Tip Location Research Articles

Intracavitary electrocardiogram guidance for peripherally inserted central catheter placement: A systematic review and trial sequential meta-analysis.

The intracavitary electrocardiogram (IC-ECG) localization technique has been widely used in peripherally inserted central catheter (PICC) placement. However, the accuracy of IC-ECG on PICC tip localization and complications remains controversial. The purpose of this work is to evaluate the clinical efficacy and safety of IC-ECG on PICC placement. We retrieved randomized control trials from PubMed, Web of Science, Cochrane Library, EMBASE, and CNKI databases published before October 30, 2024. Patients guided by IC-ECG technology or landmark, and then used radiography to confirm the tip position, regardless of age, race, nationality, and region. Interventions other than IC-ECG or landmark were excluded. We used the Cochrane Bias Risk Assessment tools version 2 to evaluate the quality of enrolled trials. The Grading of Recommendations Assessment, Development, and Evaluation Statements online tool was used to determine the certainty of the evidence. The primary outcome was the success rate on the first attempt. Sixteen studies involving 6707 PICC patients are included. The results of the meta-analysis indicate that the IC-ECG group has a significantly higher success rate on first attempt of PICC placement (RR = 1.23, 95% CI [1.09-1.37], p < 0.00001). Total complications and phlebitis events decreased in the IC-ECG group compared with the landmark group. The mean procedure time, thrombogenesis, infection, and arrhythmia in the IC-ECG group are not statistically significant compared with the landmark group. Trial-sequential analysis (TSA) of the results indicate that sufficient events had been observed in the outcomes in success rate on first attempt, overall successful rate, total complications, phlebitis events, and infection events. The IC-ECG guided method has a higher success rate on the first attempt and lower total complication for catheter tip localization in PICC placement. IC-ECG may be considered the preferred method for accurate catheter tip placement. (PROSPERO registration number, CRD42023456651).

A method for determining crack tip location during the tuff crack propagation based on ultra-fast time resolution method and immune algorithm

A method for determining crack tip location during the tuff crack propagation based on ultra-fast time resolution method and immune algorithm

Determination of fatigue crack tip location and plastic zone dimensions using displacement fields measured by digital image correlation method

Determination of fatigue crack tip location and plastic zone dimensions using displacement fields measured by digital image correlation method

Atrial flutter after insertion of venous catheter in a newborn.

Atrial flutter (AFL) is a rare, yet potentially life-threatening tachyarrhythmia of newborns, typically associated with structural heart disease or cardiac surgery. Rarely, AFL might occur as a complication of central venous catheter (CVC) insertion, though data on its incidence and management are limited. Herein, we report the case of a full-term male newborn in therapy with heparin for left iliac thrombosis who developed AFL after a CVC placement. The persistent tachycardia (220 beats per minute) had a narrow QRS and was diagnosed as AFL based on the ECG following adenosine administration; an electrical cardioversion was needed in order to restore the sinus rhythm. Such case highlights the crucial role of real-time tip location techniques in supporting the CVC placement. Indeed, the real-time ultrasound at the bedside might be extremely helpful to promptly assess a CVC mispositioning, allowing for timely and correct management. In conclusion, this case underscores the critical role of real-time ultrasound or intracavitary ECG (IC-ECG) to prevent CVC-related complications and the need for further research into optimizing management strategies for such complications.

Phosphorylation-induced SUMOylation promotes Ulk4 condensation at ciliary tip to transduce Hedgehog signal.

