Ultrasound-guided Placement Research Articles

Radiographic, fluoroscopic, and endosonographic predictors of failed EUS-guided transgastric stent placement in patients with Roux-en-Y bypass anatomy

Background and study aims: Gastric access temporary for endoscopy (GATE) via endoscopic ultrasound-guided stent placement between the gastric pouch/jejunum and remnant stomach is used in Roux-en-Y gastric bypass (RYGB) to facilitate endoscopic retrograde cholangiopancreatography or other maneuvers. This study aimed to identify radiographic predictors of GATE failure and intraprocedure reasons for aborting. Patients and methods: Patients undergoing GATE were matched 3:1 on procedure success. Features indicating quality of the transgastric window were collected including: 1) gastric pouch/blind limb length; 2) location of remnant stomach relative to pouch or blind/roux limb; 3) pouch orientation; 4) remnant orientation; 5) length of contact; 6) tissue thickness; and 7) presence of poor contact (calcification, surgical material, intervening vasculature). Primary outcome was radiographic criteria associated with GATE failure. Secondary outcomes were endoscopic, endosonographic, and fluoroscopic intraprocedure reasons for aborting GATE. Results: Forty patients (30 successful, 10 aborted, 82.5% failed) who underwent GATE were included. Mean (±SD) age and time since RYGB were 62.8 ± 11.9 and 15.1 ± 8.6 years, respectively. There were no group demographic differences. The cumulative number of contact-related risk factors was associated with GATE failure (odds ratio 26.1, 95% confidence interval 0.004-0.337; P = 0.004). Two or more factors increased the likelihood of GATE failure (P < 0.05). Echoendoscope angulation/tip deflection, intervening vasculature, distance to remnant stomach, rapid emptying and/or insufficient filling of contrast were reported in cases of GATE failure. <b>Conclusions:</b> Radiographic features may predict GATE failure including intervening vasculature or insufficient contact between gastric pouch/blind limb and remnant. Patients demonstrating these features may benefit from alternative treatment approaches early in management.

Ultrasound-Guided Peritoneal Dialysis Catheter Placement: A Probing Review

Ultrasound-Guided Peritoneal Dialysis Catheter Placement: A Probing Review

Ultrasound-Guided Venous Catheter Placement in Prone Position.

The prone position is often used for patients with adult respiratory distress syndrome and specific surgical postures. When performing venous cannulation in this position, it is important to have a structured review to introduce the available major veins and ultrasound-guided procedure. In this review, we discuss the techniques of ultrasound-guided cannulation and provide insights into various aspects, including the anatomical locations of veins, vein sizes, placement techniques, surrounding structures at risk, and reported experiences with catheter placements. Eight major veins can be accessed in the prone position: the internal jugular vein, external jugular vein, brachiocephalic vein, basilic vein, mid-thigh femoral vein, popliteal vein, posterior tibial vein, and small saphenous vein. To minimize the risk of venous thromboembolism, the ratio of catheter diameter to vessel diameter should be less than 0.67. The review also presents the minimal requirement of venous diameter for different catheters in a tabulated form. For larger veins, real-time ultrasound guidance with the long-axis view/in-plane technique is suggested, while for smaller vessels, the short-axis view/out-of-plane technique is recommended. The review includes sonographic illustrations of the two techniques and surrounding arteries and nerves for the eight major veins. The aim of this review is to help clinicians assess the eight major veins and safely insert various types of catheters for patients in the prone position.

Percutaneous ultrasound-guided anchor wire placement aids in the intraoperative localization of nonpalpable, superficial foreign bodies and abscesses in dogs.

