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Sample records for abdominis plane catheters

  1. Children with spinal dysraphism: transversus abdominis plane (TAP) catheters to the rescue!

    PubMed

    Taylor, Lauren J; Birmingham, Patrick; Yerkes, Elizabeth; Suresh, Santhanam

    2010-10-01

    Transversus abdominis plane (TAP) block catheters may offer an alternative to a central neuraxial blockade for patients undergoing major abdominal surgery (Paediatr Anaesth 19: 2009; 296). This case series consists of two children with spinal dysraphism in whom bilateral TAP block catheters were placed for postoperative pain relief. Administration of low dose, low concentration local anesthetic provided both children with excellent postoperative analgesia.

  2. Thoracic epidural catheter for postoperative pain control following an ineffective transversus abdominis plane block using liposome bupivacaine

    PubMed Central

    Terrien, Brian D; Espinoza, David; Stehman, Charles C; Rodriguez, Gabriel A; Connolly, Nicholas C

    2017-01-01

    A 24-year-old female with a history of ulcerative colitis underwent colectomy. The patient received an ineffective transversus abdominis plane (TAP) block with liposome bupivacaine (Exparel) intraoperatively and was started on a hydromorphone patient-controlled analgesia 5 hours after the TAP block, which did not relieve her pain. A continuous thoracic epidural (CTE) was then placed after blood levels of bupivacaine were drawn, and the patient immediately experienced significant pain relief. The combined use of liposome bupivacaine and bupivacaine CTE infusion in the postoperative management of this patient demonstrated no safety concerns, provided excellent analgesia and plasma concentrations of bupivacaine remained far below toxic levels. PMID:28144162

  3. Continuous postoperative analgesia via quadratus lumborum block - an alternative to transversus abdominis plane block.

    PubMed

    Visoiu, Mihaela; Yakovleva, Nataliya

    2013-10-01

    Different transversus abdominis plane blocks techniques cause variations in postoperative analgesia characteristics. We report the use of unilateral quadratus lumborum catheter for analgesia following colostomy closure. The catheter was placed under direct ultrasound visualization and had good outcomes: low pain scores and minimal use of rescue analgesic medication. No complications were reported in this pediatric patient. More studies are needed to evaluate the effectiveness and safety of this regional anesthesia technique.

  4. Studies on the spread of local anaesthetic solution in transversus abdominis plane blocks.

    PubMed

    Carney, J; Finnerty, O; Rauf, J; Bergin, D; Laffey, J G; Mc Donnell, J G

    2011-11-01

    The extent of analgesia provided by transversus abdominis plane blocks depends upon the site of injection and pattern of spread within the plane. There are currently a number of ultrasound-guided approaches in use, including an anterior oblique-subcostal approach, a mid-axillary approach and a more recently proposed posterior approach. We wished to determine whether the site of injection of local anaesthetic into the transversus abdominis plane affects the spread of the local anaesthetic within that plane, by studying the spread of a local anaesthetic and contrast solution in four groups of volunteers. The first group underwent the classical landmark-based transversus abdominis plane block whereby two different volumes of injectate were studied: 0.3 ml.kg(-1) vs 0.6 ml.kg(-1). The second group underwent transversus abdominis plane block using the anterior subcostal approach. The third group underwent transversus abdominis plane block using the mid-axillary approach. The fourth group underwent transversus abdominis plane block using the posterior approach, in which local anaesthetic was deposited close to the antero-lateral border of the quadratus lumborum. All volunteers subsequently underwent magnetic resonance imaging at 1, 2 and 4 h following each block to determine the spread of local anaesthetic over time. The studies demonstrated that the anterior subcostal and mid-axillary ultrasound approaches resulted in a predominantly anterior spread of the contrast solution within the transversus abdominis plane and relatively little posterior spread. There was no spread to the paravertebral space with the anterior subcostal approach. The mid-axillary transversus abdominis plane block gave faint contrast enhancement in the paravertebral space at T12-L2. In contrast, the posterior approaches, using both landmark and ultrasound identifications, resulted in predominantly posterior spread of contrast around the quadratus lumborum to the paravertebral space from T5 to L1

  5. Evolution of the transversus abdominis plane block and its role in postoperative analgesia.

    PubMed

    Lissauer, Jonathan; Mancuso, Kenneth; Merritt, Christopher; Prabhakar, Amit; Kaye, Alan David; Urman, Richard D

    2014-06-01

    Since it was first described by Rafi in 2001, the transversus abdominis plane (TAP) block can be best described as a peripheral nerve block to the anterior abdominal wall (T6 to L1). The TAP block is specifically a local anesthetic injection into the fascial plane superficial to the transversus abdominis muscle and deep to the internal oblique muscle. The TAP block has been a subject of controversy with regard to utility, to indications, and more fundamentally, how best to place the block and its precise mechanism of action. The evolution of thinking with regard to this block, or more correctly family of interrelated blocks, includes knowledge of underlying anatomy, as well as an appreciation of its varied approaches. The TAP block affords excellent analgesia for abdominal procedures. In summary, the TAP block affords effective analgesia with opioid sparing effects, technical simplicity, and long duration of action. Some disadvantages include the need for bilateral block for midline incisions and absence of effectiveness for visceral pain.

  6. Transversus abdominis plane block in renal allotransplant recipients: A retrospective chart review

    PubMed Central

    Gopwani, SR; Rosenblatt, MA

    2016-01-01

    Context: The efficacy of the transversus abdominis plane (TAP) block appears to vary considerably, depending on the surgical procedure and block technique. Aims: This study aims to add to the existing literature and provide a more clear understanding of the TAP blocks role as a postoperative analgesic technique, specifically in renal allotransplant recipients. Settings and Design: A retrospective chart review was conducted by querying the intraoperative electronic medical record system of a 1200-bed tertiary academic hospital over a 5 months period, and reviewing anesthetic techniques, as well as postoperative morphine equivalent consumption. Materials and Methods: Fifty renal allotransplant recipients were identified, 13 of whom received TAP blocks while 37 received no regional analgesic technique. All blocks were performed under ultrasound guidance, with 20 mL of 0.25% bupivacaine injected in the transversus abdominis fascial plane under direct visualization. The primary outcome was postoperative morphine equivalent consumption. Statistical Analysis Used: Morphine consumption was compared with the two-tailed Mann–Whitney U-test. Continuous variables of patient baseline characteristics were analyzed with unpaired t-test and categorical variables with Fischer Exact Test. A P < 0.05 was considered statistically significant. Results: A statistically significant decrease in cumulative morphine consumption was found in the group that received the TAP block at 6 h (2.46 mg vs. 7.27 mg, P = 0.0010), 12 h (3.88 mg vs. 10.20 mg, P = 0.0005), 24 h (6.96 mg vs. 14.75 mg, P = 0.0013), and 48 h (11 mg vs. 20.13 mg, P = 0.0092). Conclusions: The TAP block is a beneficial postoperative analgesic, opiate-sparing technique in renal allotransplant recipients. PMID:27833477

  7. Evolution of transversus abdominis plane infiltration techniques for postsurgical analgesia following abdominal surgeries

    PubMed Central

    Gadsden, Jeffrey; Ayad, Sabry; Gonzales, Jeffrey J; Mehta, Jaideep; Boublik, Jan; Hutchins, Jacob

    2015-01-01

    Transversus abdominis plane (TAP) infiltration is a regional anesthesia technique that has been demonstrated to be effective for management of postsurgical pain after abdominal surgery. There are several different clinical variations in the approaches used for achieving analgesia via TAP infiltration, and methods for identification of the TAP have evolved considerably since the landmark-guided technique was first described in 2001. There are many factors that impact the analgesic outcomes following TAP infiltration, and the various nuances of this technique have led to debate regarding procedural classification of TAP infiltration. Based on our current understanding of fascial and neuronal anatomy of the anterior abdominal wall, as well as available evidence from studies assessing local anesthetic spread and cutaneous sensory block following TAP infiltration, it is clear that TAP infiltration techniques are appropriately classified as field blocks. While the objective of peripheral nerve block and TAP infiltration are similar in that both approaches block sensory response in order to achieve analgesia, the technical components of the two procedures are different. Unlike peripheral nerve block, which involves identification or stimulation of a specific nerve or nerve plexus, followed by administration of a local anesthetic in close proximity, TAP infiltration involves administration and spread of local anesthetic within an anatomical plane of the surgical site. PMID:26677342

  8. Efficacy of Transversus Abdominis Plane Block and Rectus Sheath Block in Laparoscopic Inguinal Hernia Surgery

    PubMed Central

    Takebayashi, Katsushi; Matsumura, Masakata; Kawai, Yasuhiro; Hoashi, Takahiko; Katsura, Nagato; Fukuda, Seijun; Shimizu, Kenji; Inada, Takuji; Sato, Masugi

    2015-01-01

    We aimed to assess the efficacy of transversus abdominis plane (TAP) block and rectus sheath (RS) block in patients undergoing laparoscopic inguinal hernia surgery. Few studies have addressed the efficacy and safety associated with TAP block and RS block for laparoscopic surgery. Thirty-two patients underwent laparoscopic inguinal hernia surgery, either with TAP and RS block (Block+ group, n = 18) or without peripheral nerve block (Block− group, n = 14). Preoperatively, TAP and RS block were performed through ultrasound guidance. We evaluated postoperative pain control and patient outcomes. The mean postoperative hospital stays were 1.56 days (Block+ group) and 2.07 days (Block− group; range, 1–3 days in both groups; P = 0.0038). A total of 11 patients and 1 patient underwent day surgery in the Block+ and Block− groups, respectively (P = 0.0012). Good postoperative pain control was more commonly observed in the Block+ group than in the Block− group (P = 0.011). TAP and RS block was effective in reducing postoperative pain and was associated with a fast recovery in patients undergoing laparoscopic inguinal hernia surgery. PMID:25875548

  9. Ultrasound-guided transversus abdominis plane block: What are the benefits of adding dexmedetomidine to ropivacaine?

    PubMed Central

    Mishra, Manjaree; Mishra, Shashi Prakash; Singh, Somendra Pal

    2017-01-01

    Background: Ultrasound-guided transversus abdominis plane (TAP) block has recently come up as a modality to take care of postoperative pain. It can somewhat avoid the use of intravenous opioid analgesics and hence to avoid its complications. We have performed a prospective, double-blinded, randomized study to assess the analgesic effect of adding dexmedetomidine to local ropivacaine on TAP block for patients undergoing lower abdominal surgeries. Aim: The aim is to assess whether addition of dexmedetomidine to ropivacaine may bring some improvements to the analgesic efficacy of TAP blocks in patients undergoing lower abdominal surgeries. Materials and Methods: The study was conducted on forty patients undergoing lower abdominal surgeries under general anesthesia. The patients were divided into two groups: one receiving plain ropivacaine (Group 1) and other receiving ropivacaine with dexmedetomidine (Group 2) during TAP block. The patients in the two groups were compared for age, sex, body mass index, incidence of postoperative nausea, and vomiting and pain as measured on visual analog scale (VAS). Results: There was significantly lower pain score on VAS at 1, 3, 6, 12, and 18 h in Group 2 than in Group 1. Conclusion: The addition of dexmedetomidine to ropivacaine during TAP block improves analgesic effect of TAP block and prolongs the duration of analgesia as well. PMID:28217055

  10. [Why and how to perform an ultrasound-guided transversus abdominis plane block: A step-by-step approach].

    PubMed

    Nohuz, E; El Drayi, B; Triki, A; Grossmannova, K; Boudier, B; Koffi, K; Albaut, M; Dualé, C

    2016-12-01

    Used in clinical practice as part of a multimodal analgesic regimen, the transversus abdominis plane block (TAP block) is a relative novel procedure in which local anaesthetic agents are injected into the anatomic neurofascial space between the internal oblique and the transversus abdominis muscle. It allows a significantly prolonged duration of analgesia during the early postoperative stage in abdominal surgery. This regional anesthesia technique provides analgesia to the skin, muscles of the anterior abdominal wall and parietal peritoneum in order to decrease the incision-related pain. Thus, it reduces postoperative opiate requirements and opioids-related side effects (nausea, vomiting, delayed resumption of intestinal transit, drowsiness, respiratory depression, urine retention). Additionally, the TAP block appears particularly interesting when neuraxial techniques or opioids are contraindicated. Moreover, the ultrasound-guided procedure provides a significant success rate of this block and additionally avoids major complications. We describe our technique of ultrasound-guided TAP block and discuss its indications, contraindication and potential complications.

  11. Analgesic efficacy of ultrasound-guided subcostal transversus abdominis plane block

    PubMed Central

    Ma, Jianfeng; Jiang, Yifei; Tang, Shiyi; Wang, Benfu; Lian, Qingquan; Xie, Zuokai; Li, Jun

    2017-01-01

    Abstract Background: To evaluate the analgesic efficacy on defined areas of the abdomen and back after ultrasound-guided subcostal transversus abdominis plane (TAP) block using 0.25% levobupivacaine 0.5 mL/kg. Methods: Twenty patients undergoing elective laparoscopic cholecystectomy, between 20 and 60 years of age with operative time <1 hour, received subcostal TAP block using 0.25% levobupivacaine 0.5 mL/kg on the left side. Surgery started after 1 hour of observation. Sensory assessment was undertaken using pinprick and 75% ethyl alcohol at 10, 20, 30 minutes, 1, 3, and 12 hours after TAP block at 19 testing zones that were divided by anatomic landmark lines on the abdomen and the back. Efficacy of zone was defined as loss of cold temperature sensation or loss of pinprick pain sensation in more than 50% patients in that testing zone. Duration was determined by analgesia and loss of temperature sensation beginning within 30 minutes of TAP block placement lasting until time points of 1, 3, and 12 hours. All of the testing zones were divided as Group I effective at 20 minutes in less than 50% patients (0%–50%), Group II 50% to 70% patients, Group III 70% to 90% patients, and Group IV 90% to 100% patients. Results: Twenty patients meeting the study requirements were included. At each time point, the efficacies among 4 groups were significantly different. Subcostal TAP had good efficacy and stable duration in zones 1, 2, 3, 5, and 6. Conclusion: Subcostal TAP block with 0.25% levobupivacaine 0.5 mL/kg dose provided effective analgesia in the anterior abdominal wall between medioventral line to anterior axillary line except the lateral upper abdominal region. PMID:28272260

  12. Transversus Abdominis Plane Versus Ilioinguinal and Iliohypogastric Nerve Blocks for Analgesia Following Open Inguinal Herniorrhaphy*

    PubMed Central

    Stav, Anatoli; Reytman, Leonid; Stav, Michael-Yohay; Troitsa, Anton; Kirshon, Mark; Alfici, Ricardo; Dudkiewicz, Mickey; Sternberg, Ahud

    2016-01-01

    Objectives We hypothesized that preoperative (pre-op) ultrasound (US)-guided posterior transversus abdominis plane block (TAP) and US-guided ilioinguinal and iliohypogastric nerve block (ILI+IHG) will produce a comparable analgesia after Lichtenstein patch tension-free method of open inguinal hernia repair in adult men. The genital branch of the genitofemoral nerve will be blocked separately. Methods This is a prospective, randomized, controlled, and observer-blinded clinical study. A total of 166 adult men were randomly assigned to one of three groups: a pre-op TAP group, a pre-op ILI+IHG group, and a control group. An intraoperative block of the genital branch of the genitofemoral nerve was performed in all patients in all three groups, followed by postoperative patient-controlled intravenous analgesia with morphine. The pain intensity and morphine consumption immediately after surgery and during the 24 hours after surgery were compared between the groups. Results A total of 149 patients completed the study protocol. The intensity of pain immediately after surgery and morphine consumption were similar in the two “block” groups; however, they were significantly decreased compared with the control group. During the 24 hours after surgery, morphine consumption in the ILI+IHG group decreased compared with the TAP group, as well as in each “block” group versus the control group. Twenty-four hours after surgery, all evaluated parameters were similar. Conclusion Ultrasound-guided ILI+IHG provided better pain control than US-guided posterior TAP following the Lichtenstein patch tension-free method of open inguinal hernia repair in men during 24 hours after surgery. (ClinicalTrials.gov number: NCT01429480.) PMID:27487311

  13. Utility of ultrasound-guided transversus abdominis plane block for day-case inguinal hernia repair

    PubMed Central

    Pitoni, Sara; Gonnella, Gianluigi; Alfieri, Sergio; Catarci, Stefano; Draisci, Gaetano

    2017-01-01

    Background The transversus abdominis plane (TAP) block is a regional anesthesia technique that effectively reduces the pain intensity and use of analgesia in abdominal surgery. The aim of this study was to determine the utility of the ultrasound-guided TAP block in improving the efficacy of the ultrasound-guided ilioinguinal/iliohypogastric nerve (IIN/IHN) block for intraoperative anesthesia and postoperative pain control in day-case inguinal hernia repair (IHR). Methods We conducted a descriptive study of patients undergoing elective primary unilateral open IHR. Fifty-nine patients were divided into two groups according to the anesthetic technique used: ultrasound-guided TAP block plus ultrasound-guided IIN/IHN block (TAP group) vs. ultrasound-guided IIN/IHN block alone (IIN/IHN group). The outcome measures were the adequacy of anesthesia during surgery and postoperative analgesia. Results Four patients (12.5%) in the TAP group and 10 patients (37.0%) in the IIN/IHN group experienced inadequate anesthesia and needed systemic sedation (P < 0.05). No significant differences in additional local anesthetic volume were found between the two groups. Patients in the TAP group reported lower pain scores at the end of surgery (0.4 ± 0.8 vs. 2.1 ± 2.5, P < 0.01), at 2 hours after surgery (0.8 ± 1.3 vs. 3.0 ± 2.2, P < 0.01), at discharge (1.4 ± 1.2 vs. 4.3 ± 2.2, P < 0.01), and at 24 hours (1.5 ± 1.1 vs. 4.5 ± 2.3, P < 0.01). Conclusions The combination of the TAP and IIN/IHN blocks is associated with better intraoperative anesthesia and lower postoperative pain scores compared with the IIN/IHN block alone. PMID:28184266

  14. Addition of clonidine to bupivacaine in transversus abdominis plane block prolongs postoperative analgesia after cesarean section

    PubMed Central

    Singh, Ranju; Kumar, Nishant; Jain, Aruna; Joy, Sudipta

    2016-01-01

    Background and Aims: The aim was to compare duration of postoperative analgesia with addition of clonidine to bupivacaine in bilateral transversus abdominis plane (TAP) block after lower segment cesarean section (LSCS). Material and Methods: One hundred American Society of Anesthesiologists (ASA) grade I and II pregnant patients undergoing LSCS under spinal anesthesia were randomly divided to receive either 20 ml bupivacaine 0.25% (Group B; n = 50) or 20 ml bupivacaine+1ug/kg clonidine bilaterally (Group BC; n = 50) in TAP block in a double-blind fashion. The total duration of analgesia, patient satisfaction score, total requirement of analgesics in the first 24 h, and the side effects of clonidine such as sedation, dryness of mouth, hypotension, and bradycardia were observed. P < 0.05 was taken as significant. Results: In 99 patients analyzed, TAP block failed in five patients. Duration of analgesia was significantly longer in Group BC (17.8 ± 3.7 h) compared to Group B (7.3 ± 1.2 h; P < 0.01). Mean consumption of diclofenac was 150 mg and 65.4 mg in Groups B and BC (P < 0.01), respectively. All patients in Group BC were extremely satisfied (P < 0.01) while those in Group B were satisfied. Thirteen patients (28%) in Group BC were sedated but arousable (P = 0.01) compared to none in Group B. In Group BC, 19 patients complained of dry mouth compared to 13 in Group B (P = 0.121). None of the patients experienced hypotension or bradycardia. Conclusion: Addition of clonidine 1 μg/kg to 20 ml bupivacaine 0.25% in TAP block bilaterally for cesarean section significantly increases the duration of postoperative analgesia, decreases postoperative analgesic requirement, and increases maternal comfort compared to 20 ml of bupivacaine 0.25% alone. PMID:28096583

  15. Quadratus lumborum catheters for breast reconstruction requiring transverse rectus abdominis myocutaneous flaps.

    PubMed

    Spence, Nicole Z; Olszynski, Patrycja; Lehan, Anne; Horn, Jean-Lois; Webb, Christopher A J

    2016-06-01

    Patients diagnosed with breast cancer may opt to undergo surgical reconstructive flaps at the time of or after mastectomies. These surgeries leave patients with significant postoperative pain and sometimes involve large surgical beds including graft sites from the abdomen to reconstruct the breast. Consequently, multimodal methods of pain management have become highly favored. Quadratus lumborum catheters offer an opioid-sparing technique that can be performed easily and safely. We present a case of a patient who underwent a breast flap reconstruction and had bilateral quadratus lumborum catheters placed for perioperative pain control.

