaging device will have positive results for patients and nurses.

An Analysis of Learning Curve Effect on the Speed and Quality of High Dose Rate Prostate Brachytherapy Procedures

To evaluate the impact of learning curve effect on the provision of High Dose Rate (HDR) prostate brachytherapy boost at a recently initiated program within a smaller Canadian Academic Cancer Center. From 2015 to 2019, 266 patients with intermediate or unfavorable risk prostate cancer were treated with single fraction HDR prostate brachytherapy boost (15 Gy), followed by combination external beam radiation therapy (37.5 – 46 Gy) at a single Canadian cancer institution. Detailed time records were recorded for all phases of the procedures including: total procedure time, catheter insertion / placement, contouring, second oncologist check, catheter reconstruction, planning / dose optimization, QA / second checks, and treatment delivery. Dosimetric values from the delivered plans were also analyzed, including metrics for: Prostate (D90, V100, V150, V200), urethra (D10, max), and rectum (V75, V80, V100, max). The experience of each team member (previous number of procedures performed since program inception) was also recorded. Radiation Oncologist (RO) experience was not a significant predictor of total procedure time (p = 0.163) nor total catheter placement time (p = 0.583). Planner experience was significantly correlated with reduced catheter reconstruction time, and consequently, total procedure time (β = -0.376 minutes / case experience, P<0.001). There were statistically significant differences in mean prostate D90 (105.36 vs 106.05%, p = 0.04), V100 (94.69% vs. 95.31%, p = 0.014), and urethra D10 (113.61 vs. 112.74%, p = 0.008) when comparing dosimetry from an oncologist’s first 20 cases compared to those afterwards. RO experience was correlated with improvement in prostate D90 (β = 0.000156, p = 0.008), V100 (β = 0.000144, p = 0.001), and V200 (β = -0.000152, p = 0.008), and urethra D10 (β = -0.000159, p = 0.011). HDR Prostate brachytherapy can provide radiotherapy with excellent dosimetric characteristics regardless of previous institutional experience. In our study, institutional oncologist experience provided a modest, but measurable improvement in dosimetric quality. Institutional experience reduced total procedure time; this improvement was mainly attributable to the planner. These findings support the use of HDR prostate brachytherapy as a robust technique even for newer adopters, and may further inform cancer centers initiating new HDR Brachytherapy programs or training new staff.

Venous blood gas parameters, electrolytes, glucose and lactate concentration in sick neonatal foals: Direct venipuncture versus push-pull technique.

Blood collection by indwelling intravenous catheter (IVC) avoids repeated venipuncture, which could cause thrombophlebitis risk, anxiety and pain in patients. To compare blood gas parameters, electrolytes, glucose, lactate and haematocrit concentration obtained from venous blood samples collected via a jugular IVC by push-pull (PP) technique to those obtained by venipuncture in hospitalised foals, at the time of catheter placement (T0) and 24hours after the beginning of intravenous therapy (T24). Prospective observational study. Paired blood samples were drawn from hospitalised foals at T0 and T24. In each foal, one venous blood sample was collected via IVC by the following PP technique: 2.4mL of blood was aspirated and immediately reinfused through the catheter three times consecutively, then 1mL of blood was collected using a 1mL heparinised syringe. Thereafter, another sample was collected by direct venipuncture of the contralateral jugular vein, with an identical 1mL heparinised syringe, with a 1-inch, 20-G needle. All samples were analysed with an automated blood gas analyser within 10minutes of collection. The agreement between the two techniques was assessed by Bland-Altman analysis and intraclass correlation coefficient (ICC). The level of agreement of blood gas values obtained by the two different techniques was high with very small bias and clinically acceptable ICC (>0.907 at T0; >0.794 at T24) for all variables, except for haematocrit (bias -3.52 at T0; -2.44 at T24) and PvO2 at T0 and T24 (ICC 0.669 and 0.733, respectively). Potential sub-clinical catheter-related complications were not investigated by ultrasound or bacterial culture of the catheter; short duration of the study. PP technique appears to be acceptable for collection of blood samples for venous blood gas parameters, as well as electrolytes, glucose and lactate in sick neonatal foals.