Hedgehog (Hh) signaling controls embryonic development and adult tissue homeostasis through the Gli family of transcription factors. In vertebrates, Hh signal transduction depends on the primary cilium where Gli is thought to be activated at the ciliary tip, but the underlying mechanism has remained poorly understood. Here we provide evidence that two Unc-51-like kinase (Ulk) family members Stk36 and Ulk4 regulate Gli2 ciliary tip localization and activation through phosphorylation and SUMOylation-mediated condensation in response to Shh. We find that Stk36-mediated phosphorylation of Ulk4 promotes its SUMOylation in response to Shh, and the subsequent interaction between SUMO and a SUMO-Interacting-Motif (SIM) in the C-terminal region of Ulk4 drives Ulk4 self-assembly to form biomolecular condensates that also recruit Stk36 and Gli2. SUMOylation or SIM-deficient Ulk4 failed to accumulate at ciliary tip to activate Gli2 whereas phospho-mimetic mutation of Ulk4 sufficed to drive Ulk4/Stk36/Gli2 condensation at ciliary tip, leading to constitutive Shh pathway activation in a manner dependent on Ulk4 SUMOylation. Taken together, our results suggest that phosphorylation-dependent SUMOylation of Ulk4 promotes kinase-substrate condensation at ciliary tip to transduce the Hh signal.

Real-Time 3D Instrument Tip Tracking Using 2D X-Ray Fluoroscopy With Vessel Deformation Correction Under Free Breathing.

Accurate localization of the instrument tip within the hepatic vein is crucial for the success of transjugular intrahepatic portosystemic shunt (TIPS) procedures. Real-time tracking of the instrument tip in X-ray images is greatly influenced by vessel deformation due to patient's pose variation, respiratory motion, and puncture manipulation, frequently resulting in failed punctures. We propose a novel framework called deformable instrument tip tracking (DITT) to obtain the real-time tip positioning within the 3D deformable vasculature. First, we introduce a pose alignment module to improve the rigid matching between the preoperative vessel centerline and the intraoperative instrument centerline, in which the accurate matching of 3D/2D centerline features is implemented with an adaptive point sampling strategy. Second, a respiration compensation module using monoplane X-ray image sequences is constructed and provides the motion prior to predict intraoperative liver movement. Third, a deformation correction module is proposed to rectify the vessel deformation during procedures, in which a manifold regularization and the maximum likelihood-based acceleration are introduced to obtain the accurate and fast deformation learning. Experimental results on simulated and clinical datasets show an average tracking error of 1.59 0.57 mm and 1.67 0.54 mm, respectively. Our framework can track the tip in 3D vessel and dynamically overlap the branch roadmapping onto X-ray images to provide real-time guidance. Accurate and fast (43ms per frame) tip tracking with the proposed framework possesses a good potential for improving the outcomes of TIPS treatment and minimizes the usage of contrast agent.

Application of point-of-care ultrasound-guided tip navigation combined with visualised directional high-frequency linear array probe compression to improve the success rate of umbilical venous catheterisation in critical neonates: protocol of a multicentre randomised controlled trial in neonatal units

IntroductionConventional umbilical venous catheterisation (UVC) relies on ‘blind’ insertion without ultrasound guidance, resulting in low success and high complication rates. While point-of-care ultrasound (POCUS)-based tip navigation and location has improved...

Impact of silicone midline catheter tip location on catheter-related complications and indwelling duration: results from a multicentre randomised clinical trial in China

ObjectiveTo explore the impact of the terminal tip location of silicone midline catheter (MC, a type of intravenous catheter measuring 20–30 cm in length and inserted into upper arm veins...

Reducing Peripherally Inserted Central Catheter Tip Migration in Neonates: A Proactive Approach to Detection and Repositioning.

Objective: Peripherally Inserted Central Catheter (PICC) tip migration often occurs after placement despite efforts to position the tip centrally. This study aimed to quantify PICC tip migration within 3-7 h post-insertion and evaluate the effectiveness of manual adjustments for repositioning. Methods: This single-centre retrospective study evaluated the impact of a proactive approach following PICC placement, which included standardized body positioning during X-rays, defined target PICC tip locations, radiological surveillance at 4-6 h post-insertion, and guided manual adjustments. We included all infants receiving PICCs during a five-year period; trained nurses and physicians in vascular access performed the insertions. Results: Of 712 infants included, the median gestational age was 30 weeks, and the median birth weight was 1386 g. PICC tip migration occurred in 211 infants (30%) within 3-7 h post-insertion, with 81% of cases involving inward migration into the cardiac silhouette. Migration was more common in upper limb PICCs (82%). Manual adjustments achieved satisfactory repositioning in 191 infants (83%). None of the infants experienced pericardial effusion. Conclusions: A proactive approach that standardized imaging protocols, timing, and PICC tip positioning detected migration in 30% of infants and successfully facilitated repositioning in 83% of cases.