  16. Is unilateral transversus abdominis plane block an analgesic alternative for ureteric shock wave lithotripsy?

    PubMed Central

    Elnabtity, Ali Mohamed Ali; Tawfeek, Mohamed M.; Keera, Amr Ali; Badran, Yasser Ali

    2015-01-01

    Background: Various sedative and analgesic techniques have been used during shock wave lithotripsy (SWL). Aim: This study aimed at evaluating the efficacy of ultrasound-guided unilateral transversus abdominis plane (TAP) block as an analgesic technique alternative during ureteric SWL. Settings and Design: Prospective randomized comparative study. Materials and Methods: Fifty patients scheduled for ureteric SWL were randomly allocated into two equal groups: Group (F) received 1.5 mcg/kg fentanyl intravenous and group (T) received unilateral TAP block with injection of 25 ml of bupivacaine 0.25% (62.5 mg). Statistical Analysis: Statistical analysis was performed using SPSS program version 19 and EP16 program. Results: The visual analog scale was significantly less in group (T) than in group (F) both intra-operatively (at 10, 20, 30, and 40 min) and postoperatively (at 10 min intervals in the postanesthesia care unit [PACU]) (P < 0.001). Rescue analgesia with pethidine during the procedure and in the PACU was less (P < 0.001) in the group (T) than group (F) with a median of 20 mg versus 55 mg, respectively. The higher sedation scores observed in group (F) at 15, 25, and 35 min during the procedure, and at 20 min during the PACU time were statistically highly significant (P < 0.001), but only significant at 10 min (P = 0.03) and 30 min (P = 0.007) during the PACU time. There was also highly significant decrease (P < 0.001) in the time of PACU stay in group (T) (38.2 ± 6.6 min) compared with group (F) (89.2 ± 13.39 min). We recorded 6 patients in group (F) (24%) who have developed respiratory depression (respiratory rate < 10 breaths/min) compared to 0% in group (T) (P = 0.022). In addition, in group (F) nausea was noted in 8 patients (32%) and vomiting in 6 patients (24%), which was statistically significant when compared to group (T) (0%) (P = 0.01 and 0.022, respectively). Conclusion: Ultrasound-guided unilateral TAP block is an effective alternative analgesic

  17. Analgesic efficacy of transversus abdominis plane block in neonates and early infants for colostomy and reversal of colostomy.

    PubMed

    Chen, Chee Kean; Teo, Shu Ching; Phui, Vui Eng; Saman, Mat Ariffin

    2015-01-01

    The application of ultrasound-guided transversus abdominis plane (TAP) block in paediatric population is gaining popularity among anaesthetists. We present a case series of ultrasound-guided TAP block in ten neonate and infants undergoing colostomy and reversal of stoma. Classical TAP as described by Hebbard was carried out and a maximum dosage of 1ml/kg of 0.25% levobupivacaine was injected. Pain score was assessed using Neonatal Infant Pain Scale for 24 hours. In all patients, the block was successful with minimal hemodynamic changes intraoperatively and no additional systemic analgesia was needed intraoperative and immediate postoperatively. Ultrasound-guided TAP block has an important role in providing safe and effective analgesia for colostomy creation and reversal of stoma surgeries in paediatric population.

  18. Ultrasound-guided transversus abdominis plane block for post-operative analgesia in patients undergoing caesarean section

    PubMed Central

    Mankikar, Maitreyi Gajanan; Sardesai, Shalini Pravin; Ghodki, Poonam Sachin

    2016-01-01

    Background and Aims: Transversus abdominis plane (TAP) block is a fascial plane block providing post-operative analgesia in patients undergoing surgery with infra-umbilical incisions. We evaluated analgesic efficacy of TAP block with ropivacaine for 24 h after caesarean section through a Pfannenstiel incision. Methods: Sixty patients undergoing caesarean section under spinal anaesthesia were randomised to undergo TAP block with ropivacaine (n = 30) versus control group (n = 30) with normal saline, in addition to standard analgesia with intravenous paracetamol and tramadol. At the end of the surgery, ultrasound-guided TAP plane block was given bilaterally using ropivacaine or normal saline (15 ml on either side). Each patient was assessed post-operatively by a blinded investigator at regular intervals up to 24 h for visual analogue score (VAS) and requirement of analgesia. SPSS version 18.0 software was used. Demographic data were analysed using Student's t-test and the other parameters using paired t-test. Results: TAP block with ropivacaine compared with normal saline reduced post-operative VAS at 24 h (P = 0.004918). Time for rescue analgesia in the study group was prolonged from 4.1 to 9.53 h (P = 0.01631). Mean requirement of tramadol in the first 24 h was reduced in the study group. Conclusion: US guided TAP block after caesarean section reduces the analgesic requirement in the first 24 h. PMID:27141108

  19. Unilateral versus bilateral ultrasound-guided transversus abdominis plane blocks during ureteric shock wave lithotripsy: A prospective randomized trial

    PubMed Central

    Elnabtity, Ali Mohamed Ali; Shabana, Waleed Mansour

    2016-01-01

    Background: Ultrasound-guided transversus abdominis plane (TAP) block has been used for intra- and post-operative analgesia during abdominal operations and for ureteric shock wave lithotripsy (SWL) as well. Aim: This study aimed at comparing ultrasound-guided unilateral versus bilateral TAP blocks as analgesic techniques for unilateral ureteric SWL. Settings and Design: Prospective randomized comparative study. Patients and Methods: Sixty patients scheduled for unilateral ureteric SWL were randomly allocated into two groups: Group (U) received unilateral TAP block in the form of 25 ml of bupivacaine 0.25% (i.e., 62.5 mg), and Group (B) received bilateral TAP blocks in the form of 25 ml of bupivacaine 0.25% (i.e., 62.5 mg) on each side. Statistical Analysis: This was performed using SPSS program version 19 ((IBM Corp., Armonk, NY, USA) and EP 16 program. Results: The mean values of intra- and post-procedural visual analog scale at different time intervals were around (30), which was statistically insignificant between groups (P > 0.05). There were no significant differences between groups regarding cardiopulmonary stability, postanesthesia care unit time, the total amount of rescue fentanyl and patient satisfaction scores (P > 0.05). There were no significant side effects in both groups. Conclusion: Ultrasound-guided unilateral TAP block is as safe and effective analgesic technique as bilateral TAP blocks during unilateral ureteric SWL. It can be used as the sole analgesic technique during ureteric SWL. PMID:27453645

  20. The analgesic efficacy of ultrasound-guided transversus abdominis plane block on postoperative pain and morphine consumption in varicocelectomy

    PubMed Central

    Ömür, Dilek; Oğuzalp, Hüseyin; Kiraz, Hasan A.; Ekin, Serpil; Alan, Cabir; Ersay, Ahmet R.; Hancı, Volkan

    2016-01-01

    Objectives: To evaluate the analgesic effect of transversus abdominis plane (TAP) block administered before varicocele surgery. Methods: This study was completed at the Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey, between January 2011 and April 2013. In a prospective, double blind, randomized, placebo controlled clinical study, 40 male patients scheduled for elective varicocele operations were randomized to group T (treatment group) or group C (controls). After receiving general anesthesia, group T received a TAP block using 20 mL 0.25% bupivacaine on the operation side, whereas group C received a control block using 20 mL 0.9% Sodium chloride. During the first 24 hours after surgery, the patient pain was evaluated using the visual analogue scale (VAS) at rest and while coughing. Postoperative patient controlled analgesia morphine consumption, VAS scores, and side effects were recorded. Results: Of 34 patients, Group T (n=18) had significantly lower VAS pain scores than Group C (n=16) both at rest and while coughing. The total morphine consumed was lower (7.7 ± 4.0) versus 21.6 ± 12.4 mg, p<0.001) in the 24 hours after surgery. Conclusion: As part of a multimodal analgesic regime after varicocelectomy surgery, morphine consumption and VAS pain scores were significantly lower among those receiving 20 mL 0.25% bupivacaine administered for a TAP block than among controls. PMID:27279511

  1. Population pharmacokinetic model of free and total ropivacaine after transversus abdominis plane nerve block in patients undergoing liver resection

    PubMed Central

    Ollier, Edouard; Heritier, Fabrice; Bonnet, Caroline; Hodin, Sophie; Beauchesne, Brigitte; Molliex, Serge; Delavenne, Xavier

    2015-01-01

    Aims The aim of this study was to develop a pharmacokinetic model in order to characterize the free and total ropivacaine concentrations after transversus abdominis plane block in a population of patients undergoing liver resection surgery. In particular, we evaluated the impact of the size of liver resection on ropivacaine pharmacokinetics. Methods This work is based on a single-centre, double-blinded, randomized, placebo-controlled study. Among the 39 patients included, 19 patients were randomized to the ropivacaine group. The free and total ropivacaine concentrations were measured in nine or 10 blood samples per patient. A pharmacokinetic model was built using a nonlinear mixed-effect modelling approach. Results The free ropivacaine concentrations remained under the previously published toxic threshold. A one-compartment model, including protein binding site with a first-order absorption, best described the data. The protein binding site concentration was considered as a latent variable. Bodyweight, the number of resected liver segments and postoperative fibrinogen evolution were, respectively, included in the calculation of the volume of distribution, clearance and binding site production rate. The resection of three or more liver segments was associated with a 53% decrease in the free ropivacaine clearance. Conclusions Although large liver resections were associated with lower free ropivacaine clearance, the ropivacaine pharmacokinetic profile remained within the safe range after this type of surgery. PMID:25557141

  2. Pethidine efficacy in achieving the ultrasound-guided oblique subcostal transversus abdominis plane block in laparoscopic cholecystectomy: A prospective study

    PubMed Central

    Breazu, Caius Mihai; Ciobanu, Lidia; Bartos, Adrian; Bodea, Raluca; Mircea, Petru Adrian; Ionescu, Daniela

    2017-01-01

    Pethidine is a synthetic opioid with local anesthetic properties. Our goal was to evaluate the analgesic efficacy of pethidine for achieving the ultrasound-guided oblique subcostal transversus abdominis plane (OSTAP) block in laparoscopic cholecystectomy. This prospective, double-blind study included 79 patients of physical status I and II according to American Society of Anesthesiologists, scheduled for elective laparoscopic cholecystectomy. The patients were randomly allocated into three groups, depending on the drug used to achieve preoperative bilateral OSTAP block: 1) OSTAP-Placebo (treated with normal saline); 2) OSTAP-Bupivacaine (treated with 0.25% bupivacaine); and 3) OSTAP-Pethidine (treated with 1% pethidine). The efficacy of pethidine in achieving the OSTAP block was analyzed using visual analog scale (VAS), intraoperative opioid dose, opioid consumption in post anesthesia care unit, and opioid consumption in the first 24 postoperative hours. The pain scores assessed by VAS at 0, 2, 4, 6, 12, and 24 hours were significantly lower in OSTAP-Pethidine than in OSTAP-Placebo group (p < 0.001). The mean intraoperative opioid consumption was significantly lower in OSTAP-Pethidine compared to OSTAP-Placebo group (150 versus 400 mg, p < 0.001), as well as the mean opioid consumption in the first 24 hours (20.4 versus 78 mg, p < 0.001). Comparing VAS assessment between OSTAP-Bupivacaine and OSTAP-Pethidine groups, statistically significant differences were observed only for the immediate postoperative pain assessment (0 hours), where lower values were observed in OSTAP-Pethidine group (p = 0.004). There were no statistically significant differences in the incidence of postoperative nausea and vomiting (p = 0.131) between the groups. The use of 1% pethidine can be an alternative to 0.25% bupivacaine in achieving OSTAP block for laparoscopic cholecystectomy. PMID:28027453

  3. Addition of fentanyl to the ultrasound-guided transversus abdominis plane block does not improve analgesia following cesarean delivery

    PubMed Central

    WANG, LI-ZHONG; LIU, XIA; ZHANG, YING-FA; HU, XIAO-XIA; ZHANG, XIAO-MING

    2016-01-01

    The present study aimed to investigate whether the addition of fentanyl to the transversus abdominis plane (TAP) block procedure may improve analgesic duration following cesarean delivery. A total of 147 nulliparous women with an American Society of Anesthesiologists physical status I–II, scheduled for elective cesarean delivery under spinal anesthesia, were enrolled in the present study. All patients underwent cesarean delivery under spinal anesthesia with 10 mg bupivacaine and 10 µg fentanyl, after which the patients underwent an ultrasound-guided bilateral TAP block with either 0.375% ropivacaine (group TR; n=48), 0.375% ropivacaine and 50 µg subcutaneous fentanyl (group TRSF; n=49), or a mixture of 0.375% ropivacaine and 50 µg fentanyl (2.5 µg/ml; group TRF; n=50) per side. The TAP block formed part of a multimodal analgesic regimen comprising patient-controlled analgesia (PCA) with intravenous fentanyl, and regular treatment with diclofenac and paracetamol. The TAP block was performed in the midaxillary line using an in-plane technique. The primary outcome was the time to the first PCA, whereas secondary outcomes were the cumulative and interval PCA consumptions, visual analogue scale (VAS) pain scores at rest and during movement, side effects assessed at 2, 6, 12, 24 and 48 h postoperatively, and patient satisfaction with postoperative analgesia. No significant differences were observed in the median time to the first PCA among the three groups (P=0.640), which were 150 min (70–720 min) in group TR, 165 min (90–670 min) in group TRSF, and 190 min (70–680 min) in group TRF. Fentanyl consumption, VAS pain scores, side effects and patient satisfaction were similar among the three groups; however, the demand for fentanyl was significantly decreased in the TRSF and TRF groups at 2 h postoperatively (P=0.001 and 0.002, respectively), as compared with group TR. No complications attributed to the TAP block were detected. In conclusion, the results of the

  4. Infiltration of liposome bupivacaine into the transversus abdominis plane for postsurgical analgesia in robotic laparoscopic prostatectomy: a pilot study

    PubMed Central

    Sternlicht, Andrew; Shapiro, Max; Robelen, Gary; Vellayappan, Usha; Tuerk, Ingolf A

    2014-01-01

    Background Transversus abdominis plane (TAP) infiltration has been increasingly used for postsurgical analgesia in abdominal/pelvic procedures; however, duration/extent of analgesia with standard local anesthetics is limited. This pilot study assessed the preliminary efficacy and safety of two volumes of liposome bupivacaine administered via TAP infiltration in patients undergoing robotic laparoscopic prostatectomy. Methods In this single-center, open-label, prospective study, patients older than 18 years received TAP infiltration with liposome bupivacaine immediately after surgery. The first 12 patients received a total volume of 20 mL liposome bupivacaine (266 mg); the next 12 received 40 mL liposome bupivacaine (266 mg). The liposome bupivacaine was diluted with 0.9% normal saline. The primary efficacy measure was duration of analgesia, measured by time to first opioid administration. Secondary outcome measures included patient-assessed pain scores, opioid use, and opioid-related adverse events (AEs). Results Twenty-four patients received liposome bupivacaine (20 mL, n=12; 40 mL, n=12) and were included in the primary analysis. Three refused participation in a 10-day follow-up visit and did not complete the study. Median time to first opioid administration after surgery was 23 and 26 minutes for the 20 and 40 mL groups, respectively. Mean total amount of postsurgical opioids ranged from 25.4 to 27.3 mg; after hospital discharge to day 10, both groups required a mean of 0.7 oxycodone/acetaminophen tablets/day. Mean pain scores of 4.4 and 5.3 were reported at 1 hour and 3.1 and 3.9 at 2 hours postsurgery, with 20 and 40 mL doses, respectively. Neither group had mean scores higher than 3.0 at any further assessments. No opioid-related or treatment-related serious AEs were reported. Conclusion Median time to first opioid administration did not differ between the two groups. No differences in secondary outcomes were observed on the basis of volume administered. These

  5. Comparison of Transversus Abdominis Plane Infiltration with Liposomal Bupivacaine versus Continuous Epidural Analgesia versus Intravenous Opioid Analgesia

    PubMed Central

    Ayad, Sabry; Babazade, Rovnat; Elsharkawy, Hesham; Nadar, Vinayak; Lokhande, Chetan; Makarova, Natalya; Khanna, Rashi; Sessler, Daniel I.; Turan, Alparslan

    2016-01-01

    Epidural analgesia is considered the standard of care but cannot be provided to all patients Liposomal bupivacaine has been approved for field blocks such as transversus abdominis plane (TAP) blocks but has not been clinically compared against other modalities. In this retrospective propensity matched cohort study we thus tested the primary hypothesis that TAP infiltration are noninferior (not worse) to continuous epidural analgesia and superior (better) to intravenous opioid analgesia in patients recovering from major lower abdominal surgery. 318 patients were propensity matched on 18 potential factors among three groups (106 per group): 1) TAP infiltration with bupivacaine liposome; 2) continuous Epidural analgesia with plain bupivacaine; and; 3) intravenous patient-controlled analgesia (IV PCA). We claimed TAP noninferior (not worse) over Epidural if TAP was noninferior (not worse) on total morphine-equivalent opioid and time-weighted average pain score (10-point scale) within first 72 hours after surgery with noninferiority deltas of 1 (10-point scale) for pain and an increase less of 20% in the mean morphine equivalent opioid consumption. We claimed TAP or Epidural groups superior (better) over IV PCA if TAP or Epidural was superior on opioid consumption and at least noninferior on pain outcome. Multivariable linear regressions within the propensity-matched cohorts were used to model total morphine-equivalent opioid dose and time-weighted average pain score within first 72 hours after surgery; joint hypothesis framework was used for formal testing. TAP infiltration were noninferior to Epidural on both primary outcomes (p<0.001). TAP infiltration were noninferior to IV PCA on pain scores (p = 0.001) but we did not find superiority on opioid consumption (p = 0.37). We did not find noninferiority of Epidural over IV PCA on pain scores (P = 0.13) and nor did we find superiority on opioid consumption (P = 0.98). TAP infiltration with liposomal bupivacaine and