To describe and evaluate the use of preoperative percutaneous ultrasound-guided anchor wire placement to aid intraoperative localization of superficial foreign bodies and abscesses in dogs. 11 dogs. In a retrospective observational study, the medical records of dogs that underwent surgical exploration of superficial abscesses, guided by anchor wire, between 2018 and 2023 were reviewed for clinical and histopathological findings and complications. Owners or veterinarians were contacted to collect long-term follow-up information. 11 dogs were included. Superficial swelling was the most common clinical presentation. Computed tomography and ultrasound revealed an abscess cavity and suspected foreign body in 9 dogs and an abscess cavity without evidence of a foreign body in 2 dogs. Anchor wires were placed in close proximity to the foreign body or inside the abscess. All documented foreign bodies were successfully located and retrieved. Two dogs suffered minor postoperative complications. No major intra- or postoperative complications were documented. One dog displayed recurrence of clinical signs, but no further surgical management was required. Preoperative percutaneous placement of an anchor wire via ultrasound guidance was successful in aiding intraoperative localization of nonpalpable abscesses and retrieval of foreign bodies. This technique may decrease surgical time, minimize the surgical approach required, and increase the likelihood of successful localization.

Bridging the procedures skill gap from medical school to residency: a simulation-based mastery learning curriculum

ABSTRACT Background The transition from medical student to intern is a recognized educational gap. To help address this, the Association of American Medical Colleges developed the Core Entrustable Professional Activities for entering residency. As these metrics outline expectations for all graduating students regardless of specialty, the described procedural expectations are appropriately basic. However, in procedure-heavy specialties such as emergency medicine, the ability to perform advanced procedures continues to contribute to the disconnect between undergraduate and graduate medical education. To prepare our graduating students for their internship in emergency medicine, we developed a simulation-based mastery learning curriculum housed within a specialty-specific program. Our overall goal was to develop the students’ procedural competency for central venous catheter placement and endotracheal intubation before graduation from medical school. Methods Twenty-five students participated in a simulation-based mastery learning procedures curriculum for ultrasound-guided internal jugular central venous catheter placement and endotracheal intubation. Students underwent baseline assessment, deliberate practice, and post-test assessments. Both the baseline and post-test assessments used the same internally developed checklists with pre-established minimum passing scores. Results Despite completing an emergency medicine rotation and a critical care rotation, none of the students met the competency standard during their baseline assessments. All twenty-five students demonstrated competency on both procedures by the end of the curriculum. A second post-test was required to demonstrate achievement of the central venous catheter and endotracheal intubation minimum passing scores by 16% and 28% of students, respectively. Conclusions Students demonstrated procedural competency for central venous catheter placement and endotracheal intubation by engaging in simulation-based mastery learning procedures curriculum as they completed their medical school training. With three instructional hours, students were able to achieve basic procedural competence for two common, high-risk procedures they will need to perform during emergency medicine residency training.

Systematic review of ultrasound-guided central venous catheter placement-related complications in neonates and infants aged

Although ultrasound can be considered an assistant method, successful placement of a central venous catheter (CVC) in infants is still challenging. The incidence of CVC placement-related complications is still high. Therefore, this systematic review aimed to synthesize evidence to assess the effects of ultrasound-guided CVC placement on adverse outcomes in infants and neonates aged <12 months. PubMed, Ovid, EMBASE, and the Cochrane Library were searched to identify potentially relevant studies. The main outcome was the incidence of adverse events, which included inadvertent arterial puncture, hematoma, pneumothorax and hemothorax, catheter kinking, threading, and malpositioning problems, venous thrombosis, catheter-related infection, phlebitis, and cardiac tamponade. Eleven studies involving 2097 patients were included in the final analysis. The odds of inadvertent arterial puncture, and catheter kinking, threading, and malpositioning problems were lower in the ultrasound group than in the control group. No significant difference was detected in the incidence of hematoma or venous thrombosis between the control and ultrasound groups. Other complications, such as pneumothorax, hemothorax, phlebitis, and cardiac tamponade, rarely occurred. Ultrasound-guided CVC placement can improve the safety of punctures in neonates and infants. CVC punctures should be guided in real-time by ultrasound.