Watchful waiting is an appropriate option for peritoneal dialysis candidates with an asymptomatic ventral hernia.

Expert consensus recommends that all ventral hernias be repaired prior to, or concomitantly with, peritoneal dialysis (PD) catheter insertion. We examined the clinical outcomes of patients undergoing initial PD catheter insertion, with asymptomatic ventral hernias that were not repaired and rather managed using a watchful waiting approach. A single-center, retrospective review of patients undergoing PD catheter insertion from 2005-2019 was performed. Patients who did not undergo repair of a pre-existing ventral hernia at the time of their initial PD catheter insertion were included. The primary endpoint was ventral hernia repair following PD catheter insertion. Forty-one patients were included. Most patients presented with an umbilical hernia (78%). Six patients (15%) underwent ventral hernia repair at a median postoperative interval of 12months [IQR 8-16], due to abdominal discomfort and hernia enlargement (n = 2) and incarceration (n = 2). Two patients remained asymptomatic, yet underwent ventral hernia repair at the time of renal transplantation. The cumulative incidence of ventral hernia repair within 12 and 24 months of PD catheter insertion was 13% and 21%, respectively. Watchful waiting may be an acceptable option for select patients with asymptomatic ventral hernias at the time of initial PD catheter placement. These findings highlight the need to better identify factors associated with asymptomatic ventral hernias that do not warrant concomitant repair to aid surgeons in the decision-making process.

P1132EXIT-SITE CARE PROTOCOLS IN PORTUGAL AND ITS ASSOCIATION WITH CATHETER-RELATED INFECTIONS RATE

Abstract Background and Aims Exit-site infections (ESi) are frequent complications in peritoneal dialysis (PD) patients and their prevention and treatment are key aspects to lower peritonitis’ risk. The aim of this study was to evaluate the annual incidence rate of ESi and peritonitis in Portugal and to study possible associations between exit-site (ES) care protocols in each Portuguese unit and the number / rate of ESi and peritonitis. Method We performed a national study using two questionnaires at each Portuguese PD Unit: one about the incidence of catheter-related infections, the other characterizing patients’ education and ES care protocols. ESi and peritonitis were defined according to ISPD guidelines. Associations between variables were performed using T-student test or pairwise correlation test. STATA software was used. Results Of the 23 Portuguese PD Units, 14 units answered both questionnaires. In the last two years (2017 &amp; 2018), those units followed 1453 patients. Portuguese ESi incidence rate was 0.41 episodes per year [1 episode per 29.2 months (MSSA incidence rate 0.13; MRSA incidence rate 0.03; Pseudomonas incidence rate 0.07)] and the peritonites incidence rate was 0.37 (1 episode per 32.5 months). We found a trend between the absolute number of ESi episodes and the number of peritonites in each unit (r=0.5, p=0.05). Although ESi prevention guidelines were known by 100% of the Portuguese units, only three out of 5 of the selected guidelines for this study were followed by 100% of the units: monitoring catheter-related infections on a yearly basis; using antibiotic prophylaxis at time of catheter placement and treating nasal carriage of S. aureus. The other 2 guidelines have variable implementation: 12 out of 14 units (86%) perform screening of nasal carriage of S. aureus and only 6 out of 14 (43%) of the units recommend daily topic antibiotic cream at the ES. We didn’t find associations between those differences and ESi incidence. Whenever S. aureus carriage is detected, 100% of the units proceed treating with mupirocine using different posology (twice or three times a day, 5 or 7 or 21 days, with/out chlorexidine). Also, the screening of nasal carriage of S. aureus is different: only pre catheter implantation (n=4); annually (n=4); semi annually (n=3); bimonthly (n=2). Oral antibiotics are prescribed after catheter placement in 4 units. We didn’t find statistical differences in ESi / peritonitis, comparing those practices. Regarding to ES care protocols, ESi rate was lower with non-occlusive dressing (0.38 vs. 0.57) immediately after catheter insertion. ESi and peritonitis rate were lower in units where bathing without ES dressing is advocated (n=9, 0.58 &amp; 0.37 vs. 0.32 &amp; 0.34). The use of bath sponge is associated with higher ESi rate (0.57 vs. 0.34). The use of colostomy bags in beach baths was associated with lower incidence rate of ESi compared to regular dressing or waterproof dressing (o.32 vs. 0.54). 100% of units use two different empirical antibiotics for initial ESi treatment. In the presence of chronic ESi, 3 units don’t perform shaving of external cuff and peritonitis rate is higher in those who do not apply this procedure (0.38 vs. 0.31). Conclusion in Portuguese PD units there is a wide variability in ISPD guidelines implementation and ES care protocols. We found that using non-occlusive dressing immediately after catheter insertion, removing ES dressing before shower, bathing not using a sponge and using colostomy bags at beach baths were associated with lower incidence rate of ESi. Shaving of the external cuff was associated with lower incidence rate of peritonitis. A regular national audit of PD Units is an important tool of quality improvement to clarify the best procedures for reduction of catheter-related infections in PD.

