Use Of Smaller Catheters Research Articles

Pierwotna przezskórma interwencja wieńcowa za pomocą cewnika diagnostycznego typu Tiger w przypadku nietypowego odejścia gałęzi pnia lewej tętnicy wieńcowej

The use of smaller catheters for diagnostic and intervention purpose is becoming increasingly popular due to the shift towards transradial catheterisation. The use of smaller catheters permits smaller arterial punctures, which translates into early mobilisation and discharge, as it may obviate the need for closure devices, lesser contrast volume use, potential nephrotoxicity and decreased morbidity. Here, we report a case, where standard 5 F Tiger diagnostic catheters (Terumo Radifocus Optitorque, Japan) was used for primary percutaneous coronary intervention of left circumflex artery with abnormal take-off of the left main.

Study of pigtail catheter and chest tube in management of secondary spontaneous pneumothorax

BackgroundThe initial management for a large and symptomatic secondary spontaneous (SSP) pneumothorax is to remove the air from the pleural space, but recommended methods varied across guidelines, from a large bored chest tube toward less invasive management with the use of smaller catheters. So the aim of this study is to elucidate the effectiveness, safety and tolerability of small bore catheter in draining (SSP). Patients and methodsThis study is a prospective randomized controlled trial (RCT) which was carried out at Chest Department, Zagazig University Hospitals and included 22 patients with SSP. The cases were enrolled into the study according to the following criteria: first episode of SSP, large size pneumothorax, SSP with circulatory and respiratory distress (tension pneumothorax) irrespective of the size of pneumothorax. The patients were randomly assigned into two groups into: test group including 11 patients who underwent small bore pigtail catheter drainage (14 Fr) and a control group including 11 patients who underwent conventional large bore chest tube drainage (30 Fr). Follow up of patients and extubation after resolution of pneumothorax was applied. Success of drainage was considered with full lung reexpansion and extubation with hospital discharge. ResultsThe frequency of success rate in the pigtail group and ICT group is nearly comparable (72.7%) and (63.6%) without significant difference. The frequency of complications following SSP drainage in patients of both studied groups was 36.7%. The more frequent complications among the failed cases was tube displacement and sepsis followed by surgical emphysema. The frequency of drainage complications was more frequent in failed cases of ICT than failed cases of the pigtail group with a significant difference. Among patients with successful outcome, pigtail catheter drainage of SSP was associated with significant and highly significant reduction in drainage duration and length of hospital stay in comparison to ICT drainage. ConclusionPigtail catheter drainage is nearly effective as ICT drainage of first episode of SSP. Pigtail catheter offers a safe, tolerable method for draining SSP with a shorter duration of drainage and hospital stay more than ICT. Increasing BMI is associated with drainage failure of SSP, where obesity is considered as a risk factor with high specificity for pigtail catheter drainage failure.

Downsizing – the Future of Interventional Cardiology

The concept of downsized catheters (i.e., using catheters smaller than 6 French) for invasive coronary procedures, such as diagnostic cardiac catheterisation and percutaneous coronary intervention, has been developing over the years, particularly as a result of the rise of the transradial approach. Recent advances have allowed the use of smaller and sheathless catheters, which confer a number of advantages – such as fewer vascular complications, reduced use of contrast agent and reduced haemostasis – thus increasing patient safety and comfort and allowing more rapid patient mobilisation. Reductions in patient complications, number and length of hospital stay, and amount of contrast agent used can also lead to cost savings. While the use of smaller catheters has been hindered in the past because of poor angiographic image quality, new automated contrast injectors have helped overcome this limitation. There is a need to make interventional cardiologists worldwide more aware of the benefits of downsizing, in the light of the latest technical developments and the increased use of transradial approach.

Diagnosis and management of upper extremity deep-vein thrombosis in adults

Upper extremity deep-vein thrombosis (UEDVT) is common and can cause important complications, including pulmonary embolism and post-thrombotic syndrome. An increase in the use of central venous catheters, particularly peripherally inserted central catheters has been associated with an increasing rate of disease. Accurate diagnosis is essential to guide management, but there are limitations to the available evidence for available diagnostic tests. Anticoagulation is the mainstay of therapy, but interventional treatments may be considered in select situations. The risk of UEDVT may be reduced by more careful selection of patients who receive central venous catheters and by use of smaller catheters. Herein we review the diagnosis, management and prevention of UEDVT. Due to paucity of research, some principles are drawn from studies of lower extremity DVT. We present a practical approach to diagnosing the patient with suspected deep-vein thrombosis of the upper extremity.