Augmented reality visualization for ultrasound-guided interventions: a pilot randomized crossover trial to assess trainee performance and cognitive load

BackgroundAugmented reality (AR) technology involving head-mounted displays (HMD) represents a significant innovation in medical education, particularly for training in guided invasive procedures. Novice physicians often face challenges in simultaneously identifying anatomical landmarks and performing procedures when learning point-of-care ultrasound (POCUS). Our primary objective was to determine the effectiveness of AR in enhancing physician training for ultrasound-guided interventions using AR visual overlays. The secondary objective was to compare cognitive load between traditional ultrasound training settings and AR-assisted training settings.MethodsThis randomized crossover study, conducted from 2021 to 2022, compared performance and cognitive load of trainees attempting accurate central venous catheter (CVC) placement using an AR-HMD to display ultrasound images (AR-US), compared with standard ultrasound without visual overlay (S-US). We enrolled 47 trainees, including 22 final-year undergraduate medical students and 25 postgraduate physicians (years 1–4) from three hospitals in Taiwan. All participants had basic training in US-guided CVC placement but lacked AR-US experience. Performance and cognitive load were assessed using time measurements and NASA Task Load Index (NASA-TLX), covering the dimensions of Mental-, Physical- and Temporal Demand, and Performance, Effort and Frustration.ResultsWe found AR technology reduced the time required for critical steps in CVC placement, while minimizing users’ neck strain. Female and junior trainees using AR-US identified anatomy and localized veins faster than those using S-US. Using AR-US, female trainees significantly outperformed males in anatomical identification [mean difference (MD): -10.79 s (95% CI: -2.37 to -19.21)]. The NASA-TLX cognitive load assessment showed mental workload trending lower in all dimensions except performance while using AR-US, compared to S-US. Similarly, junior trainees’ effort- and frustration scores were lower [MD: -2.73 (95% CI: -5.04 to -0.41) and -2.41 (95% CI: -4.51 to -0.31), respectively], as were female trainees’ effort scores [MD: -3.07 (95% CI: -6.10 to -0.03)] when using AR-US, compared to S-US, whereby these differences were statistically significant.ConclusionsAR technology helped improve trainee performance and reduced cognitive load during ultrasound-guided CVC placement. These findings support the application of AR technology to enhance physician training in ultrasound-guided interventional procedures, suggesting that AR-HMDs could be a valuable tool in medical education.Trial registrationThe trial was registered with Clinicaltrials.gov on 20/09/2023 as a clinical trial, under the identifier NCT 06055400.

Single-Plane Versus Synchronous Biplane Ultrasound Imaging During Vascular Access Procedures: Which Is Better and How Can We Improve?

Highlights Biplane ultrasound imaging reduces need for probe manipulation during procedure. Providers note clinical benefit of biplane ultrasound imaging for vascular access. Biplane disadvantages include probe size, imaging quality, size of the screen. Thorough didactic and practical education is essential for biplane success. Abstract Background: Use of ultrasound guidance for vascular access procedures is commonplace in inpatient and outpatient care settings. Standard ultrasound probes offer the operator a single-plane view, necessitating rotation of probe to attain dual complimentary views. This mechanical probe rotation increases technical difficulty of ultrasound use. The purpose of this study is to evaluate the rate of cannulation success and efficiency of a synchronous biplane ultrasound mode in ultrasound-guided arterial line placement as compared with a standard single-view ultrasound mode in the operating room setting. Methods: Patients scheduled for elective surgery in which a radial arterial catheter would be used for hemodynamic monitoring were approached for consent to this study. Patients were randomized to either undergo placement with single-plane view versus synchronous biplane view; outcomes were recorded. Providers were provided preprocedural ultrasound education as well as the option of a short hands-on experience; their level of experience was noted. Results: Placement time of a peripheral arterial catheter was longer and required more attempts to be successful using synchronous biplane imaging as compared with single-plane imaging across providers of all skill/experience levels. Subjectively, providers noted the benefit of synchronous biplane imaging in vascular access; however, disadvantages including probe size, quality of imaging, and size of the screen were noted. Discussion: Thorough education regarding the use and functionality of biplane synchronous imaging in vascular access is essential. Additional guided-practice time with experienced operators could also be helpful to overcome the challenges observed in this study.