Improvement in outcomes with ultrasound-guided ventriculoperitoneal shunt insertion.

Improvement in outcomes with ultrasound-guided ventriculoperitoneal shunt insertion.

Use of Point-of-Care Ultrasound for Central Line Placement: A Quality Improvement Project.

Point-of-care ultrasound (POCUS) is a reliable tool and is slowly being incorporated into neonatal care. Central line (CL) placement is the most common procedure in the neonatal intensive care unit. Radiographs remain the current standard to confirm the location of the central line tip (CLT). Catheters often need adjustments with multiple x-rays. A quality improvement (QI) project was designed to use POCUS and increase the percentage of CLs needing only 1 x-ray to confirm CLT location by 25% in 1year. CLs placed between July 2021 and February 2024 were included. There were 3 key drivers: POCUS training, promoting POCUS acceptance, and standardizing the scanning process. The primary outcome was the percentage of CLs placed with POCUS that required only 1 x-ray to confirm placement. The secondary outcome was the number of inadvertently placed arterial peripherally inserted central catheters (PICCs). Process measures were the percentage of providers competent to use POCUS and the percentage of CLs inserted and checked with POCUS. Statistical process control charts were used for analysis. Targeted interventions increased the percentage of CLs that needed only 1 x-ray from 35% to 57%. Forty-eight percent of providers were competent, and 47% of CLs were assessed by POCUS. Five PICCs were inadvertently inserted into an artery during the baseline vs zero after the interventions. QI methodology and targeted interventions were associated with a reduction of x-rays in neonates requiring CL placement to confirm position and a reduction in the inadvertent arterial insertion of PICCs.

The Effect of Endotracheal Tube (ETT) Tip Position on Lung Aeration in Term and Preterm Neonates: A Comparative Analysis.

Proper endotracheal tube (ETT) position is crucial for neonatal lung aeration. The purpose of this study is to determine the effect of ETT tip position on lung aeration in term and preterm infants. Methods: This retrospective chart study involved neonates who were admitted to the Neonatal Intensive Care Unit (NICU) and intubated, and it was carried out from February 2023 to July 2023 at the Sindh Institute of Child Health and Neonatology. ETT tip positionwas analyzed, and chest x-rays (CXRs) were obtained within four hours of intubation. On a CXR, lung expansion evident to eight or eight and a half ribs was considered adequate lung inflation/aeration; fewer than eight ribs were considered poor lung inflation/aeration. To ascertain relationships between ETT tip location and lung aeration, data were examined using the chi-square testin SPSS version 26(IBM Corp., Armonk, NY). Out of 149 neonates, 105 (70.5%) were preterm and 44 (29.5%) were term. Optimal lung aeration was observed in 124 neonates (83.2%). The ETT tip was positioned at T1-T2 in 86 neonates (57.7%) and at T3-T4 in 63 neonates (42.3%). For term neonates, those with the ETT tip at T1-T2 exhibited significantly higher rates of optimal lung aeration (72.2%) compared to those with the tip at T3-T4 (27.8%, p = 0.019). Conversely, no significant difference in lung aeration was noted among preterm neonates based on ETT position (p = 0.745). In conclusion, our study found a significant association between ETT tip positioning at T1-T2 and optimal lung aeration in term neonates. This suggests that precise ETT placement may play an important role in achieving better lung aeration in term infants, while slight positional deviations may be less impactful for lung aeration in preterm neonates. These findings may guide NICU protocols to consider gestational age when tailoring ventilation strategies, emphasizing the importance of anatomical and physiological differences in neonatal respiratory care.

Stability of Thermoablation Antenna Using a Patient-Mounted Navigation System: Initial Clinical Experience.