  6. Ultrasound-Guided Out-of-Plane vs. In-Plane Interscalene Catheters: A Randomized, Prospective Study

    PubMed Central

    Schwenk, Eric S.; Gandhi, Kishor; Baratta, Jaime L.; Torjman, Marc; Epstein, Richard H.; Chung, Jaeyoon; Vaghari, Benjamin A.; Beausang, David; Bojaxhi, Elird; Grady, Bernadette

    2015-01-01

    Background: Continuous interscalene blocks provide excellent analgesia after shoulder surgery. Although the safety of the ultrasound-guided in-plane approach has been touted, technical and patient factors can limit this approach. We developed a caudad-to-cephalad out-of-plane approach and hypothesized that it would decrease pain ratings due to better catheter alignment with the brachial plexus compared to the in-plane technique in a randomized, controlled study. Objectives: To compare an out-of-plane interscalene catheter technique to the in-plane technique in a randomized clinical trial. Patients and Methods: Eighty-four patients undergoing open shoulder surgery were randomized to either the in-plane or out-of-plane ultrasound-guided continuous interscalene technique. The primary outcome was VAS pain rating at 24 hours. Secondary outcomes included pain ratings in the recovery room and at 48 hours, morphine consumption, the incidence of catheter dislodgments, procedure time, and block difficulty. Procedural data and all pain ratings were collected by blinded observers. Results: There were no differences in the primary outcome of median VAS pain rating at 24 hours between the out-of-plane and in-plane groups (1.50; IQR, [0 - 4.38] vs. 1.25; IQR, [0 - 3.75]; P = 0.57). There were also no differences, respectively, between out-of-plane and in-plane median PACU pain ratings (1.0; IQR, [0 - 3.5] vs. 0.25; IQR, [0 - 2.5]; P = 0.08) and median 48-hour pain ratings (1.25; IQR, [1.25 - 2.63] vs. 0.50; IQR, [0 - 1.88]; P = 0.30). There were no differences in any other secondary endpoint. Conclusions: Our out-of-plane technique did not provide superior analgesia to the in-plane technique. It did not increase the number of complications. Our technique is an acceptable alternative in situations where the in-plane technique is difficult to perform. PMID:26705526

  7. Ultrasound-guided rectus sheath and transversus abdominis plane blocks for perioperative analgesia in upper abdominal surgery: A randomized controlled study

    PubMed Central

    Abdelsalam, Khaled; Mohamdin, OW

    2016-01-01

    Background: Regional anesthetic techniques can be used to alleviate postoperative pain in patients undergoing major upper abdominal surgery. Our aim was to evaluate the efficacy of bilateral ultrasound (US)-guided rectus sheath (RS) and transversus abdominis plane (TAP) blocks for better perioperative analgesia. Patients and Methods: It is a prospective, observer-blinded, randomized clinical study. 40 eligible patients undergoing elective liver resection or Whipple procedure were included. All patients received a standardized anesthetic technique. Group 1 (n = 20) received preincisional US-guided bilateral RS and TAP blocks using 20 ml volume of bupivacaine 0.25% for each, and group 2 (n = 20) received local wound infiltration at end of surgery with 40 ml of bupivacaine 0.25%. A standardized postoperative analgesic regimen composed of intravenous paracetamol and a morphine patient-controlled analgesia (PCA). The use of intraoperative fentanyl and recovery room morphine boluses, PCA-administered morphine, pain scores as well as number of patients’ experienced postoperative nausea and vomiting in the ward at 6 and 24 h were recorded. Results: Group 1 patients received a significantly lower cumulative intraoperative fentanyl, significantly lesser boluses of morphine in postanesthesia care unit, as well, significantly lower cumulative 24 h postoperative morphine dosage than the group 2 patients. Pain visual analog scale scores were significantly lower at both 6 and 24 h postoperatively in TAP group when compared with the no-TAP group. There were no complications related to the TAP block procedures. No signs or symptoms of local anesthetic systemic toxicity were detected. Conclusion: The combination of bilateral US-guided RS and TAP blocks provides excellent perioperative analgesia for major upper abdominal surgery. PMID:26955306

  8. Comparison of ultrasound-guided transversus abdominis plane block with bupivacaine and ropivacaine as adjuncts for postoperative analgesia in laparoscopic cholecystectomies

    PubMed Central

    Sinha, Shradha; Palta, Sanjeev; Saroa, Richa; Prasad, Abhishek

    2016-01-01

    Background and Aims: Transversus abdominis plane (TAP) block is a popular technique for post-operative analgesia in abdominal surgeries. The aim of the study was to evaluate the relative efficacy of bupivacaine versus ropivacaine for post-operative analgesia using ultrasound-guided TAP block in laparoscopic cholecystectomies. Methods: Sixty adults undergoing elective laparoscopic cholecystectomy were randomised to receive ultrasound-guided TAP block at the end of the surgical procedure with either 0.25% bupivacaine (Group I, n = 30) or 0.375% ropivacaine (Group II, n = 30). All patients were assessed for post-operative pain and rescue analgesic consumption at 10 min, 30 min, 1 h, 4 h, 8 h, 12 h and 24 h time points. Means for normally distributed data were compared using Student's t-test, and proportions were compared using Chi-square or Fisher's exact test whichever was applicable. Results: Patients receiving ultrasound-guided TAP block with ropivacaine (Group II) had significantly lower pain scores when compared to patients who received the block with bupivacaine (Group I) at 10 min, 30 min and 1 h. However, both the drugs were equivalent for post-operative analgesia and 24 h cumulative rescue analgesic requirement (median [interquartile range]) (75.00 [75.00–75.00] in Group I vs. 75.00 [75.00–93.75] in Group II, P = 0.366). Conclusion: Ultrasound-guided TAP block with ropivacaine provides effective analgesia in the immediate post-operative period up to 1 h as compared to bupivacaine. However, both the drugs are similar in terms of 24 h cumulative rescue analgesic requirement. PMID:27141110

  9. Improved perioperative analgesia with ultrasound-guided ilioinguinal/iliohypogastric nerve or transversus abdominis plane block for open inguinal surgery: a systematic review and meta-analysis of randomized controlled trials

    PubMed Central

    Wang, Yuexiang; Wu, Tao; Terry, Marisa J.; Eldrige, Jason S.; Tong, Qiang; Erwin, Patricia J.; Wang, Zhen; Qu, Wenchun

    2016-01-01

    [Purpose] Ultrasound-guided ilioinguinal/iliohypogastric (II/IH) nerve and transversus abdominis plane (TAP) blocks have been increasingly utilized in patients for perioperative analgesia. We conducted this meta-analysis to evaluate the clinical efficacy of ultrasound-guided II/IH nerve or TAP blocks for perioperative analgesia in patients undergoing open inguinal surgery. [Subjects and Methods] A systematic search was conducted of 7 databases from the inception to March 5, 2015. Randomized controlled trials (RCTs) comparing the clinical efficacy of ultrasound-guided vs. landmark-based techniques to perform II/IH nerve and TAP blocks in patients with open inguinal surgery were included. We constructed random effects models to pool the standardized mean difference (SMD) for continuous outcomes and the odds ratio (OR) for dichotomized outcomes. [Results] Ultrasound-guided II/IH nerve or TAP blocks were associated with a reduced use of intraoperative additional analgesia and a significant reduction of pain scores during day-stay. The use of rescue drugs was also significantly lower in the ultrasound-guided group. [Conclusion] The use of ultrasound-guidance to perform an II/IH nerve or a TAP block was associated with improved perioperative analgesia in patients following open inguinal surgery compared to landmark-based methods. PMID:27134411

  10. Rectus abdominis muscle strains in tennis players

    PubMed Central

    Maquirriain, Javier; Ghisi, Juan P; Kokalj, Antonio M

    2007-01-01

    Rectus abdominis muscle strains are common and debilitating injuries among competitive tennis players. Eccentric overload, followed by forced contraction of the non‐dominant rectus abdominis during the cocking phase of the service motion is the accepted injury mechanism. A tennis‐specific rehabilitation program emphasising eccentrics and plyometric strengthening of the abdominal wall muscles, contributes to the complete functional recovery in tennis players, and could help reduce recurrences. PMID:17957025

  11. Rectus abdominis muscle strains in tennis players.

    PubMed

    Maquirriain, Javier; Ghisi, Juan P; Kokalj, Antonio M

    2007-11-01

    Rectus abdominis muscle strains are common and debilitating injuries among competitive tennis players. Eccentric overload, followed by forced contraction of the non-dominant rectus abdominis during the cocking phase of the service motion is the accepted injury mechanism. A tennis-specific rehabilitation program emphasising eccentrics and plyometric strengthening of the abdominal wall muscles, contributes to the complete functional recovery in tennis players, and could help reduce recurrences.

  12. Urinary catheters

    MedlinePlus

    ... provider's office. An indwelling catheter has a small balloon inflated on the end of it. This prevents ... When the catheter needs to be removed, the balloon is deflated. CONDOM CATHETERS Condom catheters can be ...

  13. Rectus Abdominis Endometrioma after Caesarean Section

    PubMed Central

    Mishina, Anna; Zaharia, Sergiu; Zastavnitsky, Gheorghe

    2016-01-01

    Isolated rectus abdominis muscle endometriosis is very uncommon with less than 20 case reports being published to date since its first description in 1984 by Amato and Levitt. We report another case of isolated rectus abdominis endometriosis in a 37-year-old patient with a previous caesarian section. We also discuss the diagnostic and treatment particularities in these patients. In our case, the treatment was only surgical and currently the patient is disease-free during the 24-month follow-up. PMID:27999704

  14. Catheter ablation.

    PubMed

    Fromer, M; Shenasa, M

    1991-02-01

    Catheter ablation is gaining increasing interest for the therapy of symptomatic, sustained arrhythmias of various origins. The scope of this review is to give an overview of the biophysical aspects and major characteristics of some of the most widely used energy sources in catheter ablation, e.g., the discharge of conventional defibrillators, modified defibrillators, laser light, and radiofrequency current application. Results from animal studies are considered to explain the basic mechanisms of catheter ablation. The recent achievements with the use of radiofrequency current to modify or ablate cardiac conduction properties are outlined in more detail.

  15. Intractable pain due to rectus abdominis intramuscular haemangioma.

    PubMed

    Scozzari, G; Reddavid, R; Conti, L; Trombetta, F; Toppino, M; Sandrucci, S

    2014-08-01

    Haemangiomas are tumours of vascular origin accounting for approximately 7 % of all benign tumours. Three types of haemangioma have been described according to the vessel type involved: capillary, cavernous and mixed. Intramuscular haemangiomas (IMHs) are infrequent, accounting for less than 1 % of all haemangiomas and are mostly located in the extremities and the trunk. Intramuscular haemangiomas of the rectus abdominis muscle are extremely rare, with only one previous case reported in the literature to the best of our knowledge. In this report, we present the case of a patient with intractable pain related to IMHs of the rectus abdominis and we analyse diagnostic assessment and surgical management of the condition.

  16. Catheter Ablation

    MedlinePlus

    ... you during the procedure. Machines will measure your heart’s activity. All types of ablation require cardiac catheterization to place flexible tubes, or catheters, inside your heart to make the scars. Your doctor will clean ...

  17. Catheter Embolization

    MedlinePlus

    ... the scrotum that may be a cause of infertility. Catheter embolization may be used alone or combined ... in patients with diabetes or other pre-existing kidney disease. top of page What are the limitations of ...

  18. Urinary catheter - infants

    MedlinePlus

    Bladder catheter - infants; Foley catheter - infants; Urinary catheter - neonatal ... Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine . 10th ed. Philadelphia, PA: Elsevier Saunders; ...

  19. Randomized comparison of popliteal-sciatic perineural catheter tip migration and dislocation in a cadaver model using two catheter designs

    PubMed Central

    Steffel, Lauren; Howard, Steven K.; Borg, Lindsay; Leng, Jody C.; Kim, T. Edward

    2017-01-01

    Background New catheter-over-needle (CON) technology for continuous peripheral nerve blockade has emerged, but its effect on the risk of perineural catheter tip dislocation is unknown. Less flexible catheters may be more likely to migrate away from the nerve with simulated patient movement. In the present study, we evaluated catheter tip migration between CON catheters and traditional catheter-through-needle (CTN) catheters during ultrasound-guided short-axis in-plane (SAX-IP) insertion. Methods We evaluated the migration of popliteal-sciatic catheters in a prone, unembalmed male cadaver. Thirty catheter placement trials were divided randomly into two groups based on the catheter type: CON or CTN. A single anesthesiology resident placed the catheters by SAX-IP insertion, and the catheters were then examined by ultrasound before and after ipsilateral knee range of motion (ROM) exercises (0°–130° flexion). A blinded expert regional anesthesiologist performed caliper measurements on the ultrasound images before and after the ROM exercises. The primary outcome was the change in distance from the catheter tip to the center of the nerve (cm) between before and after the ROM exercises. Results The change in the tip-to-nerve distance (median [10th–90th percentile]) was 0.06 (−0.16 to 0.23) cm for the CTN catheter and 0.00 (−0.12 to 0.69) for the CON catheter (P = 0.663). However, there was a statistically significant increase in dislocation out of the nerve compartment for the CON catheter (4/15; 0/15 for CTN) (P = 0.043). Conclusions Although the use of different catheter designs had no effect on the change in the measured migration distance of popliteal-sciatic catheters, 27% of the CON catheters were dislocated out of the nerve compartment. These results may influence the choice of catheter design when using SAX-IP perineural catheter insertion. PMID:28184270

  20. Automated Pointing of Cardiac Imaging Catheters

    PubMed Central

    Loschak, Paul M.; Brattain, Laura J.; Howe, Robert D.

    2013-01-01

    Intracardiac echocardiography (ICE) catheters enable high-quality ultrasound imaging within the heart, but their use in guiding procedures is limited due to the difficulty of manually pointing them at structures of interest. This paper presents the design and testing of a catheter steering model for robotic control of commercial ICE catheters. The four actuated degrees of freedom (4-DOF) are two catheter handle knobs to produce bi-directional bending in combination with rotation and translation of the handle. An extra degree of freedom in the system allows the imaging plane (dependent on orientation) to be directed at an object of interest. A closed form solution for forward and inverse kinematics enables control of the catheter tip position and the imaging plane orientation. The proposed algorithms were validated with a robotic test bed using electromagnetic sensor tracking of the catheter tip. The ability to automatically acquire imaging targets in the heart may improve the efficiency and effectiveness of intracardiac catheter interventions by allowing visualization of soft tissue structures that are not visible using standard fluoroscopic guidance. Although the system has been developed and tested for manipulating ICE catheters, the methods described here are applicable to any long thin tendon-driven tool (with single or bi-directional bending) requiring accurate tip position and orientation control. PMID:24683501

  1. Intraluminal fluorescence spectroscopy catheter with ultrasound guidance

    NASA Astrophysics Data System (ADS)

    Stephens, Douglas N.; Park, Jesung; Sun, Yang; Papaioannou, Thanassis; Marcu, Laura

    2009-05-01

    We demonstrate the feasibility of a time-resolved fluorescence spectroscopy (TRFS) technique for intraluminal investigation of arterial vessel composition under intravascular ultrasound (IVUS) guidance. A prototype 1.8-mm (5.4 Fr) catheter combining a side-viewing optical fiber (SVOF) and an IVUS catheter was constructed and tested with in vitro vessel phantoms. The prototype catheter can locate a fluorophore in the phantom vessel wall, steer the SVOF in place, perform blood flushing under flow conditions, and acquire high-quality TRFS data using 337-nm wavelength excitation. The catheter steering capability used for the coregistration of the IVUS image plane and the SVOF beam produce a guiding precision to an arterial phantom wall site location of 0.53+/-0.16 mm. This new intravascular multimodal catheter enables the potential for in vivo arterial plaque composition identification using TRFS.

  2. Architecture of the rectus abdominis, quadratus lumborum, and erector spinae.

    PubMed

    Delp, S L; Suryanarayanan, S; Murray, W M; Uhlir, J; Triolo, R J

    2001-03-01

    Quantitative descriptions of muscle architecture are needed to characterize the force-generating capabilities of muscles. This study reports the architecture of three major trunk muscles: the rectus abdominis, quadratus lumborum, and three columns of the erector spinae (spinalis thoracis, longissimus thoracis and iliocostalis lumborum). Musculotendon lengths, muscle lengths, fascicle lengths, sarcomere lengths, pennation angles, and muscle masses were measured in five cadavers. Optimal fascicle lengths (the fascicle length at which the muscle generates maximum force) and physiologic cross-sectional areas (the ratio of muscle volume to optimal fascicle length) were computed from these measurements. The rectus abdominis had the longest fascicles of the muscles studied, with a mean (S.D.) optimal fascicle length of 28.3 (4.2)cm. The three columns of the erector spinae had mean optimal fascicle lengths that ranged from 6.4 (0.6)cm in the spinalis thoracis to 14.2 (2.1)cm in the iliocostalis lumborum. The proximal portion of the quadratus lumborum had a mean optimal fascicle length of 8.5 (1.5)cm and the distal segment of this muscle had a mean optimal fascicle length of 5.6 (0.9)cm. The physiologic cross-sectional area of the rectus abdominis was 2.6 (0.9)cm(2), the combined physiologic cross-sectional area of the erector spinae was 11.6 (1.8)cm(2), and the physiologic cross-sectional area of the quadratus lumborum was 2.8 (0.5)cm(2). These data provide the basis for estimation of the force-generating potential of these muscles.

  3. Hemodialysis Tunneled Catheter Noninfectious Complications

    PubMed Central

    Miller, Lisa M.; MacRae, Jennifer M.; Kiaii, Mercedeh; Clark, Edward; Dipchand, Christine; Kappel, Joanne; Lok, Charmaine; Luscombe, Rick; Moist, Louise; Oliver, Matthew; Pike, Pamela; Hiremath, Swapnil

    2016-01-01

    Noninfectious hemodialysis catheter complications include catheter dysfunction, catheter-related thrombus, and central vein stenosis. The definitions, causes, and treatment strategies for catheter dysfunction are reviewed below. Catheter-related thrombus is a less common but serious complication of catheters, requiring catheter removal and systemic anticoagulation. In addition, the risk factors, clinical manifestation, and treatment options for central vein stenosis are outlined. PMID:28270922

  4. Catheter-Associated Infections

    PubMed Central

    Trautner, Barbara W.; Darouiche, Rabih O.

    2010-01-01

    Intravascular catheters and urinary catheters are the 2 most commonly inserted medical devices in the United States, and they are likewise the two most common causes of nosocomially acquired bloodstream infection. Biofilm formation on the surfaces of indwelling catheters is central to the pathogenesis of infection of both types of catheters. The cornerstone to any preventive strategy of intravascular catheter infections is strict attention to infection control practices. Antimicrobial-impregnated intravascular catheters are a useful adjunction to infection control measures. Prevention of urinary catheter–associated infection is hindered by the numbers and types of organisms present in the periurethral area as well as by the typically longer duration of catheter placement. Antimicrobial agents in general have not been effective in preventing catheter-associated urinary tract infection in persons with long-term, indwelling urethral catheters. Preventive strategies that avoid the use of antimicrobial agents may be necessary in this population. PMID:15111369

  5. Constriction of the levator hiatus during instruction of pelvic floor or transversus abdominis contraction: a 4D ultrasound study.