Learning curve of ultrasound-guided percutaneous central venous port placement in children

BackgroundAlthough percutaneous central venous port (CVP) placement can be quickly performed using minimally invasive surgery, short- and long-term complications can occur. Beginner pediatric surgeons must overcome learning curves influencing operative time and complication rates. However, few studies have been conducted on the learning curve of ultrasound-guided percutaneous CVP placement. This study analyzed the progress, results, complications, and learning curve of ultrasound-guided percutaneous CVP placement in children performed by a single beginner pediatric surgeon.MethodsData from 30 children who underwent ultrasound-guided percutaneous CVP placement were reviewed. The patient characteristics, procedure indications, access veins, operator positions, operative times, and complication rates were analyzed.ResultsCumulative sum analysis revealed two stages in the learning curve: stage 1 (initial 15 cases) and stage 2 (subsequent cases). There was a correlation between the number of cases and operative time (Pearson correlation = -0.499, p = 0.005); the operative time was significantly longer in the first than in the second stage (p = 0.007). Although surgical complications occurred more frequently in the early (26.7%) than in the late stage, it was not significantly different between the two stages (p = 0.1). During the study period, the operative time was significantly reduced owing to the change in the operator’s position from the patient’s right side to the patient’s head (p = 0.005).ConclusionsUltrasound-guided percutaneous CVP placement was a safe surgery that allowed a beginner pediatric surgeon to overcome the learning curve after only 15 cases and involved a relatively small number of complications compared with other pediatric surgeries. Additionally, the suitable position of the operator affected the surgical outcomes.

Accuracy of ultrasound-guided iliopsoas tendon injection after total hip arthroplasty: a retrospective observational study.

To describe and characterize the accuracy and benefit of a technique for performing ultrasound-guided needle placement for iliopsoas peritendon or bursa injections as an alternative method to fluoroscopic guidance. Patients with a history of total hip arthroplasty who were referred by their orthopedic surgeon for iliopsoas peritendon or bursa corticosteroid injection for iliopsoas impingement syndrome between June 2017 and December 2019 were eligible for inclusion. Of these patients, 19 received a total of 26 ultrasound-guided needle placement followed by confirmatory fluoroscopic guidance prior to injection. Pre-injection and post-injection VAS scores were collected to monitor pain. Additionally, the patients were followed for 6months via chart review after their injection to assess for complications, need for repeat injections, and progression to surgical intervention. The accuracy of a longitudinal in-plane distal to proximal approach to ultrasound guided needle placement was then evaluated. Ultrasound guided needle placement using a longitudinal in-plane distal to proximal approach demonstrated spread of contrast material in the intended anatomic location with fluoroscopic confirmation in patients who underwent iliopsoas peritendon or bursa injection post total hip arthroplasty. Ultrasound guided needle placement using a longitudinal in-plane distal to proximal approach can be an effective alternative technique for diagnostic or therapeutic iliopsoas peritendon injection in patients with total hip arthroplasty.

Suprascapular nerve peripheral nerve stimulation for pediatric cancer pain: a case series.

Aim: Despite the growing evidence supporting the use of peripheral nerve stimulation (PNS) for cancer pain in adults, it is underutilized in the pediatric oncology population. Method: We describe the use of temporary, percutaneous PNS for pain management in pediatric patients suffering from cancer related pain. Results: Two adolescent patients underwent an ultrasound-guided suprascapular nerve PNS placement utilizing the percutaneous 60-day therapy system. Both patients reported approximately 60% pain relief during the therapy, as well as up to 90days post lead removal. Conclusion: PNS may play a crucial role in the pediatric oncology population. Further studies are warranted to investigate the efficacy and safety of PNS for various cancer-related pain conditions in pediatric populations.