Effectiveness of vialon biomaterial versus teflon catheters for peripheral intravenous placement: A randomized clinical trial.

This study was to determine the effects of the two types of catheter material (vialon biomaterial and teflon) on pain intensity, dwell time, and phlebitis score for peripheral intravenous catheter (PIVC) placement. Participants (N = 208) were randomly assigned to the vialon biomaterial group (n = 104), the teflon group (n = 104). After the PIVC placement, the intensity of pain and phlebitis score were evaluated. Catheter dwell mean time was determined. The pain intensity scores were similar immediately after inserting the PIVC. No difference was observed between the pain scores in both groups (p ≥ .050). Catheter dwell mean time for the vialon biomaterial catheter group (4.72 ± 1.20 days) was significantly longer compared to the teflon catheter group (4.10 ± 0.92 days) (p ≤ .001). It was determined that the catheter was removed due to phlebitis development in 16.3% of the vialon biomaterial catheter group and 53.8% of the teflon catheter group. An advanced level of statistically significant difference was found between the two groups in terms of phlebitis development scores (p ≤ .001). This study concluded that vialon biomaterial catheter (BD Insyte™ Autoguard™ BC winged) demonstrates longer dwell time of PIVC, lower phlebitis rate and phlebitis score than teflon catheter (BD Venflon™).

An analysis of prior experience influencing quality of pulmonary artery catheter placement in residents.

Background:Prior experience may be important for successful placement of a pulmonary artery catheter (PAC). However, there is no report about the minimum number of the placement to reach acceptable technique for the catheter placement during residency.Aims:This study was designed to examine quality of the catheter placement and to assess the effect of prior experience.Setting and Design:Prospective, observational, cohort study.Methods:This study included eight residents and one experienced staff in our hospital. We prospectively examined the performance of placement of a PAC in eight residents for the first 2 months of their training period and one staff for previous 2 years. We examined the time required for the catheter placement and probability of ventricular arrhythmias during the placement. Each resident and the staff reported approximate number of past experience of the catheter placement according to the self-statement. In addition, we continued to examine the placement of a PAC in one resident with zero experience to show his improvement.Statistical Analysis:Statistical analysis was performed by Kruskal–Wallis test, Mann–Whitney test, or Fisher's exact test as appropriate and Benjamini and Hochberg method was used for multiple comparisons.Results:The catheter placement time and probability of the ventricular arrhythmias of two residents with zero experience of the placement were significantly larger than those of the staff. On the other hand, the placement quality of the other residents who experienced at least 20 PAC placements was not significantly different from that of the staff. The placement quality of one resident with zero experience became comparable with that of the staff after 20 placements.Conclusion:Our data suggested that about 20 catheter placements may be required to reach acceptable technical level for the PAC placement.