Liver Cell Transplantation: Basic Investigations for Safe Application in Infants and Small Children

Liver cell transplantation (LCT) is a very promising method for the use in pediatric patients. It is significantly less invasive than whole organ transplantation, but has the potential to cure or at least to substantially improve severe disorders like inborn errors of metabolism or acute liver failure. Prior to a widespread use of the technique in children, some important issues regarding safety and efficacy must be addressed. We developed a mathematical model to estimate total hepatocyte counts in relation to bodyweight to make possible more appropriate dose calculations. Different liver cell suspensions were studied at different flow rates and different catheter sizes to determine mechanical damage of cells by shear forces. At moderate flow rates, no significant loss of viability was observed even at a catheter diameter of 4.2F. Addition of heparin to the cell suspension is favored, which is in contrast to previous animal experiments. Mitochondrial function of the hepatocytes was determined with the WST-1 assay and was not substantially altered by cryopreservation. We conclude that especially with the use of small catheters, human LCT should be safe and efficient even in small infants and neonates.

Randomized Trial Comparing Modified Tubeless Percutaneous Nephrolithotomy with Tailed Stent with Percutaneous Nephrostomy with Small-Bore Tube

Recent trials using smaller percutaneous catheters as well as "tubeless" percutaneous technique have attempted to reduce postoperative analgesia requirements and the morbidity of a traditional large-bore nephrostomy tube after percutaneous nephrolithotomy (PCNL). We performed a randomized trial comparing tubeless procedures and use of small catheters to elucidate any differences in perioperative parameters, postoperative discomfort, complications, convalescence, and CT scan findings. Twenty-four consecutive patients underwent randomization into tubeless (using a tailed 6F double-J stent) and small tube (using an 8.2 pigtail nephrostomy tube) (N = 12 each). A CT scan of the abdomen and pelvis without contrast was obtained the morning of the first postoperative day. Morphine equivalents and a visual analog pain score, as well as questionnaires for convalescence at the postoperative check, postoperative day 1, time of tube removal (3-5 days), and 1-week follow-up were recorded. The mean pain scores and morphine requirements for the tubeless and small-tube groups at postoperative day 0, postoperative day 1, time of stent removal, and 10 days were not significantly different. Convalescence significantly favored stented patients. The CT findings were equivalent. Three patients had inadvertent dislodgment of their stents. Tubeless and small-bore procedures cause similar postoperative discomfort, with indwelling stents appearing to quicken return to normal activities. Tailed stents may not be appropriate for all patients.

A randomised comparison of the use of 4 and 6 French diagnostic catheters: the limits of downsizing

Background: The use of small catheters for coronary angiography can reduce the risk of vascular complications and allow early ambulation, but excessive downsizing may lead to poor quality imaging. The aim of this study was to assess the feasibility of performing coronary angiography using 4 French (4 F) femoral catheters. Methods: In total, 400 consecutive elective patients were randomised to undergo coronary angiography with 4 F or 6 F catheters. The puncture site was manually compressed and inspected before and after ambulation, and 24 h later. The handling difficulty of the catheters was semi-quantitatively evaluated using a three grade scoring system; angiogram quality was evaluated by two independent physicians. Results: No major procedure-related complications were observed. Coronary arteriography with 4 F catheters was possible in all of the attempted cases. There were no statistical differences between the two groups in terms of procedural or fluoroscopy time, the amount of contrast medium used, or the incidence of vascular complications, while compression time was significantly shorter in the patients studied using the smaller catheter (3.4 vs. 9.9 min; P<0.0001). Catheter stability was similar in the two groups, whereas catheter torque and the quality of the coronary angiograms were statistically better in the patients studied using six French catheters. Conclusions: Coronary angiography with 4 F catheters is technically feasible and permits early ambulation after the procedure. Although the radiological resolution of the images obtained using 4 F catheters was always adequate for clinical decision-making, the angiogram quality and catheter handling were significantly better using the 6 F system.

Laparoscopic antegrade continence enema in situ appendix procedure for refractory constipation and overflow fecal incontinence in children with spina bifida.