CT-guided microwave ablation (MWA) has become a standard procedure for a range of therapeutic and diagnostic indications, but accurate and stable positioning of the antenna is critical. In this retrospective case series, a navigation guide with a physical cube component, the Access Cube (AC), was investigated as a stability support in addition to its use as a navigation system. To our knowledge, this is the first investigation of stability in MWA. Eight MWAs performed at one centre using the AC were reviewed for clinical and technical success. The stability of the antenna was assessed by subjectively comparing the Euclidian distance (ED) between the needle tip location in the final control scan and confirmation scan. A practising radiologist not associated with the study independently assessed the coordinates, and the mean was calculated from the results. Six patients (eight procedures) were included (4 females). Mean age of the patients was 75.8 years (range 58-87). Diagnoses included liver metastasis (4, 50%), renal cell carcinoma (2, 25%) and 1 case each (12.5%) of hepatocellular carcinoma and lung metastasis. Mean tumour size was 2.4 cm (range 1.0-4.3 cm), with a mean depth of 10.6 cm (range 5-18 cm). Mean ED of needle tip between final control scan and confirmation scan was 5.82 mm. Technical and clinical success were achieved in all cases with one Grade 2 complication arising. Usage of the AC was a beneficial addition to the MWA process. Good stability of the antenna was achieved when placed through the AC, eliminating the need for the clinician to manually hold the antenna in place during ablation. Level 4, Case Series.

Experimental study of fluid displacement and viscous fingering in fractured porous media: effect of viscosity ratio

Viscous fingering instability has been analyzed through empirical studies using miscible flow displacement in fractured porous media. While significant research has been conducted on viscous fingering, limited information is available regarding its behavior in fractured porous structures. The experiments were conducted in rectangular porous models with fractures oriented at 0∘, 45∘, and 90∘, to investigate how fracture orientation influences fluid displacement, where both channeling and fingering mechanisms play significant roles. This paper, which is the second part of a previous study, places particular emphasis on the impact of the viscosity ratio, a crucial parameter in determining the complexity of the fingering patterns. Quantitative parameters such as sweep efficiency, tip location, and breakthrough time were evaluated and analyzed using image processing techniques. The results indicate that increasing the viscosity ratio leads to more complex finger formations. Additionally, as the injection rate increases, the size of the finger patterns slightly increases, while the channeling effect becomes less pronounced. Notably, fractures aligned at 0∘ had the most significant impact on the rate of sweep efficiency and tip location, increasing the tip velocity of the fingers by up to 90%.

Risk Factors for Totally Implantable Access Ports Associated Complications in Breast Cancer Patients.

ObjectiveTo investigate the risk factors for complications in breast cancer patients with totally implantable access ports (TIAPs).MethodsThis retrospective case-control study involved 471 breast cancer (BC) patients who received TIAPs during chemotherapy. We compared the demographic and clinical characteristics of patients with complications to those without, analyzed independent risk factors using binary logistic regression, and identified differences in complication rates based on catheterization site.ResultsThe most frequent complication was catheter malposition, followed by infection, thrombosis, hemothorax, and port rotation. Complications were more common in right-side BC cases (P = .026) and with left-side insertions (P = .012). Binary logistic regression identified independent risk factors for complications: catheter tip location (OR = 0.599, P = .013), and catheterization site (OR = 0.319, P = .019). Notably, left-side insertion significantly increased the risk of overall complications and catheter malposition compared to right-side insertion (OR = 3.534, P = .008; OR = 5.624, P = .004, respectively).ConclusionCatheter tip location and catheterization site independently affect complications and catheter malposition. For TIAPs implantation, particularly on the left side, a lower catheter tip location is advised to reduce complications and enhance safety.

Distributed Backface Strain Sensing of Composite Adhesively Bonded Joints under Mode II Fatigue Loading

Distributed Backface Strain Sensing of Composite Adhesively Bonded Joints under Mode II Fatigue Loading

Anatomically Guided Deep Learning System for Right Internal Jugular Line (RIJL) Segmentation and Tip Localization in Chest X-Ray.