Open cranium model for the study of cerebrovascular dynamics in intracranial hypertension

BackgroundSignificant research has been devoted to developing noninvasive approaches to neuromonitoring. Clinical validation of such approaches is often limited, with minimal data available in the clinically relevant elevated ICP range. New MethodTo allow ultrasound-guided placement of an intraventricular catheter and to perform simultaneous long-duration ICP and ultrasound recordings of cerebral blood flow, we developed a large unilateral craniectomy in a swine model. We also used a microprocessor-controlled actuator for intraventricular saline infusion to reliably and reversibly manipulate ICP according to pre-determined profiles. ResultsThe model was reproducible, resulting in over 80 hours of high-fidelity, multi-parameter physiological waveform recordings in twelve animals, with ICP ranging from 2 to 78 mmHg. ICP elevations were reversible and reproducible according to two predetermined profiles: a stepwise elevation up to an ICP of 30–35 mmHg and return to normotension, and a clinically significant plateau wave. Finally, ICP was elevated to extreme levels of greater than 60 mmHg, simulating extreme clinical emergency. Comparison with existing methodsExisting methods for ICP monitoring in large animals typically relied on burr-hole approaches for catheter placement. Accurate catheter placement can be difficult in pigs, given the thickness of their skull. Additionally, ultrasound is significantly attenuated by the skull. The open cranium model overcomes these limitations. ConclusionsThe hemicraniectomy model allowed for verified placement of the intraventricular catheter, and reversible and reliable ICP manipulation over a wide range. The large dural window additionally allowed for long-duration recording of cerebral blood flow velocity from the middle cerebral artery.

Safety and Feasibility of Electrocardiogram-Guided Tip Positioning Combined with Ultrasound-Guided Placement of Peripherally Inserted Central Catheter Performed in Severe Brain Injury Patients

ObjectiveTo explore the safety and feasibility of using electrocardiogram (ECG)-guided tip positioning combined with ultrasound-guided placement of peripherally inserted central catheters (PICC) in patients with severe brain injury in a neurosurgery intensive care unit.MethodsWe retrospectively analyzed 400 patients who underwent PICC catheterization in a neurosurgery intensive care unit from January 2017 to January 2021. Of those, a group of 157 patients received only ultrasound-guided PICC placement. The second group (243 patients) received ECG-guided tip positioning combined with ultrasound-guided PICC placement. A logistic regression analysis was conducted on gender, arm circumference, and ECG usage based on whether the results were in place. The positioning accuracy, success rate of primary catheterization, incidence of ectopic catheters, average catheterization depth, and incidence of catheterization complications were observed.ResultsLogistic regression analysis showed that only ECG guidance helps to achieve accurate PICC (OD, 4.541; 95CI, 2.224–9.271; p < 0.001). The correct placement rate of the PICC tip was significantly higher in ECG-guided tip positioning combined with the ultrasound guidance group (90.73%) compared to the ultrasound-only group (79.00%, P < 0.001). There was no significant difference between the two groups in terms of difficult catheter delivery and replace the punctured vessel, and the incidences of blocked blood return in the ECG-plus-ultrasound group was significantly better than the ultrasound group (9.55%) (χ2 = 14.402, P < 0.001).ConclusionIn patients with severe brain injury, ECG-guided tip positioning combined with ultrasound guidance in PICC catheterization can significantly increase the rate of correct tip placement without increasing the difficulty of catheterization.

Influential factors on the echogenicity of peripheral venous catheters: Insights from an experimental phantom study.