The antegrade continence enema procedure allows patients with neurogenic bowel to administer large volume enemas through a right lower quadrant stoma to flush the colon every other day. This procedure results in freedom from refractory constipation and diapers required by unexpected episodes of overflow fecal incontinence. We present a simplified laparoscopic technique using in situ appendix. A total of 6 male and 10 female children with a mean age of 12 years (range 4 to 21) and neurogenic bowel secondary to myelomeningocele underwent the antegrade continence enema in situ appendix procedure. The procedure was done with laparoscopic assistance, and associated with other bladder and bladder outlet reconstructive surgery in 5 patients. In 3 patients, a purely laparoscopic antegrade continence enema in situ appendix procedure was performed. The appendix and cecum were mobilized, and the tip of the appendix was anastomosed directly to the skin of the right lower quadrant through 1 of the 5 mm. lower quadrant port sites. The continence mechanism is simply a function of the appendix length and the mucosal coaptation of the appendiceal lumen. A 6Fr silicone Foley catheter is used to stent the mucocutaneous anastomosis. Concomitant procedures included ileocystoplasty, ileovesicostomy, sigmoidovesicostomy or ureterovesicostomy, and/or pubovaginal sling done through a low Pfannenstiel incision after laparoscopic mobilization of the appendix and cecum. The 3 patients treated with the laparoscopic antegrade continence enema procedure ate the day of surgery and were discharged home the next morning. Constipation and fecal incontinence resolved in all cases. All antegrade continence enema stomas were catheterized easily with a 6 or 8Fr feeding tube and were continent. Complications in the 8 laparoscopic and laparoscopic assisted cases included stomal stenosis requiring dilation in the office and obstructive volvulus associated with malrotation requiring segmental resection. Patient mothers in particular were gratified by this procedure at a mean followup of 11/2 years. The simplified antegrade continence enema in situ appendix procedure works well for refractory constipation and overflow fecal incontinence in children with neurogenic bowel secondary to spina bifida. Coaptation of the appendiceal lumen and use of small catheters allow for persistent continence without a formal surgically constructed valve mechanism. The combined antegrade continence enema and either ileovesicostomy or sigmoidovesicostomy continent urinary diversion procedures allow children to control bowel and bladder evacuation programs. A laparoscopic approach is reasonable particularly in cases requiring no other procedures.

ANGIOGRAPHY WITH CARBON DIOXIDE (CO 2)

CO2 possesses many advantages over conventional iodinated contrast agents used for arteriography. It is nonallergic and lacks renal toxicity. Its unique properties permit use of smaller catheters in diagnostic and therapeutic angiographic procedures, allow optimal vascular imaging of various neoplasm, assist in detection of occult gastrointestinal bleeding, and facilitate TIPS procedures. With digital subtraction techniques and stacking programs, CO2 arteriography is as accurate as iodinated contrast studies in most patients and thus is the preferred arterial imaging technique in patients with contrast allergy and renal insufficiency. CO2 is also extremely inexpensive compared with available contrast agents. Understanding of the effects of buoyancy and compressibility is necessary for safe, controlled delivery of CO2 during arteriography, but only rare complications have occurred in our large experience with CO2 angiography. Thus, use of CO2 as an arterial contrast agent significantly expands the safety and utility of arterial imaging in patients with peripheral vascular disease.

Clean Intermittent Catheterization in Spinal Cord Injury Patients: Long-Term Followup of a Hydrophilic Low Friction Technique

Clean intermittent self-catheterization is an established option in bladder management of spinal cord injury patients. Several early and a small number of long-term studies have reported good preventive or therapeutic effects on hydronephrosis, vesicourethral reflux, urinary tract infection and incontinence. Most reports describe the use of small catheters and liberal use of jelly but urethral complications, such as strictures and false passages, seem to increase with the length of followup. All 30 spinal cord injury patients in this retrospective study had used disposable hydrophilic, low friction catheters from the early shock phase to a median of 7 years (range 5 to 9). There were 26 upper motor neuron and 4 lower motor neuron lesions. After tap water soaking, the surface layer of the catheter coating has a friction constant more than 10 times lower than that for a regular plastic catheter (Nélaton) with chlorhexidine jelly. There was no hydronephrosis, pyelonephritis or renal scarring. In 3 patients who had decreased the clean intermittent self-catheterization regimen, signs of upper tract dilatation developed but the excretory urogram returned to normal after correction of the regimen. Of 30 patients 12 (40%) maintained sterile urine, while 4 of the remaining 18 with bacteriuria had episodes of urinary sepsis and chronic infections. Two patients had epididymitis. Of 6 men with occasional insertion difficulties when the clean intermittent self-catheterization regimen started after the indwelling catheter had been removed 4 showed yielding signs of strictures during the subsequent clean intermittent self-catheterization regimen. In 1 patient 2 dilation attempts had failed but the patient can perform the clean intermittent self-catheterization regimen. One patient with Crohn's disease had advanced urethral changes in the acute phase but could perform clean intermittent self-catheterization with a small catheter. One patient has had recurrent modifications of the urethral wall but no development of a false passage. The study indicates that patients who use hydrophilic low friction low friction catheters do as well as or better than patients using conventional catheters. Above all, there is no increase in severe urethral complications with time after injury. Progression towards strictures after early urethral trauma seems to be preventable by the use of this catheter.