Intraosseous Catheter Flow Rates and Ease of Placement at Various Sites in Canine Cadavers.

Objective: To compare intraosseous catheter placement difficulty, success rates, and flow rates at four different locations in canine cadavers.Design: Prospective study.Setting: Private referral center.Animals: Eleven fresh canine cadavers.Interventions: With owner consent, animals presenting for euthanasia were recruited. Animals received heparin (1,000 IU/kg IV) at least 5 min prior to euthanasia. After euthanasia, EZIO intraosseous catheters were placed into the ilial wing, proximal medial tibia, proximal lateral humerus, and distal lateral femur on one side of the animal. Time to catheter placement and catheter difficulty were scored for each placement site. Sterile saline was infused into each location simultaneously over 5 min, first via gravity then using 300 mmHg pressure. Animals were repositioned onto the contra-lateral side and the experiment repeated.Measurements and Main Results: Placement was successful in 16/22 ilial, 18/22 tibial, and 22/22 femoral and humoral attempts. A post-hoc analysis revealed the ileum had a significantly greater difficulty score when compared to the femur and humerus (p ≤ 0.0001). The femur had a statistically significant faster placement time when compared to the ileum (p ≤ 0.05). Gravity infusion rates were statistically lower in the tibia when compared to humerus (p ≤ 0.01) and between the tibia when compared to the femur (p ≤0.001). Additionally, pressurized infusion rates were statistically lower in the tibia compared to the humerus (p ≤ 0.0001), the femur (p ≤ 0.0001), and the ileum (p ≤ 0.01).Conclusions: The femur and humerus had high success rate for IO catheter placement and low placement time and difficulty scores. Pressurized intraosseous flow rates were highest in the humerus and femur. Contrary to human literature, success rates for catheter placement in the humerus and femur were higher than at other sites, suggesting the humerus and femur may be preferred sites for intraosseous catheter placement in the dog. Further investigation through a larger sample size is required to confirm these findings.

What do patients say about their experience with urinary catheters and peripherally inserted central catheters?

BackgroundLittle is known about the patient experience with urinary catheters or peripherally inserted central catheters (PICCs). We sought to better understand patient perspectives on having a urinary catheter or a PICC by reviewing open-ended comments made by patients about having either of these 2 devices. MethodsAs part of a larger study, we asked patients about certain catheter-related complications at the time of catheter placement and on days 14, 30, and 70 (PICCs only). In this larger project, we performed a structured assessment that included an open-ended question about other comments (initial interview) or problems (follow-up interview) associated with the device. For the current study, we conducted a descriptive analysis of these open-ended comments, classifying them as positive, negative, or neutral. ResultsPositive comments about urinary catheters accounted for 9 of 147 comments (6%), whereas positive comments about PICCs accounted for 10 of 100 comments (10%). Positive comments for both catheter types were mostly related to convenience. More than 80% of comments about both types of devices were negative and fell into the following areas: catheter malfunction; pain, irritation, or discomfort; interference with activities of daily living; provider error; and other. ConclusionsOur findings underscore the need to optimize the patient experience with placement, ongoing use, and removal of urinary catheters and PICCs.

Intracardiac echocardiography versus fluoroscopy for endovascular and endocardial catheter navigation during cryo-ablation of the slow pathway in AVNRT patients