    PubMed

    Bø, Kari; Braekken, Ingeborg H; Majida, Memona; Engh, Marie E

    2009-01-01

    A new theory claims that the pelvic floor muscles (PFM) can be trained via the transversus abdominis (TrA). The aim of the present study was to compare the effect of instruction of PFM and TrA contraction on constriction of the levator hiatus, using 4D perineal ultrasonography. Thirteen women with pelvic organ prolapse participated in the study. Perineal ultrasound in standing position was used to assess constriction of the levator hiatus. Analyses were conducted off-line with measurements in the axial plane of minimal hiatal dimensions. The reduction of all the hiatal dimensions was significantly greater during PFM than TrA contraction. All patients had a reduction of the levator hiatus area during PFM contraction (mean reduction 24.0%; range 6.1-49.2%). In two patients, there was an increase of the levator hiatus area during TrA contraction. Instruction of PFM contraction is more effective than TrA contraction.

  6. Rectus abdominis muscle free flap harvest by laparoscopic sheath-sparing technique.

    PubMed

    Greensmith, A; Januszkiewicz, J; Poole, G

    2000-04-01

    Previous reports of endoscopic rectus abdominis muscle harvest have described techniques that are hampered by the need for anterior rectus sheath division or mechanical devices to maintain the optical cavity. The authors report the first successful clinical case of a laparoscopic sheath-sparing rectus abdominis muscle harvest for free tissue transfer. It offers considerable advantages over the traditional open method and, with the help of an experienced laparoscopic surgeon, it should add little to operative time.

  7. 21 CFR 876.5130 - Urological catheter and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... generic type of device includes radiopaque urological catheters, ureteral catheters, urethral catheters, coude catheters, balloon retention type catheters, straight catheters, upper urinary tract...

  8. 21 CFR 876.5130 - Urological catheter and accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... generic type of device includes radiopaque urological catheters, ureteral catheters, urethral catheters, coude catheters, balloon retention type catheters, straight catheters, upper urinary tract...

  9. 21 CFR 876.5130 - Urological catheter and accessories.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... generic type of device includes radiopaque urological catheters, ureteral catheters, urethral catheters, coude catheters, balloon retention type catheters, straight catheters, upper urinary tract...

  10. 21 CFR 876.5130 - Urological catheter and accessories.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... generic type of device includes radiopaque urological catheters, ureteral catheters, urethral catheters, coudé catheters, balloon retention type catheters, straight catheters, upper urinary tract...

  11. 21 CFR 876.5130 - Urological catheter and accessories.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... generic type of device includes radiopaque urological catheters, ureteral catheters, urethral catheters, coudé catheters, balloon retention type catheters, straight catheters, upper urinary tract...

  12. Rectus abdominis overuse injury in a tennis athlete treated with traumeel

    PubMed Central

    Natsis, Konstantinos; Lyrtzis, Christos; Papathanasiou, Efthymia; Anastasopoulos, Nikos

    2012-01-01

    Summary Background: Rectus abdominis injuries are common in tennis players at all levels of competition. Traumeel® injection can be used for treatment of muscle strains and hematomas. Case Report: A 21-year-old female tennis athlete was injured on the non-dominant rectus abdominis during the cocking phase of the service motion. She suffered from pain and tenderness. One week later, during a serve, she experienced severe pain on the contralateral side of her abdomen. Conservative treatment was performed by the team physician with rest, ice therapy and analgesics for 20 days, but she had recurrent injuries. The ultrasonography and MRI showed hematoma of the rectus abdominis muscle. She was treated with 2 injections of Traumeel® on the 2nd, 4th, 6th post-traumatic day and received 1 injection on the 10th post-traumatic day. She also modified her serve technique. On the fourth post-treatment week the athlete had pain-free function and both the MRI appearance and the size of rectus abdominal muscle were normal. She returned to her sport activities. There is no recurrence of her injury 2 years later. Conclusions: Rectus abdominis hematoma must be diagnosed early. Traumeel® injections are effective, safe and well-tolerated for the treatment of overuse injury of the rectus abdominis following strain. PMID:23569472

  13. Central venous catheters - ports

    MedlinePlus

    ... of Intravascular Catheter-Related Infections. Centers For Disease Control and Prevention. April 2011. ... MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. ...

  14. Correlations between Transversus Abdominis Thickness, Lumbar Stability, and Balance of Female University Students

    PubMed Central

    Gong, Wontae

    2013-01-01

    [Purpose] The purpose of the present study was to analyze the correlations of the thicknesses of the transversus abdominis muscle (Tra) and the internal obliquus abdominis muscle (Io) with static lumbar stability (SLS), dynamic lumbar stability (DLS), and balance. [Subjects] The subjects of the present study were 40 female university students who had no physical defects or pain. [Methods] The thicknesses of Tra and Io muscles were measured using an ultrasonic imaging diagnostic unit. SLS and DLS were measured using a Pressure Biofeedback Unit (PBU), and Weight Distribution Indexes (WDI) and stability scores (SS) were measured using a balance measuring unit. [Results] As the thickness of the Tra increased, SLS, DLS, WDI, and SS improved. As SLS improved, DLS and WDI were also improved. [Conclusion] To improve lumbar stability and balance, training is needed in order to increase the muscle mass of the transversus abdominis muscle. PMID:24259828

  15. [The bladder catheter].

    PubMed

    Pestalozzi, D M

    1996-09-01

    The benefit of the transurethral catheter to protect or measure renal function is well accepted. Urethral stricture and infection of the lower urinary tract as the complications should lead to a cautious use of catheters. A careful placement, the choice of the best material and a correct management help to avoid complications. Alternatives are discussed.

  16. Abdominal Closure after TRAM Flap Breast Reconstruction with Transversus Abdominis Muscle Release and Mesh

    PubMed Central

    Avendano-Peza, Héctor; Novitsky, Yuri W.

    2016-01-01

    Summary: Breast reconstruction with a pedicled transverse rectus abdominis muscle (TRAM) flap can result in significant abdominal wall donor-site morbidity. Although the pedicled TRAM flap donor area reinforced with mesh results in decreased rates of postoperative abdominal bulging and hernias, the best technique to accomplish that is yet to be elucidated. We present our novel technique of posterior components separation with transversus abdominis muscle release and retromuscular mesh reinforcement for donor-area closure during pedicled TRAM flap breast reconstruction. PMID:27757337

  17. Catheter tracking with phase information in a magnetic resonance scanner.

    PubMed

    Anderson, Kevan J T; Scott, Greig C; Wright, Graham A

    2012-06-01

    The purpose of this study is to describe a new active technique for accurately determining both the position and orientation of the tip of a catheter during magnetic resonance (MR)-guided percutaneous cardiovascular procedures. The technique utilizes phase information introduced into the MR signal from a small receive coil located on the distal tip of the catheter. Phase patterns around a small receive coil are rich in information that is directly related to position and orientation. This information can be collected over a large spherical volume with a diameter several times that of the receive coil. The high degree of redundancy yields the potential for an accurate and robust method of catheter tracking. A tracking algorithm is presented that performs catheter tip localization using phase images acquired in two orthogonal planes without any a priori knowledge of catheter position. Associated experimentation demonstrating feasibility is also presented.

  18. Effect of pilates mat exercises and conventional exercise programmes on transversus abdominis and obliquus internus abdominis activity: pilot randomised trial.

    PubMed

    Critchley, Duncan J; Pierson, Zoe; Battersby, Gemma

    2011-04-01

    Pilates training is said to increase Transversus abdominis (TrA) and Obliquus internus (OI) activation during exercise and functional activities. 34 Pain-free health club members with no Pilates experience, mean (SD) age 30(7) years, were randomised to Pilates mat exercises or strength training. Participants exercised unsupervised twice-weekly for eight weeks. TrA and OI thickness (a proxy for muscle activity at the low-medium efforts of our exercises) were measured with ultrasound pre- and post-training during Pilates exercises 'Imprint' (an abdominal drawing-in manoeuvre) and 'Hundreds A' (lying supine, arms slightly raised, hips and knees flexed to 90°) and 'Hundreds B' (as A, with neck flexion) and functional postures sitting and standing. Pilates participants had increased TrA thickness in Hundreds A [all values mean (SD) mm]: 3.7(1.3) pre-intervention, 4.7(1.1) post-intervention (P = 0.007); and decreased OI muscle thickness during Imprint: 11.7(2.8) pre-intervention, 10.8(3.5) post-intervention (P = 0.008). Strength training participants had greater OI thickness during Imprint (P = 0.014), Hundreds A (P = 0.018) and Hundreds B (P = 0.004) than Pilates participants post-intervention. There were no changes in muscle thickness at rest or during functional postures. Pilates training appears to increase TrA activity but only when performing Pilates exercises. Further research is required into Pilates in clinical populations and how to increase deep abdominal activation during functional activities.

  19. Structure of the jet from a generic catheter tip

    NASA Astrophysics Data System (ADS)

    Foust, J.; Rockwell, D.

    2006-10-01

    A generic feature of a wide variety of central venous catheters, which are typically located within the superior vena cava (SVC), is a jet from a side hole of the catheter tip. Particle image velocimetry is employed in conjunction with a scaled-up water facility, in order to characterize the structure of the jet as a function of dimensionless hole diameter and jet velocity ratio. Quantitative patterns in the radial and crossflow planes of the catheter-SVC system define the jet evolution. It has distinctive features, relative to the classical jet in a crossflow, which issues from a small opening in a planar surface into a region of large extent.

  20. Relationship between the phases of the menstrual cycle and the transversus abdominis muscle

    PubMed Central

    Ubukata, Hitomi; Matsumura, Ayana

    2015-01-01

    [Purpose] This study investigated changes in the thickness of the transversus abdominis muscle at various stages of the menstrual cycle. [Subjects] The subjects were 15 young healthy females with regular menstrual cycles. [Methods] A regular menstrual cycle was defined as a 28-day cycle comprising 3 phases: the menstrual phase, the follicular phase, and the luteal phase. For the purpose of the study, measurements were taken at day 3 (menstrual phase), day 12 (follicular phase), and day 21 (luteal phase) of the cycle. An ultrasonic imaging diagnostic device (MyLab 25) and a linear expression probe were used for measurement of the transversus abdominis muscle. [Results] There were no significant differences in the variation rate of the thickness of the muscle at any phase of the menstrual cycle. [Conclusion] The results suggested that the sex hormones associated with the menstrual cycle do not affect the contractility or changes in the thickness of the transversus abdominis muscle. For the reasons stated above, there is little need to consider the menstrual cycle when measuring muscle thickness in physical therapy scenarios because the transversus abdominis muscle does not depend on the menstrual cycle. PMID:25931681

  1. Sinuplasty (Balloon Catheter Dilation)

    MedlinePlus

    ... development of the balloon dilating catheter and its adaptation to sinus surgery. In the 1980s, the field ... used in endoscopic sinus surgery. It is the adaptation or application of minimally-invasive balloon technology to ...

  2. Central venous catheter - flushing

    MedlinePlus

    ... To flush your catheter, you will need: Clean paper towels Saline syringes (clear), and maybe heparin syringes ( ... your fingers before washing. Dry with a clean paper towel. Set up your supplies on a clean ...

  3. Indwelling catheter care

    MedlinePlus

    ... skin care part of your daily routine. Avoid physical activity for a week or two after your catheter is placed in your bladder. Cleaning Your Skin You will need these supplies for cleaning your ...

  4. [Urinary catheter biofilm infections].

    PubMed

    Holá, V; Růzicka, F

    2008-04-01

    Urinary tract infections, most of which are biofilm infections in catheterized patients, account for more than 40% of hospital infections. Bacterial colonization of the urinary tract and catheters causes not only infection but also other complications such as catheter blockage by bacterial encrustation, urolithiasis and pyelonephritis. About 50% of long-term catheterized patients face urinary flow obstruction due to catheter encrustation, but no measure is currently available to prevent it. Encrustation has been known either to result from metabolic dysfunction or to be of microbial origin, with urease positive bacterial species implicated most often. Infectious calculi account for about 15-20% of all cases of urolithiasis and are often associated with biofilm colonization of a long-term indwelling urinary catheter or urethral stent. The use of closed catheter systems is helpful in reducing such problems; nevertheless, such a system only delays the inevitable, with infections emerging a little later. Various coatings intended to prevent the bacterial adhesion to the surface of catheters and implants and thus also the emergence of biofilm infections, unfortunately, do not inhibit the microbial adhesion completely and permanently and the only reliable method for biofilm eradication remains the removal of the foreign body from the patient.

  5. Peritoneal catheters and related infections.

    PubMed

    Thodis, Elias; Passadakis, Ploumis; Lyrantzopooulos, Nikolaos; Panagoutsos, Stelios; Vargemezis, Vassilis; Oreopoulos, Dimitrios

    2005-01-01

    Catheter related infectious complications (exit-site infections, tunnel infections, and peritonitis) remain the major reasons for technique failure during the three decades since, continuous ambulatory peritoneal dialysis (CAPD) treatment has been first established. Despite improvements in catheter's survival rates, catheter related complications result in an increase in the cumulative patients' morbidity and often leading to the catheter removal. The ideal catheter provides reliable and rapid dialysate flow rates without leaks or infections. Among several types, the double-cuff straight Tenckhoff catheter, developed in 1968, is still the most widely used, although its use is decreasing in favour of swanneck catheters. Although there are only few well-designed trials comparing catheters and catheters related infectious complications, controlling for all other important variables, no difference in these complications among the main types of catheters was seen. The single cuff catheters have been associated with a shorter survival rate and time to the first peritonitis episode than the double-cuff catheters. Also exit-site infections were found to be more frequent and significantly more resistant to treatment with single-cuff compared to double-cuff ones. Finally, better results have been reported with the latest developed presternal peritoneal dialysis catheter both regarding survival rates and exit-site infection and peritonitis rates. Recently a renewed interest in continuous flow peritoneal dialysis stimulated inventions of imaginative, double-lumen catheters since a suitable peritoneal access is a sine qua non condition for the development of this new technique of peritoneal dialysis.

  6. Rectus abdominis muscle resection and fascial reconstruction for the treatment of uterine leiomyosarcoma invading the abdominal wall: a case report.

    PubMed

    Yoon, B S; Seong, S J; Song, T; Kim, M L; Kim, M K

    2014-01-01

    The authors present a case of intra-abdominal recurrent leiomyosarcoma invading a large area of the abdominal wall. The patient underwent cytoreductive surgery, including resection of the rectus abdominis muscle, followed by reconstruction of the defect using synthetic mesh. The tumor was surgically removed by en bloc resection, including most of the rectus abdominis muscle and ileum. The abdominal wall defect was repaired using synthetic mesh. The patient underwent radiotherapy and chemotherapy after the surgery and was healthy one year later.

  7. Catheter-related bloodstream infections.

    PubMed

    Wilcox, Tracie A

    2009-06-01

    Tunneled, cuffed, double-lumen catheters are commonly used for long-term venous access in hemodialysis patients. Complications of these catheters, including catheter-related infection, are a major cause of morbidity and resource utilization in the hemodialysis population. Treatment of catheter-related bloodstream infections includes the use of antibiotics and evaluation of the need for catheter removal or exchange. Measures to prevent catheter-related infections include use of an aseptic technique and antiseptic cleaning solution, elimination of Staphylococcus aureus nasal carriage, topical exit site application of antibiotics, use of antibiotic lock solutions, and use of catheters and cuffs coated or impregnated with antimicrobial or antiseptic agents. This review article will provide an update on the prevalence, diagnosis, treatment, and prevention of catheter-related infections in the hemodialysis population.

  8. Abdominal wall injuries: rectus abdominis strains, oblique strains, rectus sheath hematoma.

    PubMed

    Johnson, Rob

    2006-04-01

    Abdominal wall injuries are reported to be less common than actually perceived by sports medicine practitioners. National Collegiate Athletic Association injury statistics for 2004-2005 cite a high of 0.71 abdominal muscle injuries per 1000 player-hours in wrestling competition to a low of 0.01 injuries per 1000 player-hours in autumn football practices. British professional soccer clubs reported an incidence of "torso" injuries of up to 7% of all injuries over the course of several seasons. Injury definition is most likely the explanation for this discrepancy. The abdominal wall muscles (rectus abdominis, external and internal obliques, and transverse abdominis) are injured by direct blows to the abdomen or by sudden or repetitive trunk movement, either rotation or flexion/extension. With the exception of the rare rectus sheath hematoma that does not self-tamponade, the treatment for these problems is nonoperative with symptoms guiding rehabilitation and return to play decisions.

  9. Balloon Catheter Prevents Contamination

    NASA Technical Reports Server (NTRS)

    Higginson, Gregory A.; Bouffard, Marc R.; Hoehicke, Beth S.; King, Bradley D.; Peterson, Sandra L.

    1994-01-01

    Balloon catheter similar to that used in such medical procedures as angioplasty and heart surgery protects small orifices against contamination and blockage by chips generated in machining operations. Includes small, inflatable balloon at end of thin, flexible tube. Contains additional features adapting it to anticontamination service: balloon larger to fit wider channel it must block; made of polyurethane (rather than latex), which does not fragment if bursts; material made thicker to resist abrasion better; and kink-resistant axial wire helps catheter negotiate tight bends.

  10. Large Asymmetric Hypertrophy of Rectus Abdominis Muscle in Professional Tennis Players

    PubMed Central

    Sanchis-Moysi, Joaquin; Idoate, Fernando; Dorado, Cecilia; Alayón, Santiago; Calbet, Jose A. L.

    2010-01-01

    Purpose To determine the volume and degree of asymmetry of the musculus rectus abdominis (RA) in professional tennis players. Methods The volume of the RA was determined using magnetic resonance imaging (MRI) in 8 professional male tennis players and 6 non-active male control subjects. Results Tennis players had 58% greater RA volume than controls (P = 0.01), due to hypertrophy of both the dominant (34% greater volume, P = 0.02) and non-dominant (82% greater volume, P = 0.01) sides, after accounting for age, the length of the RA muscle and body mass index (BMI) as covariates. In tennis players, there was a marked asymmetry in the development of the RA, which volume was 35% greater in the non-dominant compared to the dominant side (P<0.001). In contrast, no side-to-side difference in RA volume was observed in the controls (P = 0.75). The degree of side-to-side asymmetry increased linearly from the first lumbar disc to the pubic symphysis (r = 0.97, P<0.001). Conclusions Professional tennis is associated with marked hypertrophy of the musculus rectus abdominis, which achieves a volume that is 58% greater than in non-active controls. Rectus abdominis hypertrophy is more marked in the non-dominant than in the dominant side, particularly in the more distal regions. Our study supports the concept that humans can differentially recruit both rectus abdominis but also the upper and lower regions of each muscle. It remains to be determined if this disequilibrium raises the risk of injury. PMID:21209832

  11. Catheter-associated UTI

    MedlinePlus

    ... UTI; Health care-associated UTI; Catheter-associated bacteriuria; Hospital acquired-UTI Images Bladder catheterization, female Bladder catheterization, male References Calfee DP. Prevention and control of health care-associated infections. In: Goldman L, Schafer AI, eds. Goldman's Cecil ...