Ultrasound-guided placement of peripheral venous catheters requires appropriate equipment. Among the devices used, peripheral venous catheters have different structure and properties. This study aimed to define the impact of these different factors on the echogenicity of peripheral venous catheters. An open comparative study was conducted from September 2022 to May 2023. Thirteen devices were introduced in a standardized manner along the longitudinal and transverse axes with the help of guides into a phantom at different angles. Two criteria defined the echogenicity of these devices: the surface occupied by the device in the image (composite criterion: length and diameter of the device and angle of insertion) and its brightness (average of the pixel intensity of gray). Sixty-five ultrasound images were recorded and postprocessed twice (blinded to the previous measurement) by an expert operator, for reproducibility purposes. The intra-observer reproducibility of all measurements was excellent, with an intra-class coefficient of >0.90 over the entire dataset. On the longitudinal axis, echogenicity was significantly influenced by insertion angle (p = 0.009), device length (p = 0.006), and the interaction of cannula component and insertion angle (p = 0.007). On the transverse axis, no factors significantly influenced the device's echogenicity. The echogenicity of a device is an essential component of successful ultrasound-guided peripheral venous catheter placement. Optimizing catheter intrinsic factors such as components of the cannula and length, and extrinsic factor like the insertion angle should be considered in their design and use to reduce puncture failure rates.

Ultrasound-guided Axillary Artery Catheter Placement and Associated Complications in Critically Ill Patients.

Arterial catheter placement for hemodynamic monitoring is commonly performed in critically ill patients. The radial and femoral arteries are the two sites most frequently used; there is limited data on the use of the axillary artery for this purpose. The aim of this study was to investigate the rate of complications from ultrasound-guided axillary artery catheter placement in critically ill patients. A retrospective study at a tertiary care center of patients admitted to an intensive care unit who had ultrasound-guided axillary artery catheter placement during admission. Primary outcome of interest was catheter related complications, including bleeding, vascular complications, compartment syndrome, stroke or air embolism, catheter malfunction, and need for surgical intervention. This study identified 88 patients who had an ultrasound-guided axillary artery catheter placed during their admission. Of these 88, nine patients required multiple catheters placed, for a total of 99 axillary artery catheter placement events. The median age was 64 [IQR 48, 71], 41 (47%) were female, and median body mass index (BMI) was 26 [IQR 22, 30]. The most common complication was minor bleeding (11%), followed by catheter malfunction (2%), and vascular complications (2%). Univariate analyses did not show any association between demographics and clinical variables, and complications related to axillary arterial catheter. The most common complication found with ultrasound-guided axillary artery catheter placement was minor bleeding, followed by catheter malfunction, and vascular complications. Ultrasound-guided axillary arterial catheters are an alternative in patients in whom radial or femoral arterial access is difficult or not possible to achieve.

Central venous accesses in prone position during the pandemic period: A narrative review.

The unprecedented challenges posed by the global COVID-19 pandemic have magnified the significance of managing intensive care patients in prone positions, particularly those requiring mechanical ventilation. Central venous access is crucial for delivering essential therapies to patients, particularly in intensive care settings. However, the shift in patient management during the pandemic, necessitating prone positioning for improved oxygenation, presented unique hurdles in maintaining and establishing central venous access. Before the pandemic, scant literature detailed the insertion of vascular access devices in prone or unconventional positions. Limited case reports and letters highlighted the feasibility of procedures like ultrasound-guided central catheter placement in patients undergoing surgery or with specific clinical needs. During the pandemic, a surge in case reports and series illuminated the complexities faced by clinicians in maintaining vascular access during pronation procedures. These reports delineated critical scenarios, ranging from rapid clinical deterioration necessitating immediate interventions to challenges with vascular access device (VAD) malfunctions or misplacements during prone maneuvers. Patient selection and device types emerged as critical considerations. Various scenarios, including patients transitioning to prone position from non-invasive ventilation and those requiring additional access for therapies like dialysis, posed challenges in device selection and placement. Successful VAD insertion techniques in prone patients encompassed multiple anatomical sites, including the internal jugular, brachial, femoral, and popliteal veins. However, challenges persisted, particularly with respect to anatomical variations and technical complexities in cannulation. Further research, standardized protocols, and randomized studies are needed to refine and validate the proposed strategies in both pandemic and non-pandemic settings.

The Precision and Safety of Ultrasound-Guided versus Palpation-Guided Needle Placement on the Plantar Fascia and Flexor Digitorum Brevis Interface: An Anatomical Study.