Percutaneous Drainage of Lung Abscess and Infected Bulla

Background : Antibiotic therapy has proven an effective method of treatment on the majority of patients with pyogenic lung abscess and infected bulla. When medical therapy has failed, pulmonary resection is the current generally recommended therapy. But nowdays complications of percutaneous tube drainage has decreased with the use of small catheter. So we evaluated the effect of percutaneous tube drainage as an alternative therapy to the pyogenic lung abscess and infected bulla refractory to medical therapy in preference ot the pulmonary resection. Method : Nine cases of the lung abscess and three cases of infected bulla which has large cavity size over 6cm, and has underlying diseases such as lung cancer, diabetes mellitus, refractory to over 1 week of antibiotics, were performed percutaneous tube drainage with All Purpose Drainage catheter(Medi-tech, Watertown, USA) under fluoroscopy. Results : All the cases except one case which complicated empyema was improved clinically. Fever was down within 4days of percutaneous tube drainage(mean : 1.9days). Mean duration of tube drainage was 9.9days. Conclusion : Percutaneous tube drainage is an effective and relatively safe procedure in the management of lung abscesses that do not response to medical therapy. We speculate this procedure should be considered as an alternative therapy for the lung abscess refractory to medical therapy in preference to the surgery. The safety and effectiveness of this procedure in infected bulla should be evaluated with an additional study.

Retrieval of a 4-French diagnostic catheter fragment from the common carotid artery by using a stone basket.

As a result of the increased use of smaller catheters and of central venous catheter placement, embolization of a catheter fragment occurs more frequently than before. This can result in severe complications and death. The retrieval of 4-cm, 4-French catheter fragment from the right common carotid artery is described. This technique can be used in most vessels

Pediatric digital subtraction angiography: intraarterial and intracardiac applications.

Intraarterial digital subtraction angiography (IA-DSA) was performed in 80 pediatric patients. Forty-four underwent arterial injections with digital filming techniques. Of the 130 injections, DSA imaging was good or excellent in 121, often allowing resolution of vessels 1 mm in size. Thirty-six of the 80 patients underwent cardiac evaluation with intra-cardiac injections. Improved contrast resolution with IA-DSA allowed the use of smaller catheters (3-4F) and smaller amounts of contrast material. Immediate availability of subtracted images (no film processing delay) resulted in shorter total procedure time. Outpatient studies are possible. IA-DSA provides several notable advantages for the pediatric patient.

ANGIOGRAPHY OF RENAL TRANSPLANT

During the recent years there have been changes both in examination techniques and in indications for renal transplant angiography. We prefer now the use of small catheters (5 or even 4 French) which can be manipulated easily, and, with one or two sideholes, permit an injection rate of 10 ml/seconds without recoil. The trauma to the punctured artery is minimal, which is important in order to reduce the risk of bleeding in heparinized patients. Routinely an x-ray tube with 0.3 mm focal spot is used for 1.8-fold geometric magnification at serial radiography to facilitate analysis of small vascular detail. A 0.1 mm focal spot permits threefold to fourfold geometric magnification and an even closer evaluation of the cortical vasculature. Intravenous methylprednisolone therapy for acute rejection and increasing use of living related donor kidneys have changed indications for angiography. In our institution, most patients are examined because of acute rejection which progresses in spite of treatment with intravenous methylprednisolone. It is probable that angiography, along with clinical guidelines, can predict both the outcome of an acute rejection period and the patient's response to continued immunosuppressive therapy. The prognosis for recovery from an acute rejection episode is poorer and the risks for complications under continued immunosuppressive therapy are higher for cadaveric transplants than for living related donor transplants.