  12. Suprapubic catheter care

    MedlinePlus

    ... area around your catheter every day with mild soap and water. Gently pat it dry. Showers are fine. Ask your providers about bathtubs, swimming pools, and hot tubs. DO NOT use creams, powders, or sprays near the site. Apply bandages around ...

  13. [Rotational stability of angiography catheters].

    PubMed

    Schröder, J; Weber, M

    1992-10-01

    Rotatory stability is a parameter that reflects the ability of a catheter to transmit a rotation applied at the outer end to the catheter tip for the purpose of selective probing. A method for measuring the rotatory stability is described, and the results of rotatory stability measurements of 70 different commercially available catheters are reported. There is an almost linear correlation between the rotatory stability and the difference between the respective fourth power of the external and internal diameter or, approximately, to the fourth power of the external diameter for catheters without wire reinforcement. With the same cross-sectional dimensions, the rotatory stability of teflon, polyethylene, and nylon catheters has an approximate ratio of 1:2:4. Wire reinforcement increases rotatory stability by an average factor of about 3. For catheters of calibers 5 F and 6 F, a correlation between the rotatory stability and the weight of the reinforcing wire mesh is apparent.

  14. A new technique of closing a gastroatmospheric fistula with a rectus abdominis muscle flap

    PubMed Central

    Singh, Harjeet; Talukder, Shibojit; Verma, Ganga Ram

    2015-01-01

    Proximal enteroatmospheric fistulae are difficult to manage and carry high mortality from sepsis and electrolyte imbalances. Conservative management with total parenteral nutrition, exclusion of fistula, resection and anastomosis are conventional methods of treatment with low success rate. Providing muscle cover to manage an enteroatmospheric fistula is a noble concept. A postoperative high-output gastroatmospheric fistula (GAF) was repaired by superior epigastric artery-based rectus abdominis muscle flap (RAMF). Postoperative recovery was uneventful. This technique may be useful for closure of proximal enteroatmospheric fistulae that fail to heal through medical and conventional surgical management. PMID:25819831

  15. Electromyographic activity of the rectus abdominis during a traditional crunch and the basic jackknife exercise with the Ab Lounge™.

    PubMed

    Nelson, Gail A; Bent-Forsythe, Denise A; Roopchand-Martin, Sharmella C

    2012-06-01

    The use of nontraditional exercise devices such as the Ab Lounge™ has been promoted as being as effective as the traditional abdominal crunch in strengthening the abdominal musculature. Evidence for this is lacking, however. The purpose of this study was to compare the degree of activation of the upper and lower rectus abdominis using electromyography (EMG) during a traditional crunch with the basic jackknife using the Ab Lounge™. Twenty-two subjects (6 men and 16 women) were randomly selected from the student population at the University of the West Indies (Mona Campus). The mean age of the participants was 20.5 ± 1.5 years, height 166.4 ± 6.2 cm, weight 64 ± 10.3 kg, and waist-hip ratio 0.7 ± 0.1. Surface EMG was used to assess the muscle activity from the upper and lower rectus abdominis while each exercise was performed. The EMG data were full-wave rectified and normalized using a mathematical model that was set up in Microsoft Excel for Windows XP. Statistical analysis was performed on the data using a univariate analysis of variance with gender as a covariate. Significance was determined by p < 0.05. The mean EMG data recorded for the upper rectus abdominis was significantly higher with the traditional crunch when compared with the basic jackknife performed on the Ab Lounge™ (F = 4.39, p = 0.04). The traditional crunch produced a higher level of activity in the lower rectus abdominis when compared with the basic jackknife, but this was not statistically significant (F = 0.249, p = 0.62). There was no significant interaction between gender and the effect of the type of exercise on upper and lower rectus abdominis activation. These results suggest that the traditional abdominal crunch is more effective than the basic jackknife is in activating the rectus abdominis musculature.

  16. Reconstruction of full-thickness chest wall defects using rectus abdominis musculocutaneous flap: A report of fifteen cases

    SciTech Connect

    Miyamoto, Y.; Hattori, T.; Niimoto, M.; Toge, T. )

    1986-02-01

    In 15 patients chest walls were excised because of recurrent breast cancer, radiation ulcer, or rib tumor. In most cases the full-thickness defect of the chest wall was about 10 x 10 cm. Reconstruction was performed using only a rectus abdominis musculocutaneous flap. No patient developed circulation problems in the flap or severe flail chest, and we had successful results in all our cases. These results show that the rectus abdominis musculocutaneous flap is quite effective and safe to use in the reconstruction of chest wall defects.

  17. Rectus abdominis muscle injuries in elite handball players: management and rehabilitation.

    PubMed

    Balius, Ramon; Pedret, Carles; Pacheco, Laura; Gutierrez, Josep Antoni; Vives, Joan; Escoda, Jaume

    2011-01-01

    Muscle injuries generally occur in two-joint muscles with a high percentage of type II fibers during the performance of eccentric activity. Some muscle injuries, such as those located in the adductor longus, a monoarticular muscle, as well as rectus abdominis do not fully comply with these requirements. This study examines five cases of elite handball players with ruptured rectus abdominals. Sonographically, lesions in rectus abdominis are shown as a disruption of the fibrillar pattern with a hematic suffusion that invades the entire lesion. In some of the cases, the ultrasound study was complemented with a MRI. A unified rehabilitation protocol was applied and the return to play time of each handball player ranged between 16 and 22 days, with an average of 18.2 days. Follow-up at 15 months showed no evidence of re-injury or residual discomfort and all of them are playing at their highest level. The aim of this study was to illustrate a feature of handball injury that, as in tennis and volleyball, is uncommon and so far has not been specifically reported. The phenomenon of contralateral abdominal hypertrophy in handball appears in the dominant arm as in tennis and volleyball.

  18. Relation between serum ischemia-modified albumin levels and rectus abdominis muscle flap viability.

    PubMed

    Livaoğlu, Murat; Arvas, Leyla; Karaçal, Naci; Menteşe, Ahmet; Karahan, S Caner; Sözen, Emrah

    2011-05-01

    Ischemia is a major cause of flap failure in reconstructive surgery. To detect circulatory compromise, many flap monitoring methods are used; however, there is no any optimal standard method. Ischemia-modified albumin (IMA) is an ischemia marker, which has recently been investigated in many studies and largely validated for early detection of ischemia. In this study, we investigated possible relationship between muscle flap viability and serum IMA levels in experimental flap model. The rectus abdominis muscle flap model was used in 18 New Zealand white rabbits. The study was planned using 3 groups. In group 1, the rectus abdominis muscle flap was harvested as a superior pedicle-based flap in which the inferior pedicle was sacrificed. In group 2, the flap was harvested by severing the superior pedicle. Both pedicles were harvested in group 3. Serum IMA levels were measured before the procedure and 1 hour, 6 hours, and 7 days postoperatively and then compared. In group 3, in which the ischemia was evident, and in group 1, IMA levels were significantly high 1 hour postoperatively (P < 0.05). There was no other significant difference in any of the other studied parameters between the groups. In conclusion, IMA can be used as a biochemical parameter for monitoring muscle flap viability.

  19. Rectus abdominis muscle injuries in elite handball players: management and rehabilitation

    PubMed Central

    Balius, Ramon; Pedret, Carles; Pacheco, Laura; Gutierrez, Josep Antoni; Vives, Joan; Escoda, Jaume

    2011-01-01

    Muscle injuries generally occur in two-joint muscles with a high percentage of type II fibers during the performance of eccentric activity. Some muscle injuries, such as those located in the adductor longus, a monoarticular muscle, as well as rectus abdominis do not fully comply with these requirements. This study examines five cases of elite handball players with ruptured rectus abdominals. Sonographically, lesions in rectus abdominis are shown as a disruption of the fibrillar pattern with a hematic suffusion that invades the entire lesion. In some of the cases, the ultrasound study was complemented with a MRI. A unified rehabilitation protocol was applied and the return to play time of each handball player ranged between 16 and 22 days, with an average of 18.2 days. Follow-up at 15 months showed no evidence of re-injury or residual discomfort and all of them are playing at their highest level. The aim of this study was to illustrate a feature of handball injury that, as in tennis and volleyball, is uncommon and so far has not been specifically reported. The phenomenon of contralateral abdominal hypertrophy in handball appears in the dominant arm as in tennis and volleyball. PMID:24198573

  20. Balloon catheter coronary angioplasty

    SciTech Connect

    Angelini, P.

    1987-01-01

    The author has produced a reference and teaching book on balloon angioplasty. Because it borders in surgery and is performed on an awake patient without circulatory assistance, it is a complex and demanding procedure that requires thorough knowledge before it is attempted. The text is divided into seven sections. The first section describes coronary anatomy and pathophysiology, defines the objectives and mechanisms of the procedure and lists four possible physiologic results. The next section describes equipment in the catheterization laboratory, catheters, guidewires and required personnel. The following section is on the procedure itself and includes a discussion of examination, testing, technique and follow-up. The fourth section details possible complications that can occur during the procedure, such as coronary spasms, occlusion, thrombosis, perforations and ruptures, and also discusses cardiac surgery after failed angioplasty. The fifth section details complex or unusual cases that can occur. The sixth and seventh sections discuss radiation, alternative procedures and the future of angioplasty.

  1. [Catheter-related infections: microbiology].

    PubMed

    Timsit, J F

    2005-03-01

    Coagulase negative staphylococci, Staphylococcus aureus and Pseudomonas sp. are the most frequent microorganisms responsible for catheter-related infections. A relative frequency of microorganisms varies according to the countries, microenvironment and outbreaks of multiresistant bacterias. Infections due to fungi, S. aureus and Pseudomonas sp. are associated with the more severe complications. Recent data suggest that chlorhexidine, either used for cutaneous antisepsis or for catheter impregnation decreases infections due to gram positive cocci. Ecological data should be taken into account when deciding a probabilistic treatment in case of suspicion of catheter-related infection.

  2. Workhorse Flaps in Chest Wall Reconstruction: The Pectoralis Major, Latissimus Dorsi, and Rectus Abdominis Flaps

    PubMed Central

    Bakri, Karim; Mardini, Samir; Evans, Karen K.; Carlsen, Brian T.; Arnold, Phillip G.

    2011-01-01

    Large and life-threatening thoracic cage defects can result from the treatment of traumatic injuries, tumors, infection, congenital anomalies, and radiation injury and require prompt reconstruction to restore respiratory function and soft tissue closure. Important factors for consideration are coverage with healthy tissue to heal a wound, the potential alteration in respiratory mechanics created by large extirpations or nonhealing thoracic wounds, and the need for immediate coverage for vital structures. The choice of technique depends on the size and extent of the defect, its location, and donor site availability with consideration to previous thoracic or abdominal operations. The focus of this article is specifically to describe the use of the pectoralis major, latissimus dorsi, and rectus abdominis muscle flaps for reconstruction of thoracic defects, as these are the workhorse flaps commonly used for chest wall reconstruction. PMID:22294942

  3. Insertional tendinopathy of the adductors and rectus abdominis in athletes: a review

    PubMed Central

    Valent, Alessandro; Frizziero, Antonio; Bressan, Stefano; Zanella, Elena; Giannotti, Erika; Masiero, Stefano

    2012-01-01

    Summary Insertional tendinopathy of the adductors and rectus abdominis is common in male athletes, especially in soccer players. It may be worsened by physical activity and it usually limits sport performance. The management goal in the acute phase consists of analgesic and anti-inflammatory drugs and physical rehabilitation. In the early stages of rehabilitation, strengthening exercises of adductors and abdominal muscles, such as postural exercises, have been suggested. In the sub-acute phase, muscular strength is targeted by overload training in the gym or aquatherapy; core stability exercises seem to be useful in this phase. Finally, specific sport actions are introduced by increasingly complex exercises along with a preventive program to limit pain recurrences. PMID:23738289

  4. Extensive Chest Wall Tissue Loss and its Management by Vertical Rectus Abdominis Myocutaneous Flap

    PubMed Central

    Basu, Sandip Kanti; Bain, Jayanta; Chattopadhyay, Debarati; Majumdar, Bijay Kumar

    2017-01-01

    Extensive electric burn around the chest in children is rare and this type of injury always poses a great challenge for its management. A 12-year-old male child with extensive electric burn of the chest wall was admitted to hospital. It was a neglected case of 9 days old burn; the young boy was in critical condition having systemic features of toxemia with widespread necrosis of the skin, subcutaneous tissues, and muscles along with exposed bones (ribs and sternum) with the risk of impending rupture of pleura through the exposed intercostal spaces. After initial resuscitation, a thorough debridement of all necrotic tissues was done. Thereafter, a superiorly based vertical rectus abdominis myocutaneous flap was harvested to cover the exposed bones and intercostal spaces. The remaining raw areas were skin grafted. The child made an excellent recovery with good outcome. PMID:28082777

  5. In situ Transverse Rectus Abdominis Myocutaneous Flap: A Rat Model of Myocutaneous Ischemia Reperfusion Injury

    PubMed Central

    Edmunds, Marie-Claire; Wigmore, Stephen; Kluth, David

    2013-01-01

    Free tissue transfer is the gold standard of reconstructive surgery to repair complex defects not amenable to local options or those requiring composite tissue. Ischemia reperfusion injury (IRI) is a known cause of partial free flap failure and has no effective treatment. Establishing a laboratory model of this injury can prove costly both financially as larger mammals are conventionally used and in the expertise required by the technical difficulty of these procedures typically requires employing an experienced microsurgeon. This publication and video demonstrate the effective use of a model of IRI in rats which does not require microsurgical expertise. This procedure is an in situ model of a transverse abdominis myocutaneous (TRAM) flap where atraumatic clamps are utilized to reproduce the ischemia-reperfusion injury associated with this surgery. A laser Doppler Imaging (LDI) scanner is employed to assess flap perfusion and the image processing software, Image J to assess percentage area skin survival as a primary outcome measure of injury. PMID:23770929

  6. A panel data set on harvest and perfusion decellularization of porcine rectus abdominis

    PubMed Central

    Zhang, Jian; Cheng, Wen Yue; Hu, Zhi Qian; Turner, Neill J.; Zhang, Li; Wang, Qiang; Badylak, Stephen F.

    2016-01-01

    In this dataset, we particularly depicted the harvest and perfusion decellularization of porcine rectus abdominis (RA), accompanied with displaying of the retained vascular trees within the perfusion-decellularized skeletal muscle matrix (pM-ECM) using vascular corrosion casting. In addition, several important tips for successful pM-ECM preparation were emphasized, which including using anatomically isolated skeletal muscle as tissue source with all main feeding and draining vessels perfused, preserving the internal microcirculation availability, aseptic technique and pyrogen free in all steps, sequential perfusion via artery or vein, and longtime washing after decellularization. The data are supplemental to our original research article describing detailed associations of pM-ECM as a clinically relevant scale, three-dimensional scaffold with a vascular network template for tissue-specific regeneration, “Perfusion-decellularized skeletal muscle as a three-dimensional scaffold with a vascular network template” Zhang et al. (2016) [1]. PMID:27158653

  7. A novel method of minimally invasive rectus abdominis muscle flap harvest: Laparoscopic surgeons take note

    PubMed Central

    Aijaz, Tabish; Singhal, Dhruv; Tan, Sanda A.; Iqbal, Atif

    2017-01-01

    The rectus abdominis muscle (RAM) is a workhorse flap to fill or repair abdominal defects. A drawback of an open RAM harvest is donor site morbidity, and minimally invasive techniques for flap harvesting have been previously proposed but involve vertical division of the rectus fascia. We present a case of a 52-year-old woman with a recurrent rectovaginal fistula in a radiated field treated with a laparoscopic low anterior resection with simultaneous RAM flap harvest utilising a single Pfannenstiel incision. Our novel modified laparoscopic-assisted RAM harvest technique prevents longitudinal violation of the anterior and posterior rectus sheaths, thereby promoting a quick recovery, improved cosmesis and decreased post-operative morbidity. PMID:28281481

  8. Percutaneously inserted central catheter - infants

    MedlinePlus

    PICC - infants; PQC - infants; Pic line - infants; Per-Q cath - infants ... A percutaneously inserted central catheter (PICC) is a long, very thin, soft plastic tube that is put into a small blood vessel. This article addresses PICCs in ...

  9. Peripherally inserted central catheter - flushing

    MedlinePlus

    ... To flush your catheter, you will need: Clean paper towels Saline syringes (clear), and maybe heparin syringes ( ... your fingers before washing. Dry with a clean paper towel. Set up your supplies on a clean ...

  10. Catheter Ablation for Ventricular Arrhythmias

    PubMed Central

    Nof, Eyal; Stevenson, William G; John, Roy M

    2013-01-01

    Catheter ablation has emerged as an important and effective treatment option for many recurrent ventricular arrhythmias. The approach to ablation and the risks and outcomes are largely determined by the nature of the severity and type of underlying heart disease. In patients with structural heart disease, catheter ablation can effectively reduce ventricular tachycardia (VT) episodes and implantable cardioverter defibrillator (ICD) shocks. For VT and symptomatic premature ventricular beats that occur in the absence of structural heart disease, catheter ablation is often effective as the sole therapy. Advances in catheter technology, imaging and mapping techniques have improved success rates for ablation. This review discusses current approaches to mapping and ablation for ventricular arrhythmias. PMID:26835040

  11. Peripherally inserted central catheter - insertion

    MedlinePlus

    ... nontunneled central venous catheters. In: Mauro MA, Murphy KPJ, Thomson KR, et al., eds. Image-Guided Interventions . ... by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is ...

  12. Comparison of cuffed tunneled hemodialysis catheter survival.

    PubMed

    Rocklin, M A; Dwight, C A; Callen, L J; Bispham, B Z; Spiegel, D M

    2001-03-01

    Despite efforts to have hemodialysis patients begin renal replacement therapy with a mature arteriovenous shunt, many patients begin dialysis with a cuffed tunneled catheter as their access. An increasing number of differently designed tunneled hemodialysis catheters have become available in the last decade. The primary aim of this study is to compare catheter survival for Hickman (Bard, Salt Lake City, UT) and Opti-flow (Bard) catheters. The 16-month experience with 182 catheters, totaling 13,861 catheter-days, is reported. The probability of Hickman catheter failure at 30, 60, and 90 days was 29%, 49%, and 67%. The probability of Opti-flow catheter failure was significantly less at 10%, 24%, and 38% for the same times, respectively (P: < 0.05 for all time points). The difference in catheter failure rates was caused by a greater malfunction rate of Hickman catheters; the two catheters had similar infection rates. We conclude that survival of Opti-flow catheters was significantly better than that of Hickman catheters from 30 to 90 days, which is a clinically relevant period when patients are waiting for maturation of a permanent access or replacement of a failed access. Since the conclusion of our study, we documented 10 episodes of Opti-flow catheter malfunction within 4 months secondary to hairline fracture of the arterial hub. The Opti-flow catheter was recalled and is now available with retooled hubs.