BackgroundA new zero-fluoroscopy technique for electrophysiology catheter navigation relying on intracardiac echocardiography (ICE) has been recently reported (Ice&ICE trial). We investigated potential differences in efficacy, safety or procedural performance between conventional fluoroscopy- and ICE-guided cryothermal ablation (CA) in symptomatic AVNRT patients.MethodsClinical and electrophysiological data of AVNRT patients included in the Ice&ICE trial (22 patients, 16 females; =zero-fluoroscopy group) were compared to those of consecutive AVNRT patients, who underwent fluoroscopy-guided CA (25 patients, 17 females; = fluoroscopy group) during the last 2 years in our institution.ResultsSlow pathway ablation or modulation was successful in all patients. Fluoroscopy time and radiation dose in the fluoroscopy group were 11.2 ± 9.0 min and 20.3 ± 16.2Gycm2, whereas no fluoroscopy was used in the opposite group (p < 0.001, respectively). EPS duration was not different between the groups (zero-fluoroscopy:101.6 ± 40.2 min, fluoroscopy:99.4 ± 37.2 min, p = n.s.). Catheter placement time was significantly shorter in the fluoroscopy group (2.2 ± 1.6 min vs. 12.0 ± 7.5 min, p < 0.05), whereas cryo-application duration (from the first cryo-mapping to the last CA) was significantly shorter in the zero-fluoroscopy group (27.5 ± 37.0 min vs. 38.1 ± 33.9 min, p < 0.05). Mean cryo-mapping and CA applications were numerically lower in the zero-fluoroscopy group (CM:7.5 ± 5.7 vs. 8.8 ± 6.2; CA:3.1 ± 1.7 vs. 3.2 ± 2.0, p = n.s.). No major adverse events occurred in both groups. After 15.0 ± 4.2 months, arrhythmia recurrence was not different between the groups (4.5% vs. 8.0%, p = n.s.).ConclusionsZero-fluoroscopy ICE-guided EP catheter navigation shows comparable efficacy and safety to fluoroscopic guidance during CA in AVNRT patients. ICE visualization of catheters and endocardial structures within the triangle of Koch shortens the cryo-application duration, though time needed for catheter placement is longer, when compared with conventional fluoroscopic guidance, which results in similar mean EPS duration with both navigation techniques.Trial registration(German Clinical Trials Register ID: DRKS00011360; Registration Date 14.12.2016)

Effect of clinical nursing path on prevention of postoperative urinary retention in patients with cervical cancer surgery

Objective To investigate the application effect of clinical nursing path on prevention of postoperative urinary retention in patients with cervical cancer surgery. Methods From June 2016 to November 2017, a total of 80 patients admitted to the hospital for radical cervical cancer surgery were selected as the research objects.According to different responsibility groups, they were divided into the study group and the control group, 40 cases of each group.The study group received clinical nursing intervention.The control group received routine nursing intervention. Results Bladder function, quality of life, nursing satisfaction of patients in the study group were significantly better than those in the control group, and the differences were statistically significant(P<0.05). The incidence of urinary retention, catheter placement time, catheter replacement rate, residual urine volume and length of hospital stay were significantly lower in the study group than those in the control group, and the differences were statistically significant(P<0.05). Conclusions Clinical nursing pathway intervention for patients undergoing radical cervical cancer surgery can effectively reduce the incidence of urinary retention in patients undergoing radical cervical cancer surgery, improve the quality of life and nursing satisfaction of patients, which is worthy of promotion and application. Key words: Clinical nursing path; Cervical cancer; Radical surgery; Urinary retention

Comparing Incidence of Thrombosis in PICC and Midlines and Evaluating the Role of Anticoagulation, Site of Insertion, and Risk Factors

HighlightsNew practice models are in demand for prevention and reduction in rates of catheter thrombosis that can be devastating to the health care system and patients Risk factors for catheter thrombosis were analyzed retrospectively for their impact Site of insertion and overall use of anticoagulation at the time of catheter placement did not show any significant impact on incidence of thrombosis Several variables (i.e., triple lumen, critically ill) were used to create a clinical prediction score model

ANALGESIC EFFECTIVENESS OF CONTINUOUS INTERSCALENE CATHETER USE FOR AMBULATORY SHOULDER SURGERY IN PEDIATRIC AND ADOLESCENT PATIENTS