Evidence suggests the plantar fascia and its interphase with the flexor digitorum brevis muscle can play a relevant role in plantar heel pain. Needling interventions could offer an appropriate treatment strategy to addressing this interface. We compared the accuracy and safety of ultrasound-guided versus palpation-guided procedures for the proper targeting of the interface between the plantar fascia and the flexor digitorum brevis with a solid needle. A crossover cadaveric study was conducted. Five experienced therapists performed a series of 20 needle insertions each (n = 100 in total, 10 landmark-guided and 10 ultrasound-guided) on 10 anatomical samples. The therapists were instructed to accurately place the needle on the interface between the plantar fascia and the flexor digitorum brevis muscle. The distance of the tip of the needle to the identified target (accuracy), the surrounding sensitive structures targeted (safety), the time needed for the procedure, the number of needle passes, and the needle length outside the skin were assessed. The ultrasound-guided technique was associated with a significantly higher accuracy (p < 0.001) but without differences in safety (p = 0.249) as compared to the palpation-guided procedure. Our results suggest that ultrasound-guided insertion exhibits greater accuracy but not greater safety than palpation-guided insertion when targeting the interface between the plantar fascia and the flexor digitorum brevis.

(206) EXPLORING THE IMPACT OF VARICOCELE ON PROSTATE CANCER PATIENTS: A PROPENSITY-SCORE MATCHED ANALYSIS USING GLOBAL REAL-WORLD DATA

Abstract Introduction Varicocele is the most common cause of male infertility. Emerging evidence has raised questions about a potential association between infertility and aggressive prostate cancer (PCa). Objective Our aim was to investigate whether having a varicocele affects PCa. Methods We queried the TriNetX database with access to electronic medical records from 108 partner healthcare organizations worldwide, covering over 129 million patients. We focused on adult males with prostate cancer between 2003 and 2023. Scrotal varices (ICD-10-CM: I86.1) were used to identify varicocele, while prostate cancer patients were identified by ICD-10-CM: C61 codes. We compared the baseline characteristics of PCa patients with and without varicocele, including erectile dysfunction (ED) (ICD-10-CM: N52) and “rising PSA level following PCa treatment” (coded as R97.21). We adjusted for age, BMI, diabetes mellitus, hypertensive diseases, total and free serum/plasma PSA levels, and Gleason score through logistic regression with a 1:1 propensity score matching (PSM). Calculated risk ratios (RR) and Kaplan Meier survival (KM) were calculated after PSM. Results Following PSM, 3809 PCa patients were divided into two groups, with an average age of 66.9 +/−10.6 years. Of the varicocele group, 50.97% were coded for “elevated PSA levels”, compared to 33.87% in the non-varicocele group, (p = &amp;lt; 0.001). Additionally, 33.89% of the varicocele group experienced ED, compared to 11.84% in the non-varicocele group, (p = &amp;lt; 0.001). Rising PSA level following PCa treatment was observed in 1.60% of the varicocele group, significantly higher than the non-varicocele group at 0.53%, (p = &amp;lt;0.001). Varicocele patients also exhibited a significantly higher rate of PCa screening, biopsy, and ultrasound-guided needle placement. On KM 5-year survival analysis for ED, patients without varicocele had 78.04% survival probability compared to 70.96% for patients with varicocele, (p = &amp;lt; 0.001). Conclusions Our study suggests a potential hypothetical association between varicocele and adverse outcomes in prostate cancer patients, including elevated PSA, ED, and rising PSA after PCa treatment. Further research is warranted to understand the clinical implications of this association and determine the usefulness of varicocelectomy on PCa outcomes. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Clarus Therapeutics, Antares Pharma, Acerus.