  13. Motion compensation by registration-based catheter tracking

    NASA Astrophysics Data System (ADS)

    Brost, Alexander; Wimmer, Andreas; Liao, Rui; Hornegger, Joachim; Strobel, Norbert

    2011-03-01

    The treatment of atrial fibrillation has gained increasing importance in the field of computer-aided interventions. State-of-the-art treatment involves the electrical isolation of the pulmonary veins attached to the left atrium under fluoroscopic X-ray image guidance. Due to the rather low soft-tissue contrast of X-ray fluoroscopy, the heart is difficult to see. To overcome this problem, overlay images from pre-operative 3-D volumetric data can be used to add anatomical detail. Unfortunately, these overlay images are static at the moment, i.e., they do not move with respiratory and cardiac motion. The lack of motion compensation may impair X-ray based catheter navigation, because the physician could potentially position catheters incorrectly. To improve overlay-based catheter navigation, we present a novel two stage approach for respiratory and cardiac motion compensation. First, a cascade of boosted classifiers is employed to segment a commonly used circumferential mapping catheter which is firmly fixed at the ostium of the pulmonary vein during ablation. Then, a 2-D/2-D model-based registration is applied to track the segmented mapping catheter. Our novel hybrid approach was evaluated on 10 clinical data sets consisting of 498 fluoroscopic monoplane frames. We obtained an average 2-D tracking error of 0.61 mm, with a minimum error of 0.26 mm and a maximum error of 1.62 mm. These results demonstrate that motion compensation using registration-based catheter tracking is both feasible and accurate. Using this approach, we can only estimate in-plane motion. Fortunately, compensating for this is often sufficient for EP procedures where the motion is governed by breathing.

  14. Prevention and management of hemodialysis catheter infections.

    PubMed

    Ramanathan, Venkat; Darouiche, Rabih O

    2012-12-01

    Hemodialysis (HD) catheters are associated with blood stream infections, and catheter use continues to be high among incident and prevalent patients on maintenance HD. Migration of micro-organism along the external surface of the catheter is probably the most common route of infection, followed by the endoluminal route of contamination. Almost all HD catheters have biofilm formation on their surfaces and this serves as a good reservoir for micro-organisms. These active but protected microorganisms have been implicated in local and systemic infections associated with HD catheters. Good personal hygiene, exit-site care with topical antibiotics and antibiotic lock solution in the dialysis catheter reduce the incidence of catheter infection. In selected subgroup of patients, HD catheter is promptly removed after the diagnosis of blood stream infection. However, catheter guidewire exchange is an acceptable alternate strategy in some patients. The most important goal should be to increase the rate of incident arteriovenous fistula use in the HD population.

  15. Intracorporeal knotting of a femoral nerve catheter.

    PubMed

    Ghanem, Mohamed; Schnoor, Jörg; Wiegel, Martin; Josten, Christoph; Reske, Andreas W

    2015-01-01

    Peripheral nerve catheters are effective and well-established tools to provide postoperative analgesia to patients undergoing orthopedic surgery. The performance of these techniques is usually considered safe. However, placement of nerve catheters may be associated with a considerable number of side effects and major complications have repeatedly been published. In this work, we report on a patient who underwent total knee replacement with spinal anesthesia and preoperative insertion of femoral and sciatic nerve catheters for postoperative analgesia. During insertion of the femoral catheter, significant resistance was encountered upon retracting the catheter. This occurred due to knotting of the catheter. The catheter had to be removed by operative intervention which has to be considered a major complication. The postoperative course was uneventful. The principles for removal of entrapped peripheral catheters are not well established, may differ from those for neuroaxial catheters, and range from cautious manipulation up to surgical intervention.

  16. Intracorporeal knotting of a femoral nerve catheter

    PubMed Central

    Ghanem, Mohamed; Schnoor, Jörg; Wiegel, Martin; Josten, Christoph; Reske, Andreas W.

    2015-01-01

    Peripheral nerve catheters are effective and well-established tools to provide postoperative analgesia to patients undergoing orthopedic surgery. The performance of these techniques is usually considered safe. However, placement of nerve catheters may be associated with a considerable number of side effects and major complications have repeatedly been published. In this work, we report on a patient who underwent total knee replacement with spinal anesthesia and preoperative insertion of femoral and sciatic nerve catheters for postoperative analgesia. During insertion of the femoral catheter, significant resistance was encountered upon retracting the catheter. This occurred due to knotting of the catheter. The catheter had to be removed by operative intervention which has to be considered a major complication. The postoperative course was uneventful. The principles for removal of entrapped peripheral catheters are not well established, may differ from those for neuroaxial catheters, and range from cautious manipulation up to surgical intervention. PMID:26504733

  17. Accelerated 3D catheter visualization from triplanar MR projection images.

    PubMed

    Schirra, Carsten Oliver; Weiss, Steffen; Krueger, Sascha; Caulfield, Denis; Pedersen, Steen F; Razavi, Reza; Kozerke, Sebastian; Schaeffter, Tobias

    2010-07-01

    One major obstacle for MR-guided catheterizations is long acquisition times associated with visualizing interventional devices. Therefore, most techniques presented hitherto rely on single-plane imaging to visualize the catheter. Recently, accelerated three-dimensional (3D) imaging based on compressed sensing has been proposed to reduce acquisition times. However, frame rates with this technique remain low, and the 3D reconstruction problem yields a considerable computational load. In X-ray angiography, it is well understood that the shape of interventional devices can be derived in 3D space from a limited number of projection images. In this work, this fact is exploited to develop a method for 3D visualization of active catheters from multiplanar two-dimensional (2D) projection MR images. This is favorable to 3D MRI as the overall number of acquired profiles, and consequently the acquisition time, is reduced. To further reduce measurement times, compressed sensing is employed. Furthermore, a novel single-channel catheter design is presented that combines a solenoidal tip coil in series with a single-loop antenna, enabling simultaneous tip tracking and shape visualization. The tracked tip and catheter properties provide constraints for compressed sensing reconstruction and subsequent 2D/3D curve fitting. The feasibility of the method is demonstrated in phantoms and in an in vivo pig experiment.

  18. Compensation for Unconstrained Catheter Shaft Motion in Cardiac Catheters

    PubMed Central

    Degirmenci, Alperen; Loschak, Paul M.; Tschabrunn, Cory M.; Anter, Elad; Howe, Robert D.

    2016-01-01

    Cardiac catheterization with ultrasound (US) imaging catheters provides real time US imaging from within the heart, but manually navigating a four degree of freedom (DOF) imaging catheter is difficult and requires extensive training. Existing work has demonstrated robotic catheter steering in constrained bench top environments. Closed-loop control in an unconstrained setting, such as patient vasculature, remains a significant challenge due to friction, backlash, and physiological disturbances. In this paper we present a new method for closed-loop control of the catheter tip that can accurately and robustly steer 4-DOF cardiac catheters and other flexible manipulators despite these effects. The performance of the system is demonstrated in a vasculature phantom and an in vivo porcine animal model. During bench top studies the robotic system converged to the desired US imager pose with sub-millimeter and sub-degree-level accuracy. During animal trials the system achieved 2.0 mm and 0.65° accuracy. Accurate and robust robotic navigation of flexible manipulators will enable enhanced visualization and treatment during procedures. PMID:27525170

  19. Comparison of the thicknesses of the transversus abdominis and internal abdominal obliques during plank exercises on different support surfaces.

    PubMed

    Do, Yong-Chan; Yoo, Won-Gyu

    2015-01-01

    [Purpose] This study applied variable plank exercises on a stable surface consisting of a mat, on an unstable surface consisting of a dynamic cushion placed under the upper extremities and lower extremities. [Subjects] Forty-three healthy male and female subjects in their 20s voluntarily consented to participate in this study. [Methods] The subjects performed the plank exercises on the three support surfaces. Ultrasound imaging was conducted while they carried out plank exercises. [Results] The changes in the thicknesses of both the transversus abdominis and internal abdominal obliques were statistically more significant for LEDCP than for MatP. In addition, the changes in the thickness of the transversus abdominis were statistically more significant for LEDCP than for UEDCP. [Conclusion] Therefore, applying an unstable condition to the lower limbs using a dynamic cushion is considered more effective during plank exercises.

  20. Three-dimensional tracking of cardiac catheters using an inverse geometry x-ray fluoroscopy system

    SciTech Connect

    Speidel, Michael A.; Tomkowiak, Michael T.; Raval, Amish N.; Van Lysel, Michael S.

    2010-12-15

    Purpose: Scanning beam digital x-ray (SBDX) is an inverse geometry fluoroscopic system with high dose efficiency and the ability to perform continuous real-time tomosynthesis at multiple planes. This study describes a tomosynthesis-based method for 3D tracking of high-contrast objects and present the first experimental investigation of cardiac catheter tracking using a prototype SBDX system. Methods: The 3D tracking algorithm utilizes the stack of regularly spaced tomosynthetic planes that are generated by SBDX after each frame period (15 frames/s). Gradient-filtered versions of the image planes are generated, the filtered images are segmented into object regions, and then a 3D coordinate is calculated for each object region. Two phantom studies of tracking performance were conducted. In the first study, an ablation catheter in a chest phantom was imaged as it was pulled along a 3D trajectory defined by a catheter sheath (10, 25, and 50 mm/s pullback speeds). SBDX tip tracking coordinates were compared to the 3D trajectory of the sheath as determined from a CT scan of the phantom after the registration of the SBDX and CT coordinate systems. In the second study, frame-to-frame tracking precision was measured for six different catheter configurations as a function of image noise level (662-7625 photons/mm{sup 2} mean detected x-ray fluence at isocenter). Results: During catheter pullbacks, the 3D distance between the tracked catheter tip and the sheath centerline was 1.0{+-}0.8 mm (mean {+-}one standard deviation). The electrode to centerline distances were comparable to the diameter of the catheter tip (2.3 mm), the confining sheath (4 mm outside diameter), and the estimated SBDX-to-CT registration error ({+-}0.7 mm). The tip position was localized for all 332 image frames analyzed and 83% of tracked positions were inside the 3D sheath volume derived from CT. The pullback speeds derived from the catheter trajectories were within 5% of the programed pullback speeds

  1. Catheter-based photoacoustic endoscope

    PubMed Central

    Yang, Joon-Mo; Li, Chiye; Chen, Ruimin; Zhou, Qifa; Shung, K. Kirk; Wang, Lihong V.

    2014-01-01

    Abstract. We report a flexible shaft-based mechanical scanning photoacoustic endoscopy (PAE) system that can be potentially used for imaging the human gastrointestinal tract via the instrument channel of a clinical video endoscope. The development of such a catheter endoscope has been an important challenge to realize the technique’s benefits in clinical settings. We successfully implemented a prototype PAE system that has a 3.2-mm diameter and 2.5-m long catheter section. As the instrument’s flexible shaft and scanning tip are fully encapsulated in a plastic catheter, it easily fits within the 3.7-mm diameter instrument channel of a clinical video endoscope. Here, we demonstrate the intra-instrument channel workability and in vivo animal imaging capability of the PAE system. PMID:24887743

  2. Catheter-based photoacoustic endoscope

    NASA Astrophysics Data System (ADS)

    Yang, Joon-Mo; Li, Chiye; Chen, Ruimin; Zhou, Qifa; Shung, K. Kirk; Wang, Lihong V.

    2014-06-01

    We report a flexible shaft-based mechanical scanning photoacoustic endoscopy (PAE) system that can be potentially used for imaging the human gastrointestinal tract via the instrument channel of a clinical video endoscope. The development of such a catheter endoscope has been an important challenge to realize the technique's benefits in clinical settings. We successfully implemented a prototype PAE system that has a 3.2-mm diameter and 2.5-m long catheter section. As the instrument's flexible shaft and scanning tip are fully encapsulated in a plastic catheter, it easily fits within the 3.7-mm diameter instrument channel of a clinical video endoscope. Here, we demonstrate the intra-instrument channel workability and in vivo animal imaging capability of the PAE system.

  3. Safeguards May Be Reducing Serious Catheter Infections

    MedlinePlus

    ... They include using sterile gloves, covering catheters with antimicrobial dressings and checking catheters daily for signs of movement or infection. Many hospitals have also added extra training, equipment and supplies. For this study, Nuckols and her colleagues analyzed ...

  4. Hemodialysis Tunneled Catheter-Related Infections

    PubMed Central

    Miller, Lisa M.; Clark, Edward; Dipchand, Christine; Hiremath, Swapnil; Kappel, Joanne; Kiaii, Mercedeh; Lok, Charmaine; Luscombe, Rick; Moist, Louise; Oliver, Matthew; MacRae, Jennifer

    2016-01-01

    Catheter-related bloodstream infections, exit-site infections, and tunnel infections are common complications related to hemodialysis central venous catheter use. The various definitions of catheter-related infections are reviewed, and various preventive strategies are discussed. Treatment options, for both empiric and definitive infections, including antibiotic locks and systemic antibiotics, are reviewed. PMID:28270921

  5. 21 CFR 874.4175 - Nasopharyngeal catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Surgical Devices § 874.4175 Nasopharyngeal catheter. (a) Identification. A nasopharyngeal catheter is a device consisting of a bougie or filiform catheter that is intended for use in probing or dilating the eustachian tube. This generic type of device...

  6. 21 CFR 874.4175 - Nasopharyngeal catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Surgical Devices § 874.4175 Nasopharyngeal catheter. (a) Identification. A nasopharyngeal catheter is a device consisting of a bougie or filiform catheter that is intended for use in probing or dilating the eustachian tube. This generic type of device...

  7. 21 CFR 870.1280 - Steerable catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Steerable catheter. 870.1280 Section 870.1280 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1280 Steerable catheter. (a) Identification. A steerable catheter is...

  8. Complications and oncologic outcomes of pedicled transverse rectus abdominis myocutaneous flap in breast cancer patients

    PubMed Central

    Somintara, Ongart; Lertsithichai, Panuwat; Kongdan, Youwanush; Supsamutchai, Chairat; Sukpanich, Rupporn

    2016-01-01

    Background There are several techniques for harvesting the pedicled transverse rectus abdominis myocutaneous (TRAM) flap after mastectomy in breast cancer patients. We examined the whole muscle with partial sheath sparing technique and determined factors associated with its complications and oncological outcomes. Methods We retrospectively reviewed the results of 168 TRAM flaps performed between January 2003 and December 2010, focusing on complications and oncologic outcomes. Results Among the 168 pedicled TRAM flap procedures in 158 patients, flap complications occurred in 34%. Most of the flap complications included some degree of fat necrosis. There was no total flap loss. Flap complications were associated with elderly patients and the presence of major donor site complications. Abdominal bulging and hernia occurred in 12% of patients. The bi-pedicled TRAM flap and higher body mass index (BMI) were significant factors associated with increased donor site complications. Seven patients (4%) developed loco-regional recurrence. Within a median follow-up of 27 months, distant metastasis and death occurred in 6% and 4% of patients, respectively. Conclusions The pedicled TRAM flap using the whole muscle with partial sheath sparing technique in the present study is consistent with the results from previous studies in flap complication rates and oncological outcomes. PMID:27563562

  9. Effectiveness of different central venous catheters for catheter-related infections: a network meta-analysis.

    PubMed

    Wang, H; Huang, T; Jing, J; Jin, J; Wang, P; Yang, M; Cui, W; Zheng, Y; Shen, H

    2010-09-01

    We aimed to compare the effectiveness of various catheters for prevention of catheter-related infection and to evaluate whether specific catheters are superior to others for reducing catheter-related infections. We identified randomised, controlled trials that compared different types of central venous catheter (CVC), evaluating catheter-related infections in a systematic search of articles published from January 1996 to November 2009 via Medline, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. Network meta-analysis with a mixed treatment comparison method using Bayesian Markov Chain Monte Carlo simulation was used to combine direct within-trial, between-treatment comparisons with indirect trial evidence. Forty-eight clinical trials (12 828 CVCs) investigating 10 intervention catheters contributed to the analyses. For prevention of CVC colonisation, adjusted silver iontophoretic catheters (odds ratio: 0.58; 95% confidence interval: 0.33-0.95), chlorhexidine and silver sulfadiazine catheters (0.49; 0.36-0.64), chlorhexidine and silver sulfadiazine blue plus catheters (0.37; 0.17-0.69), minocycline-rifampicin catheters (0.28; 0.17-0.43) and miconazole-rifampicin catheters (0.11; 0.02-0.33) were associated with a significantly lower rate of catheter colonisation compared with standard catheters. For prevention of CRBSI, adjusted heparin-bonded catheters (0.20; 0.06-0.44) and minocycline-rifampicin catheters (0.18; 0.08-0.34) were associated with a significantly lower rate of CRBSI with standard catheters. Rifampicin-based impregnated catheters seem to be better for prevention of catheter-related infection compared with the other catheters.

  10. Patency and complications of translumbar dialysis catheters

    PubMed Central

    Liu, Fanna; Bennett, Stacy; Arrigain, Susana; Schold, Jesse; Heyka, Robert; McLennan, Gordon; Navaneethan, Sankar D.

    2016-01-01

    Background Translumbar tunneled dialysis catheter (TLDC) is a temporary dialysis access for patients exhausted traditional access for dialysis. While few small studies reported successes with TLDC, additional studies are warranted to understand the short and long-term patency and safety of TLDC. Methods We conducted a retrospective analysis of adult patients who received TLDC for hemodialysis access from June 2006 to June 2013. Patient demographics, comorbid conditions, dialysis details, catheter insertion procedures and associated complications, catheter patency, and patient survival data were collected. Catheter patency was studied using Kaplan-Meier curve; catheter functionality was assessed with catheter intervals and catheter related complications were used to estimate catheter safety. Results There were 84 TLDCs inserted in 28 patients with 28 primary insertions and 56 exchanges. All TLDC insertions were technically successful with good blood flow during dialysis (>300 ml/min) and no immediate complications (major bleeding or clotting) were noted. The median number of days in place for initial catheter, secondary catheter and total catheter were 65, 84 and 244 respectively. The catheter patency rate at 3, 6 and 12 months were 43%, 25% and 7% respectively. The main complications were poor blood flow (40%) and catheter related infection (36%), which led to 30.8% and 35.9% catheter removal respectively. After translumbar catheter, 42.8% of the patients were successfully converted to another vascular access or peritoneal dialysis. Conclusion This study data suggests that TLDC might serve as a safe, alternate access for dialysis patients in short-term who have exhausted conventional vascular access. PMID:25800550

  11. Catheter-related bloodstream infections

    PubMed Central

    Gahlot, Rupam; Nigam, Chaitanya; Kumar, Vikas; Yadav, Ghanshyam; Anupurba, Shampa

    2014-01-01

    Central-venous-catheter-related bloodstream infections (CRBSIs) are an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. Consequences depend on associated organisms, underlying pre-morbid conditions, timeliness, and appropriateness of the treatment/interventions received. We have summarized risk factors, pathogenesis, etiology, diagnosis, and management of CRBSI in this review. PMID:25024944

  12. Central venous catheter - dressing change

    MedlinePlus

    ... flushing Peripherally inserted central catheter - flushing Sterile technique Surgical wound care - open Review Date 9/17/2016 Updated by: Debra G. Wechter, MD, FACS, general surgery practice specializing in breast cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, ...