BACKGROUND Continuous interscalene catheters are utilized for inpatient and outpatient postoperative pain control after shoulder surgery. Although prior studies have primarily been limited to adult populations, benefits of peripheral nerve catheters in ambulatory surgical centers have been shown to reduce post operative pain scores, opioid requirements, and post operative nausea. However, their use in a solely pediatric ambulatory setting has not been investigated. The purpose of this study was to retrospectively review the adverse events, analgesic effectiveness, and opioid use after continuous interscalene catheters for ambulatory shoulder surgery in pediatric and adolescent patients. METHODS A retrospective review was performed of 15 pediatric and adolescent patients (4 female, 11 male), mean age 16 years (range, 12-18 years), and mean weight 78.3 kg (range 53-130 kg), who underwent ultrasound-guided interscalene catheter placement for outpatient shoulder surgery from April 2017 through May 2018. All but one surgery were performed at a dedicated pediatric ambulatory surgery center. Catheters were initially dosed with 0.5% ropivacaine (n = 13) or 0.2% ropivacaine (n = 2) at volumes of 0.1-0.2ml/kg (total, 6-20 ml). By the conclusion of surgery, all catheters were continuously infusing 0.2% ropivacaine at 3-6ml/hr with the majority (n = 10) at 4ml/hr via elastomeric pumps. Time for catheter placement, intraoperative and postoperative intravenous opioids, post-anesthesia recovery unit (PACU) length of stay (LOS), PACU maximum pain scores and rescue medications for post-operative nausea and vomiting (PONV) were recorded. After discharge, all patients received multimodal analgesia (ibuprofen, acetaminophen, and rescue oxycodone). Patients were assessed on postoperative days (POD) 1-3 for numerical rating pain scores (0-10) at rest and with movement, supplemental oxycodone use in the past 24 hours, satisfaction, and adverse effects of treatment. RESULTS Catheter placement was 100% successful; no procedure had to be aborted during placement because of inability to place catheter. The average time for catheter placement was 11.8 minutes (range, 3-19 minutes). There were 3 adverse events, including one accidental catheter removal in PACU, one dressing failure requiring removal of catheter on POD 2, and one case of Horner’s Syndrome. There were no signs of infection, local anesthetic toxicity, or shortness of breath described in any patients. Short acting opioids (Alfentanil and Fentanyl) were used intraoperatively in all but 2 patients, with average dose of 8.5mcg/kg Alfentanil and 0.7mcg/kg Fentanyl. Two patients received long-acting opioids intraoperatively. The mean PACU maximum pain score was 1.4 (range, 0-9). Only 3 patients received rescue intravenous morphine in the PACU with a mean dose of 0.035mg/kg. Mean PACU LOS was 112 minutes (range, 85 – 210 minutes). No patients required any rescue PONV medications in the PACU. Mean pain scores for POD 1- 3 at rest were 2.1, 2.3, and 2.6, respectively; scores with movement were 3.6, 3, and 4.4, respectively. Mean doses (i.e., times of administration) of oxycodone on POD 1-3 respectively were 1.5, 1.3 and 0.5 (range 0-5 doses). All but one patient was very satisfied and would have the catheter placed again. CONCLUSIONS Outpatient use of continuous interscalene catheters in pediatric and adolescent patients provides excellent intraoperative and early postoperative analgesia during and following shoulder surgery. Their routine use should be considered as they minimize perioperative opioid use with minimal adverse events, adding only small delay to surgical time.

Peritoneal Dialysis Access Associated Infections.

Infection is a significant driver of morbidity and mortality in patients with end-stage renal disease undergoing maintenance dialysis. In the United States, septicemia and other infections account for 8% deaths in patients undergoing dialysis. In patients undergoing peritoneal dialysis (PD), PD-related peritonitis remains the most frequent treatment-related infection and is the greatest contributor to infection-related morbidity, including risk for hospitalization, and temporary or permanent transfer to hemodialysis. In the 4 decades since the introduction of ambulatory PD in clinical practice, a large number of treatment innovations have been shown to be effective in reducing the risk for exit site infection and PD-related peritonitis. Notwithstanding the evidence for efficacy of these innovations and the numerous adverse health consequences with PD-related peritonitis, the uptake of these interventions in clinical practice around the world remains inconsistent. This article reviews current knowledge with regards to prevention of PD-associated infections, and the diagnosis and management of exit site infections and peritonitis.