The right internal jugular line (RIJL) is a type of central venous catheter (CVC) inserted into the right internal jugular vein to deliver medications and monitor vital functions in ICU patients. The placement of RIJL is routinely checked by a clinician in a chest X-ray (CXR) image to ensure its proper function and patient safety. To reduce the workload of clinicians, deep learning-based automated detection algorithms have been developed to detect CVCs in CXRs. Although RIJL is the most widely used type of CVCs, there is a paucity of investigations focused on its accurate segmentation and tip localization. In this study, we propose a deep learning system that integrates an anatomical landmark segmentation, an RIJL segmentation network, and a postprocessing function to segment the RIJL course and detect the tip with accuracy and precision. We utilized the nnU-Net framework to configure the segmentation network. The entire system was implemented on the SimpleMind Cognitive AI platform, enabling the integration of anatomical knowledge and spatial reasoning to model relationships between objects within the image. Specifically, the trachea was used as an anatomical landmark to extract a subregion in a CXR image that is most relevant to the RIJL. The subregions were used to generate cropped images, which were used to train the segmentation network. The segmentation results were recovered to original dimensions, and the most inferior point's coordinates in each image were defined as the tip. With guidance from the anatomical landmark and customized postprocessing, the proposed method achieved improved segmentation and tip localization compared to the baseline segmentation network: the mean average symmetric surface distance (ASSD) was decreased from 2.72 to 1.41 mm, and the mean tip distance was reduced from 11.27 to 8.29 mm.

Development and feasibility of an echocardiography-guided tip location program for central venous catheter implantation.

This is a prospective observational study designed to develop an echocardiography-guided tip location program for central venous catheter (CVC) implantation, and to assess the feasibility and the accuracy of the program. First, a multidisciplinary expert committee designed an echocardiography-guided tip location program; then, a pilot prospective observational study was conducted to assess the feasibility of the program in a vascular access clinic in a tertiary hospital. A total of 186 patients participated in the study. Successful echocardiography-guided tip placement was achieved in 172 (92.5%) patients. The accuracy of the program reached 99.4%. The program of echocardiography-guided tip location is feasible and accurate. Ultrasound images revealed notable discrepancies at various locations, allowing specialized nurses to conduct echocardiography-guided tip placement during CVC insertion through targeted training and practice.

Intrathecal Drug Delivery for Intractable Pain: Identified Patient Satisfaction Survey Study Comparing Intrathecal Dose With Satisfaction, Pain Relief, and Side Effects.

Intrathecal Drug Delivery for Intractable Pain: Identified Patient Satisfaction Survey Study Comparing Intrathecal Dose With Satisfaction, Pain Relief, and Side Effects.

Deep Learning to Localize Photoacoustic Sources in Three Dimensions: Theory and Implementation.

Surgical tool tip localization and tracking are essential components of surgical and interventional procedures. The cross sections of tool tips can be considered as acoustic point sources to achieve these tasks with deep learning applied to photoacoustic channel data. However, source localization was previously limited to the lateral and axial dimensions of an ultrasound transducer. In this paper, we developed a novel deep learning-based three-dimensional (3D) photoacoustic point source localization system using an object detection-based approach extended from our previous work. In addition, we derived theoretical relationships among point source locations, sound speeds, and waveform shapes in raw photoacoustic channel data frames. We then used this theory to develop a novel deep learning instance segmentation-based 3D point source localization system. When tested with 4,000 simulated, 993 phantom, and 1,983 ex vivo channel data frames, the two systems achieved F1 scores as high as 99.82%, 93.05%, and 98.20%, respectively, and Euclidean localization errors (mean ± one standard deviation) as low as 1.46±1.11 mm, 1.58±1.30 mm, and 1.55±0.86 mm, respectively. In addition, the instance segmentation-based system simultaneously estimated sound speeds with absolute errors (mean ± one standard deviation) of 19.22±26.26 m/s in simulated data and standard deviations ranging 14.6-32.3 m/s in experimental data. These results demonstrate the potential of the proposed photoacoustic imaging-based methods to localize and track tool tips in three dimensions during surgical and interventional procedures.