  13. Cytometric Catheter for Neurosurgical Applications

    SciTech Connect

    Evans III, Boyd Mccutchen; Allison, Stephen W; Fillmore, Helen; Broaddus, William C; Dyer, Rachel L; Gillies, George

    2010-01-01

    Implantation of neural progenitor cells into the central nervous system has attracted strong interest for treatment of a variety of pathologies. For example, the replacement of dopamine-producing (DA) neural cells in the brain appears promising for the treatment of patients affected by Parkinson's disease. Previous studies of cell-replacement strategies have shown that less than 90% of implanted cells survive longer than 24 - 48 hours following the implantation procedure. However, it is unknown if these cells were viable upon delivery, or if they were affected by other factors such as brain pathology or an immune response. An instrumented cell-delivery catheter has been developed to assist in answering these questions by facilitating quantification and monitoring of the viability of the cells delivered. The catheter uses a fiber optic probe to perform flourescence-based cytometric measurments on cells exiting the port at the catheter tip. The current implementation of this design is on a 3.2 mm diameter catheter with 245 micrometer diameter optical fibers. Results of fluorescence testing data are presented and show that the device can characterize the quantity of cell densities ranging from 60,000 cells/ml to 600,000 cells/ml with a coefficient of determination of 0.93.

  14. Avoiding Complications in Abdominal Wall Surgery: A Mathematical Model to Predict the Course of the Motor Innervation of the Rectus Abdominis.

    PubMed

    Tessone, Ariel; Nava, Maurizio; Blondeel, Phillip; Spano, Andrea

    2016-02-01

    Ever since its introduction, the transverse rectus abdominis myocutaneous flap has become the mainstay of autologous breast reconstruction. However, concerns regarding donor site morbidity due to the breach of abdominal wall musculature integrity soon followed. Muscle-sparing techniques, eventually eliminating the muscle from the flap all-together with the deep inferior epigastric artery perforator flap, did not eliminate the problem of abdominal wall weakness. This led to the conclusion that motor innervation might be at fault. Studies have shown that even in the presence of an intact rectus abdominis muscle, and an intact anterior rectus sheath, denervation of the rectus abdominis muscle results in significant abdominal wall weakness leading to superior and inferior abdominal bulges, and abdominal herniation. Our aim was to establish a mathematical model to predict the location of the motor innervation to the rectus abdominis muscle, and thus provide surgeons with a tool that will allow them to reduce abdominal morbidity during deep inferior epigastric artery perforator and free muscle-sparing transverse rectus abdominis myocutaneous surgery. We dissected 42 cadaveric hemiabdomens and mapped the course of the thoracolumbar nerves. We then standardized and analyzed our findings and presented them as a relative map which can be adjusted to body type and dimensions. Our dissections show that the motor innervation is closely related to the lateral vascular supply. Thus, when possible, we support the preferred utilization of the medial vascular supply, and the preservation of the lateral supply and motor innervation.

  15. Measurement of craniocaudal catheter displacement between fractions in computed tomography-based high dose rate brachytherapy of prostate cancer.

    PubMed

    Kim, Yongbok; Hsu, I-Chow J; Pouliot, Jean

    2007-09-17

    The objective of this work is to measure the cranio-caudal displacement of catheters occurring between consecutive fractions of transrectal ultrasound (TRUS) guided high dose rate (HDR) prostate brachytherapy. Ten consecutive patients were treated with 2 fractions of 9.5 Gy TRUS guided HDR brachytherapy using dental putty for the fixation of catheters. For each patient, a CT scan with 3 mm slice thickness was acquired before each of the two fractions. Two different references were employed to measure the catheter displacement between fractions: the ischial bone as a bony marker (BM) and the center of two gold markers (COGM) implanted in the prostate. The catheter displacement was calculated by multiplying the thickness of CT slice with the difference in number of CT slices between the reference slice and the slice containing the tip of a catheter. The average (range) magnitude of caudal catheter displacement was 2.7 mm (-6.0 to 13.5 mm) for BM method and 5.4 mm (-3.75 to 18.0 mm) for COGM method, respectively. The measurement data obtained from BM and COGM methods verified that both prostate movement and catheter displacement occurred independently between fractions. The most anterior and medial two catheters (catheter position 8 and 12) had the greatest tendency to be displaced in the caudal direction because they were located at the most distant position from the fulcrum, susceptible to the rotation of the dental putty in lateral plane due to the movement of patient legs between fractions. In conclusion, the use of both BM and COGM methods can demonstrate the prostate and catheter movement relative to the BM between fractions. We found a pattern of catheter displacement using our technique. Based on our finding further improvement of our results may be possible by modification of our current technique.

  16. SU-E-T-362: Automatic Catheter Reconstruction of Flap Applicators in HDR Surface Brachytherapy

    SciTech Connect

    Buzurovic, I; Devlin, P; Hansen, J; O'Farrell, D; Bhagwat, M; Friesen, S; Damato, A; Lewis, J; Cormack, R

    2014-06-01

    Purpose: Catheter reconstruction is crucial for the accurate delivery of radiation dose in HDR brachytherapy. The process becomes complicated and time-consuming for large superficial clinical targets with a complex topology. A novel method for the automatic catheter reconstruction of flap applicators is proposed in this study. Methods: We have developed a program package capable of image manipulation, using C++class libraries of The-Visualization-Toolkit(VTK) software system. The workflow for automatic catheter reconstruction is: a)an anchor point is placed in 3D or in the axial view of the first slice at the tip of the first, last and middle points for the curved surface; b)similar points are placed on the last slice of the image set; c)the surface detection algorithm automatically registers the points to the images and applies the surface reconstruction filter; d)then a structured grid surface is generated through the center of the treatment catheters placed at a distance of 5mm from the patient's skin. As a result, a mesh-style plane is generated with the reconstructed catheters placed 10mm apart. To demonstrate automatic catheter reconstruction, we used CT images of patients diagnosed with cutaneous T-cell-lymphoma and imaged with Freiburg-Flap-Applicators (Nucletron™-Elekta, Netherlands). The coordinates for each catheter were generated and compared to the control points selected during the manual reconstruction for 16catheters and 368control point Results: The variation of the catheter tip positions between the automatically and manually reconstructed catheters was 0.17mm(SD=0.23mm). The position difference between the manually selected catheter control points and the corresponding points obtained automatically was 0.17mm in the x-direction (SD=0.23mm), 0.13mm in the y-direction (SD=0.22mm), and 0.14mm in the z-direction (SD=0.24mm). Conclusion: This study shows the feasibility of the automatic catheter reconstruction of flap applicators with a high level

  17. Swiss Ball Versus Mat Exercises For Core Activation of Transverse Abdominis in Recreational Athletes

    PubMed Central

    Nayak, Nirmala; Nair, Sudeep; Sherpa, Lobsang Bhuti; Dsouza, Diana

    2016-01-01

    Introduction Core stability is an essential component for improving athletic performance and injury prevention. Exercises on a Swiss ball and on the mat are two different ways of improving core stability. Comparison of these methods can help physiotherapists incorporate the better method for athletic training and rehabilitation. Aim To compare swiss ball and mat exercises for core stability of transverse abdominis in recreational athletes. Materials and Methods This pilot randomized control trial was performed on a total of 25 recreational athletes. Subjects were alternatively allocated into three different groups: group A performed swiss ball exercises; group B performed mat exercises; and group C was the control group. Statistical analysis Paired t-test for pre and post values within the group and one-way ANOVA for between the groups comparison was used. Results There was significant improvement in the core stability in Group A (Pre values: 3.6±2.06; Post values: 8.3±3.02; p-value: <0.05) and Group B (Pre values: 2.1±2.4; Post values: 4.3±2.5; p-value<0.05), however, improvement was more in group A compared to group B. Conclusion There was significant improvement seen in the recreational athletes performing exercises on Swiss ball as compared to athletes performing exercises on mat. Therefore, Swiss ball exercises can be included in the prehabilitation and rehabilitation stages of athletic training to prevent injury and enhanced recovery post injury, thereby, improving performance of the athletes. PMID:28208990

  18. Untangling of knotted urethral catheters.

    PubMed

    Sambrook, Andrew J; Todd, Alistair

    2007-04-01

    Intravesical catheter knotting during micturating cystourethrography is a rare but recognized complication of the procedure. We were able to untangle a knot utilizing a fluoroscopically guided vascular guidewire. Following this success, a small study was performed using a model. Various types of guidewires and techniques were tested for different diameters of knots in order to predict the likelihood of success in this type of situation.

  19. Central vascular catheters and infections.

    PubMed

    Dioni, Elisabetta; Franceschini, Renata; Marzollo, Roberto; Oprandi, Daniela; Chirico, Gaetano

    2014-03-01

    Newborn infants in critical conditions require a permanent intra-venous line to allow for the administration of fluids, parenteral nutrition and drugs. The use of central venous catheters, however, is associated with an increased risk of infections, leading to prolongation of length of stay and higher hospitalization costs, particularly in extremely preterm infants. Dwell time is a significant factor for complications, with a predicted risk of catheter related infections of about 4 per 1000 catheter-days. To reduce the incidence of complications, several requirements must be met, including adequate staff and resources to provide education, training, and quality improvement programs, within a culture of communication and teamwork. Rigorous reporting schedule on line care and the implementation of unique bundle elements, the use of health care failure mode and effect analysis, the judicious use of antibiotics through an antimicrobial stewardship strategy, the application of specific antifungal prophylaxis are among the most effective interventions, while the addition of heparin to parenteral solution, or the use of antibiotic plus heparin lock therapy are under evaluation. Nursing assistance plays a fundamental role in managing central venous lines and in reducing or preventing the incidence of infection, by the application of several complex professional strategies.

  20. Infections associated with the central venous catheters.

    PubMed

    Drasković, Biljana; Fabri, Izabella; Benka, Anna Uram; Rakić, Goran

    2014-01-01

    Central venous catheters are of an essential importance to critically ill patients who require long-term venous access for various purposes. Their use made the treatment much easier, but still they are not harmless and are prone to numerous complications. Catheter infections represent the most significant complication in their use. The frequency of infections varies in different patient care settings, but their appearance mostly depends on the patient's health condition, catheter insertion time, localization of the catheter and type of the used catheter. Since they are one of the leading causes of nosocomial infections and related to significant number of morbidity and mortality in intensive care units, it is very important that maximal aseptic precautions are taken during the insertion and the maintenance period. Prevention of infection of the central venous catheters demands several measures that should be applied routinely.

  1. Position Control of Motion Compensation Cardiac Catheters

    PubMed Central

    Kesner, Samuel B.; Howe, Robert D.

    2011-01-01

    Robotic catheters have the potential to revolutionize cardiac surgery by enabling minimally invasive structural repairs within the beating heart. This paper presents an actuated catheter system that compensates for the fast motion of cardiac tissue using 3D ultrasound image guidance. We describe the design and operation of the mechanical drive system and catheter module and analyze the catheter performance limitations of friction and backlash in detail. To mitigate these limitations, we propose and evaluate mechanical and control system compensation methods, including inverse and model-based backlash compensation, to improve the system performance. Finally, in vivo results are presented that demonstrate that the catheter can track the cardiac tissue motion with less than 1 mm RMS error. The ultimate goal of this research is to create a fast and dexterous robotic catheter system that can perform surgery on the delicate structures inside of the beating heart. PMID:21874124

  2. Catheter-associated urinary tract infections.

    PubMed

    Warren, J W

    2001-04-01

    Nosocomial urinary tract infection (UTI) is the most common infection acquired in both hospitals and nursing homes and is usually associated with catheterization. This infection would be even more common but for the use of the closed catheter system. Most modifications have not improved on the closed catheter itself. Even with meticulous care, this system will not prevent bacteriuria. After bacteriuria develops, the ability to limit its complications is minimal. Once a catheter is put in place, the clinician must keep two concepts in mind: keep the catheter system closed in order to postpone the onset of bacteriuria, and remove the catheter as soon as possible. If the catheter can be removed before bacteriuria develops, postponement becomes prevention.

  3. Accidental Entrapment of Electrical Mapping Catheter by Chiari's Network in Right Atrium during Catheter Ablation Procedure

    PubMed Central

    Sakamoto, Atsushi; Urushida, Tsuyoshi; Sakakibara, Tomoaki; Sano, Makoto; Suwa, Kenichiro; Saitoh, Takeji; Saotome, Masao; Katoh, Hideki; Satoh, Hiroshi; Hayashi, Hideharu

    2016-01-01

    A 78-year-old male was admitted to our hospital due to frequent palpitation. His electrocardiogram (ECG) presented regular narrow QRS tachycardia with 170 bpm, and catheter ablation was planned. During electroanatomical mapping of the right atrium (RA) with a multiloop mapping catheter, the catheter head was entrapped nearby the ostium of inferior vena cava. Rotation and traction of the catheter failed to detach the catheter head from the RA wall. Exfoliation of connective tissue twined around catheter tip by forceps, which were designed for endomyocardial biopsy, succeeded to retract and remove the catheter. Postprocedural echocardiography and pathologic examination proved the existence of Chiari's network. The handling of complex catheters in the RA has a potential risk of entrapment with Chiari's network. PMID:27366332

  4. Candida utilis catheter-related bloodstream infection

    PubMed Central

    Scoppettuolo, Giancarlo; Donato, Concetta; De Carolis, Elena; Vella, Antonietta; Vaccaro, Luisa; La Greca, Antonio; Fantoni, Massimo

    2014-01-01

    Central venous catheter-related fungemia are increasing in the last years, also due to rare fungi. We report the case of a Candida utilis catheter-related bloodstream infection in a patient with metastatic carcinoma of the bladder and a long term totally implanted venous catheter. The diagnosis was done by paired blood cultures and differential time to positivity. The Candida species was rapidly identified by MALDI-TOF mass spectrometry. The patient was successfully treated with anidulafungine. PMID:25473600

  5. Thrombolytic therapy for central venous catheter occlusion

    PubMed Central

    Baskin, Jacquelyn L.; Reiss, Ulrike; Wilimas, Judith A.; Metzger, Monika L.; Ribeiro, Raul C.; Pui, Ching-Hon; Howard, Scott C.

    2012-01-01

    Background Long-term central venous catheters have improved the quality of care for patients with chronic illnesses, but are complicated by obstructions which can result in delay of treatment or catheter removal. Design and Methods This paper reviews thrombolytic treatment for catheter obstruction. Literature from Medline searches using the terms “central venous catheter”, “central venous access device” OR “central venous line” associated with the terms “obstruction”, “occlusion” OR “thrombolytic” was reviewed. Efficacy of thrombolytic therapy, central venous catheter clearance rates and time to clearance were assessed. Results Alteplase, one of the current therapies, clears 52% of obstructed catheters within 30 min with 86% overall clearance (after 2 doses, when necessary). However, newer medications may have higher efficacy or shorter time to clearance. Reteplase cleared 67–74% within 30–40 min and 95% of catheters overall. Occlusions were resolved in 70 and 83% of patients with one and 2 doses of tenecteplase, respectively. Recombinant urokinase cleared 60% of catheters at 30 min and 73% overall. Alfimeprase demonstrated rapid catheter clearance with resolution in 40% of subjects within 5 min, 60% within 30 min, and 80% within 2 h. Additionally, urokinase prophylaxis decreased the incidence of catheter occlusions from 16–68% in the control group to 4–23% in the treatment group; in some studies, rates of catheter infections were also decreased in the urokinase group. Conclusions Thrombolytic agents successfully clear central venous catheter occlusions in most cases. Newer agents may act more rapidly and effectively than currently utilized therapies, but randomized studies with direct comparisons of these agents are needed to determine optimal management for catheter obstruction. PMID:22180420

  6. Slow expiration reduces sternocleidomastoid activity and increases transversus abdominis and internal oblique muscle activity during abdominal curl-up.

    PubMed

    Yoon, Tae-Lim; Kim, Ki-Song; Cynn, Heon-Seock

    2014-04-01

    The aim of this study was to investigate the effects of quiet inspiration versus slow expiration on sternocleidomastoid (SCM) and abdominal muscle activity during abdominal curl-up in healthy subjects. Twelve healthy subjects participated in this study. Surface electromyography (EMG) was used to collect activity of bilateral SCM, rectus abdominis (RA), external oblique (EO), and transversus abdominis/internal oblique (TrA/IO) muscles. A paired t-test was used to determine significant differences in the bilateral SCM, RF, EO, and TrA/IO muscles between abdominal curl-up with quiet inspiration and slow expiration. There were significantly lower EMG activity of both SCMs and greater EMG activity of both IOs during abdominal curl-up with slow expiration, compared with the EMG activity of both SCMs and IOs during abdominal curl-up with quiet inspiration (p<.05). The results of this study suggest that slow expiration would be recommended during abdominal curl-up for reduced SCM activation and selective activation of TrA/IO in healthy subjects compared with those in abdominal curl up with quiet inspiration.

  7. Erroneous laboratory values obtained from central catheters.

    PubMed

    Johnston, J B; Messina, M

    1991-01-01

    Serious analytic errors in potassium measurements have been identified in blood specimens obtained from newly inserted central catheters. Erroneous elevated readings have been related to interactions of chemistry analyzer electrodes and substances fixed to external and intraluminal walls of the central catheter. Anecdotal summaries of this phenomenon are presented to enable the nurse to recognize potential problems when sampling blood from central catheters. Studies were performed to determine the amount of flush necessary to clear the catheter of interfering residue. To eliminate this potentially hazardous occurrence, recommended flush volumes, nursing implications, and actions are described.

  8. Housestaff Knowledge Related to Urinary Catheter Utilization and Catheter-Associated Urinary Tract Infections (CAUTIs)

    PubMed Central

    Paras, Molly L.; Shenoy, Erica S.; Hsu, Heather E.; Walensky, Rochelle P.; Hooper, David C.

    2015-01-01

    Despite published catheter-associated urinary tract infection (CAUTI) prevention guidelines, inappropriate catheter use is common. We surveyed housestaff about their knowledge of CAUTIs at a teaching hospital and found the majority is aware of prevention guidelines; however, their application to clinical scenarios and catheter practices fall short of national goals. PMID:26278269

  9. Catheter indwell time and phlebitis development during peripheral intravenous catheter administration

    PubMed Central

    Pasalioglu, Kadriye Burcu; Kaya, Hatice

    2014-01-01

    Objective: Intravenous catheters have been indispensable tools of modern medicine. Although intravenous applications can be used for a multitude of purposes, these applications may cause complications, some of which have serious effects. Of these complications, the most commonly observed is phlebitis. This study was conducted to determine the effect of catheter indwell time on phlebitis development during peripheral intravenous catheter administration. Methods: This study determined the effect of catheter indwell time on phlebitis development during peripheral intravenous catheter administration. The study included a total of 103 individuals who were administered 439 catheters and satisfied the study enrollment criteria at one infectious diseases clinic in Istanbul/Turkey. Data were compiled from Patient Information Forms, Peripheral Intravenous Catheter and Therapy Information Forms, reported grades based on the Visual Infusion Phlebitis Assessment Scale, and Peripheral Intravenous Catheter Nurse Observation Forms. The data were analyzed using SPSS. Results : The mean patient age was 53.75±15.54 (standard deviation) years, and 59.2% of the study participants were men. Phlebitis was detected in 41.2% of peripheral intravenous catheters, and the rate decreased with increased catheter indwell time. Analyses showed that catheter indwell time, antibiotic usage, sex, and catheterization sites were significantly associated with development of phlebitis. Conclusion: The results of this study show that catheters can be used for longer periods of time when administered under optimal conditions and with appropriate surveillance. PMID:25097505

  10. FAQs about Catheter-Associated Urinary Tract Infection

    MedlinePlus

    ... do to help prevent catheter-associated urinary tract infections if I have a catheter? • Always clean your hands before and after doing catheter care. • Always keep your urine bag below the level ...