The ultrasound-guided versus standard technique for peripheral intravenous catheter placement by nurses: A systematic review and meta-analysis

AimTo comprehensively evaluate the efficacy of Ultrasound-guided technique for peripheral intravenous catheter placement by nurses in their daily practice. BackgroundPeripheral intravenous catheter insertion is a common clinical procedure in healthcare settings. Ultrasound-guided peripheral intravenous placement has emerged in recent decades and was recognized as particularly useful in some specific patient groups. MethodsStudies that had compared the ultrasound-guided and traditional approaches were eligible for inclusion and further analysis. The primary outcome was the success rate on the first intravenous insertion attempt. The secondary outcomes included the time needed for successful insertion, and the average number of attempts to establish the IV access. We systematically assess all studies using Cochrane Collaboration's Risk of Bias tool and the Newcastle-Ottawa Scale. We calculated the odds ratio and standardized mean difference with 95 % confidence intervals for the outcomes. Data were analyzed and visualized on Review Manager 5.3.4 and Stata 16.0. Results23 studies were included (17 randomized controlled trials and six cohort studies) with a population of 2051 patients offered ultrasound-assisted technique and 2479 treated with the conventional approach for comparison. The former approach was associated with a higher success rate on the first attempt in comparison (OR = 2.95, 95 % CI: 1.86, 4.69). This technique also took less time and less acupuncture to patients’ skin (SMD = −0.62, 95 % CI: 1.01, −0.23; SMD = −0.55, 95 % CI: 0.92, −0.18). In the sub-group analyses, children were more likely to benefit from ultrasound guided technique. Ultrasound guided technique demonstrated consistent and significant benefits in emergency clinical settings. Hospitals from different geographical locations exhibited similar trends in the three outcomes. Year of publication and study design revealed inconsistent and insignificant outcomes. ConclusionsUltrasound-guided technique can be a safer, faster, and more effective alternative to the traditional approach for nurses to establish intravenous access across different clinical settings and age groups.

Uterine Balloon Tamponade under Ultrasound Guidance in Women with Postpartum Hemorrhage: A Retrospective Cohort Study.

Background: Postpartum hemorrhage (PPH) represents one of the principal causes of maternal mortality and morbidity worldwide. Uterine balloon tamponade (UBT) is recommended for the treatment of postpartum hemorrhage due to uterine atony in women who do not respond to pharmacological first-line treatment. The success of UBT in bleeding control is related to the correct positioning of the device, since incorrect insertion can be associated with ineffectiveness and requires time-consuming repositioning maneuvers, with a further increase in blood loss. The use of ultrasound (US) during UBT may increase the success rate by preventing wrong positioning. This study aims to demonstrate the role of US guidance during UBT and to assess whether US guidance can ease positioning and reduce insertion times, preventing additional repositioning maneuvers, in comparison with a US check carried out after balloon insertion. Methods: This was a retrospective study including 370 women who underwent vaginal delivery, had PPH caused by uterine atony and required UBT at Sant'Anna Hospital from 2015 to 2019. The exclusion criteria were an abnormal placental site, vaginal or cervical trauma, coagulation defects, uterine anomalies, previous postpartum hemorrhage and previous caesarean section. Included subjects were divided into two groups: the US-guided group (n = 200) underwent Bakri balloon positioning under US guidance, and the non-guided group (n = 170) received a US check only after balloon insertion. The primary outcome was the success rate of the procedure, expressed as the percentage of cases with bleeding control without the need for balloon repositioning; the secondary outcomes were the length of the procedure and some parameters related to blood loss. Results: The success rate was 99% for the US-guided group vs. 86% for the non-guided group. None of the patients required hysterectomy. In the US-guided group with respect to the non-guided group, we observed a significant reduction in blood loss (1100 ± 450 vs. 1500 ± 600 mL; p < 0.001), Δhemoglobin level (1.8 ± 1.1 vs. 2.7 ± 2.0 g/dL, p < 0.001) and time required for the procedure (8 vs. 13 min, p < 0.001). Conclusions: Our data suggest that the use of US guidance for placement of UBT was associated with reduced need for balloon repositioning, lower blood loss, and faster resolution of postpartum hemorrhage.