  11. 21 CFR 870.1200 - Diagnostic intravascular catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... intracardiac pressures, to sample blood, and to introduce substances into the heart and vessels. Included in this generic device are right-heart catheters, left-heart catheters, and angiographic catheters,...

  12. 21 CFR 870.1200 - Diagnostic intravascular catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... intracardiac pressures, to sample blood, and to introduce substances into the heart and vessels. Included in this generic device are right-heart catheters, left-heart catheters, and angiographic catheters,...

  13. 21 CFR 870.1200 - Diagnostic intravascular catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... intracardiac pressures, to sample blood, and to introduce substances into the heart and vessels. Included in this generic device are right-heart catheters, left-heart catheters, and angiographic catheters,...

  14. 21 CFR 870.1200 - Diagnostic intravascular catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... intracardiac pressures, to sample blood, and to introduce substances into the heart and vessels. Included in this generic device are right-heart catheters, left-heart catheters, and angiographic catheters,...

  15. 21 CFR 870.1200 - Diagnostic intravascular catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... intracardiac pressures, to sample blood, and to introduce substances into the heart and vessels. Included in this generic device are right-heart catheters, left-heart catheters, and angiographic catheters,...

  16. The Effects of Stabilization and Mckenzie Exercises on Transverse Abdominis and Multifidus Muscle Thickness, Pain, and Disability: A Randomized Controlled Trial in NonSpecific Chronic Low Back Pain.

    PubMed

    Hosseinifar, Mohammad; Akbari, Mohammad; Behtash, Hamid; Amiri, Mohsen; Sarrafzadeh, Javad

    2013-12-01

    [Purpose] This study compared the effectiveness of stabilization and McKenzie exercises on pain, disability, and thickness of the transverse abdominis and multifidus muscles in patients with nonspecific chronic low back pain. [Subjects] Thirty patients were randomly assigned into two groups: the McKenzie and stabilization exercise groups. [Methods] Before and after intervention, pain, disability, and thickness of the transverse abdominis and multifidus muscles were evaluated by visual analogue scale, functional rating index, and sonography, respectively. The training program was 18 scheduled sessions of individual training for both groups. [Results] After interventions, the pain score decreased in both groups. The disability score decreased only in the stabilization group. The thickness of the left multifidus was significantly increased during resting and contracting states in the stabilization group. The thickness of the right transverse abdominis during the abdominal draw-in maneuver, and thickness of the left transverse abdominis during the active straight leg raising maneuver were significantly increased in the stabilization group. The intensity of pain, disability score, thickness of the right transverse abdominis during the abdominal draw-in manouver, and thickness of the left transverse abdominis during active straight leg raising in the stabilization group were greater than those on the Mackenzie. [Conclusion] Stabilization exercises are more effective than McKenzie exercises in improving the intensity of pain and function score and in increasing the thickness of the transverse abdominis muscle.

  17. Successful retrieval of an irretrievable jugular tesio catheter using a fogarty arterial embolectomy catheter.

    PubMed

    Arnáiz-García, María Elena; Gutiérrez-Diez, Francisco; Arnáiz-García, Ana María; Arnáiz, Javier; Expósito, Víctor; Nistal, Juan Francisco; Rodríquez-Entem, Felipe; Olalla, Juan José; López-Rodríguez, Javier; González-Santos, José María

    2014-05-01

    Long life expectancy and wide development of therapies have increased the number of patients under artificial treatment for lost kidney function or dialysis. Different options for vascular access are suitable for receiving this therapy. The use of tunneled catheters has consequently increased complications related to its use. A difficult retrieval of catheters caused by a hard fibrin sheath along its trajectory is a common drawback. Herein, we report a woman with suspicion of hemodialysis catheter infection and an irretrievable Tesio catheter. A novel technique using a Fogarty arterial catheter allowed a successful retrieval and avoided an aggressive management.

  18. Robust pigtail catheter tip detection in fluoroscopy

    NASA Astrophysics Data System (ADS)

    Tzoumas, Stratis; Wang, Peng; Zheng, Yefeng; John, Matthias; Comaniciu, Dorin

    2012-02-01

    The pigtail catheter is a type of catheter inserted into the human body during interventional surgeries such as the transcatheter aortic valve implantation (TAVI). The catheter is characterized by a tightly curled end in order to remain attached to a valve pocket during the intervention, and it is used to inject contrast agent for the visualization of the vessel in fluoroscopy. Image-based detection of this catheter is used during TAVI, in order to overlay a model of the aorta and enhance visibility during the surgery. Due to the different possible projection angles in fluoroscopy, the pigtail tip can appear in a variety of different shapes spanning from pure circular to ellipsoid or even line. Furthermore, the appearance of the catheter tip is radically altered when the contrast agent is injected during the intervention or when it is occluded by other devices. All these factors make the robust real-time detection and tracking of the pigtail catheter a challenging task. To address these challenges, this paper proposes a new tree-structured, hierarchical detection scheme, based on a shape categorization of the pigtail catheter tip, and a combination of novel Haar features. The proposed framework demonstrates improved detection performance, through a validation on a data set consisting of 272 sequences with more than 20,000 images. The detection framework presented in this paper is not limited to pigtail catheter detection, but it can also be applied successfully to any other shape-varying object with similar characteristics.

  19. 21 CFR 874.4175 - Nasopharyngeal catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Nasopharyngeal catheter. 874.4175 Section 874.4175 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Surgical Devices § 874.4175 Nasopharyngeal catheter....

  20. 21 CFR 874.4175 - Nasopharyngeal catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Nasopharyngeal catheter. 874.4175 Section 874.4175 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Surgical Devices § 874.4175 Nasopharyngeal catheter....

  1. 21 CFR 874.4175 - Nasopharyngeal catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Nasopharyngeal catheter. 874.4175 Section 874.4175 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Surgical Devices § 874.4175 Nasopharyngeal catheter....

  2. Haemodialysis catheters in the intensive care unit.

    PubMed

    Huriaux, Laetitia; Costille, Paul; Quintard, Hervé; Journois, Didier; Kellum, John A; Rimmelé, Thomas

    2016-11-29

    Ten to 15% of critically ill patients need renal replacement therapy (RRT) for severe acute kidney injury. The dialysis catheter is critical for RRT quality and efficiency. Catheters have several properties that must be optimized to promote RRT success. The distal tip has to be located in a high blood flow location, which means central venous territory. Therefore, catheters are mostly inserted into the right internal jugular vein or in femoral veins. External diameter should vary from 12 to 16 Fr in order to ensure adequate blood flow inside the catheter. Lumen shapes are theoretically designed to limit thrombotic risk with low turbulences and frictional forces against the internal wall. With low aspiration pressure, distal tip shape has to deliver sufficient blood flow, while limiting recirculation rate. Catheter material should be biocompatible. Despite in vitro data, no strong evidence supports the use of coated catheters in the ICU in order to reduce infectious risk. Antibiotic "lock" solutions are not routinely recommended. Ultrasound guidance for catheterization significantly decreases mechanical complications. Clinicians should select the optimal catheter according to patient body habitus, catheter intrinsic properties and RRT modality to be used.

  3. 3D model-based catheter tracking for motion compensation in EP procedures

    NASA Astrophysics Data System (ADS)

    Brost, Alexander; Liao, Rui; Hornegger, Joachim; Strobel, Norbert

    2010-02-01

    Atrial fibrillation is the most common sustained heart arrhythmia and a leading cause of stroke. Its treatment by radio-frequency catheter ablation, performed using fluoroscopic image guidance, is gaining increasingly more importance. Two-dimensional fluoroscopic navigation can take advantage of overlay images derived from pre-operative 3-D data to add anatomical details otherwise not visible under X-ray. Unfortunately, respiratory motion may impair the utility of these static overlay images for catheter navigation. We developed an approach for image-based 3-D motion compensation as a solution to this problem. A bi-plane C-arm system is used to take X-ray images of a special circumferential mapping catheter from two directions. In the first step of the method, a 3-D model of the device is reconstructed. Three-dimensional respiratory motion at the site of ablation is then estimated by tracking the reconstructed catheter model in 3-D. This step involves bi-plane fluoroscopy and 2-D/3-D registration. Phantom data and clinical data were used to assess our model-based catheter tracking method. Experiments involving a moving heart phantom yielded an average 2-D tracking error of 1.4 mm and an average 3-D tracking error of 1.1 mm. Our evaluation of clinical data sets comprised 469 bi-plane fluoroscopy frames (938 monoplane fluoroscopy frames). We observed an average 2-D tracking error of 1.0 mm +/- 0.4 mm and an average 3-D tracking error of 0.8 mm +/- 0.5 mm. These results demonstrate that model-based motion-compensation based on 2-D/3-D registration is both feasible and accurate.

  4. Cost/benefit analysis of chlorhexidine-silver sulfadiazine-impregnated venous catheters for femoral access.

    PubMed

    Lorente, Leonardo; Lecuona, María; Jiménez, Alejandro; Lorenzo, Lisset; Diosdado, Sara; Marca, Lucía; Mora, María L

    2014-10-01

    Sixty-four patients with chlorhexidine-silver sulfadiazine-impregnated catheters had a lower rate of catheter-related bloodstream infection and lower central venous catheter-related costs per catheter day than 190 patients with a standard catheter.

  5. Incorporating a Gaussian model at the catheter tip for improved registration of preoperative surface models

    NASA Astrophysics Data System (ADS)

    Rettmann, M. E.; Holmes, D. R., III; Packer, D. L.; Robb, R. A.

    2011-03-01

    Atrial fibrillation is a common cardiac arrhythmia in which aberrant electrical activity cause the atria to quiver which results in irregular beating of the heart. Catheter ablation therapy is becoming increasingly popular in treating atrial fibrillation, a procedure in which an electrophysiologist guides a catheter into the left atrium and creates radiofrequency lesions to stop the arrhythmia. Typical visualization tools include bi-plane fluoroscopy, 2-D ultrasound, and electroanatomic maps, however, recently there has been increased interest in incorporating preoperative surface models into the procedure. Typical strategies for registration include landmark-based and surface-based methods. Drawbacks of these approaches include difficulty in accurately locating corresponding landmark pairs and the time required to sample surface points with a catheter. In this paper, we describe a new approach which models the catheter tip as a Gaussian kernel and eliminates the need to collect surface points by instead using the stream of continuosly tracked catheter points. We demonstrate the feasibility of this technique with a left atrial phantom model and compare the results with a standard surface based approach.

  6. Laser welding of balloon catheters

    NASA Astrophysics Data System (ADS)

    Flanagan, Aidan J.

    2003-03-01

    The balloon catheter is one of the principal instruments of non-invasive vascular surgery. It is used most commonly for angioplasty (and in recent years for delivering stents) at a multitude of different sites in the body from small arteries in the heart to the bilary duct. It is composed of a polymer balloon that is attached to a polymer shaft at two points called the distal and proximal bonds. The diverse utility of balloon catheters means a large range of component sizes and materials are used during production; this leads to a complexity of bonding methods and technology. The proximal and distal bonds have been conventionally made using cyanoacrylate or UV curing glue, however with performance requirements of bond strength, flexibility, profile, and manufacturing costs these bonds are increasingly being made by welding using laser, RF, and Hot Jaw methods. This paper describes laser welding of distal and proximal balloon bonds and details beam delivery, bonding mechanisms, bond shaping, laser types, and wavelength choice.

  7. Prevention of central venous catheter bloodstream infections.

    PubMed

    Walz, J Matthias; Memtsoudis, Stavros G; Heard, Stephen O

    2010-01-01

    The majority of nosocomial bloodstream infections in critically ill patients originate from an infected central venous catheter (CVC). Catheter-related bloodstream infections (CRBSIs) cause significant morbidity and mortality and increase the cost of care. The most frequent causative organisms for CRBSI are coagulase-negative staphylococci (CoNSs), Staphylococcus aureus, enterococci, and Candida species. The path to infection frequently includes migration of skin organisms at the insertion site into the cutaneous catheter tract, resulting in microbial colonization of the catheter tip and formation of biofilm. Evidence-based strategies for the prevention of CRBSI include behavioral and educational interventions, effective skin antisepsis coupled with maximum barrier precautions, the use of antiseptic dressings, and the use of antiseptic or antibiotic impregnated catheters. Achieving and maintaining very low rates of CRBSI requires a multidisciplinary approach involving the entire health care team, the use of novel technologies in patients with the highest risk of CRBSI, and frequent reeducation of staff.

  8. Catheter-related urinary tract infection.

    PubMed

    Nicolle, Lindsay E

    2005-01-01

    Indwelling urinary catheters are used frequently in older populations. For either short- or long-term catheters, the infection rate is about 5% per day. Escherichia coli remains the most common infecting organism, but a wide variety of other organisms may be isolated, including yeast species. Bacteria tend to show increased resistance because of the repeated antimicrobial courses. Urinary tract infection (UTI) usually follows formation of biofilm on both the internal and external catheter surface. The biofilm protects organisms from both antimicrobials and the host immune response. Morbidity from UTI with short-term catheter use is limited if appropriate catheter care is practised. In patients with long-term catheters, fever from a urinary source is common with a frequency varying from 1 per 100 to 1 per 1000 catheter days. Long-term care facility residents with chronic indwelling catheters have a much greater risk for bacteraemia and other urinary complications than residents without catheters. Asymptomatic catheter-acquired UTI should not be treated with antimicrobials. Antimicrobial treatment does not decrease symptomatic episodes but will lead to emergence of more resistant organisms. For treatment of symptomatic infection, many antimicrobials are effective. Wherever possible, antimicrobial selection should be delayed until culture results are available. Whether to administer initial treatment by an oral or parenteral route is determined by clinical presentation. If empirical therapy is required, antimicrobial selection is based on variables such as route of administration, anticipated infecting organism and susceptibility, and patient tolerance. Renal function, concomitant medications, local formulary and cost may also be considered in selection of the antimicrobial agent. The duration of therapy is usually 10-14 days, but patients who respond promptly and in whom the catheter must remain in situ may be treated with a shorter 7-day course to reduce

  9. Development of Bend Sensor for Catheter Tip

    NASA Astrophysics Data System (ADS)

    Nagano, Yoshitaka; Sano, Akihito; Fujimoto, Hideo

    Recently, a minimally invasive surgery which makes the best use of the catheter has been becoming more popular. In endovascular coil embolization for a cerebral aneurysm, the observation of the catheter's painting phenomenon is very important to execute the appropriate manipulation of the delivery wire and the catheter. In this study, the internal bend sensor which consists of at least two bending enhanced plastic optical fibers was developed in order to measure the curvature of the catheter tip. Consequently, the painting could be more sensitively detected in the neighborhood of the aneurysm. In this paper, the basic characteristics of the developed sensor system are described and its usefulness is confirmed from the comparison of the insertion force of delivery wire and the curvature of catheter tip in the experiment of coil embolization.

  10. Formation of independently revascularized bowel segments using the rectus abdominis muscle flap: a rat model for jejunal prefabrication.

    PubMed

    Tan, Bien-Keem; Chen, Hung-Chi; Wei, Fu-Chan; Ma, Shwu-Fan; Lan, Chyn-Tair; See, Lai-Chu; Wan, Yung-Liang

    2002-02-01

    Reconstruction of the pharyngoesophagus with free jejunal transfer is a major challenge when recipient neck vessels are absent because of previous surgery or irradiation. In such instances, jejunal transfer using a muscle flap as a "vascular carrier" may be a problem-solving alternative. Pretransfer vascularization of the jejunum is achieved by wrapping the muscle flap around the small bowel segment. After a short staging period, the mesenteric pedicle is divided and the bowel segment is transferred up to the neck based on its new blood supply. The objectives of this study were to develop an animal model for prefabricating independently revascularized jejunal segments using the rectus abdominis muscle flap and to determine the minimal time required for independent bowel survival. Twenty-four mature (500-g to 700-g) rats were divided into six experimental groups of four animals each. In each animal, a 1.5-cm segment of proximal jejunum was isolated on two jejunal arteries and wrapped with a superior pedicled rectus abdominis muscle flap. To determine the time of neovascular takeover, the mesenteric pedicles were ligated on postoperative day 2 (group I), day 3 (group II), day 4 (group III), day 5 (group IV), day 6 (group V), and day 7 (group VI). At the time of pedicle ligation, the composite flap was transposed to a new subcutaneous position. Viability of bowel was assessed according to gross appearance and histologic examination 48 hours after transfer. Complete survival of revascularized jejunum in 11 of 12 animals was obtained after pedicle ligation on postoperative day 5 and beyond (p < 0.0001, Fisher's exact test). These bowel segments demonstrated luminal patency, intact pink mucosa, mucus production, and visible peristalsis. Histologic examination showed healthy intestinal epithelium and tissue integration along the serosa-muscle interphase. In contrast, pedicle ligation on day 4 and earlier resulted in varying degrees of bowel necrosis characterized by

  11. Evaluation of an intravenous catheter for use in the horse.

    PubMed

    Gulick, B A; Meagher, D M

    1981-02-01

    A commercially available polyvinyl chloride intravenous catheter was studied in 9 horses for 3 to 10 days to evaluate the catheter's suitability for use in the horse, to develop a new insertion technique, and to establish a protocol for catheter care. Seven of the animals were clinically normal horses receiving parenteral nutrition; one was a horse with hypocalcemia receiving frequent intravenous injections of calcium gluconate, and one was a clinically normal horse receiving no infusions. The catheter dressings were changed every 48 hours, and an aspirate from the catheter and the catheter tip was cultured at the time of catheter removal. One catheter became infected following a break in the protocol. It was concluded that the polyvinyl catheter is suitable for use in the horse and that the proposed protocol for catheter insertion and maintenance may reduce the likelihood of complications such as catheter sepsis, thrombophlebitis, and embolism.

  12. Cocontraction of Ankle Dorsiflexors and Transversus Abdominis Function in Patients With Low Back Pain

    PubMed Central

    Chon, Seung-Chul; You, Joshua H.; Saliba, Susan A.

    2012-01-01

    Context The abdominal draw-in maneuver (ADIM) with cocontraction has been shown to be a more effective method of activating the transversus abdominis (TrA) in healthy adults than the ADIM alone. Whether such an augmented core stabilization exercise is effective in managing low back pain (LBP) remains uncertain. Objective To determine the effect of 2 weeks of ADIM and cocontraction training on abdominal muscle thickness and activation timing and to monitor pain and function in patients with LBP. Design Case-control study. Setting Local orthopaedic clinic and research laboratory. Patients or Other Participants Twenty patients with mechanical LBP (age = 27.20 ± 6.46 years, height = 166.25 ± 8.70 cm, mass = 58.10 ± 11.81 kg) and 20 healthy, age-matched people (age = 24.25 ± 1.59 years, height = 168.00 ± 8.89 cm, mass = 60.65 ± 11.99 kg) volunteered for the study. Intervention(s) Both the LBP and control groups received ten 30-minute sessions of ADIM and cocontraction training of the tibialis anterior (TA) and rectus femoris (RF) muscles over a 2-week period. Main Outcome Measure(s) A separate, mixed-model analysis of variance was computed for the thicknesses of the TrA, internal oblique (IO), and external oblique muscles. The differences in mean and peak electromyographic (EMG) amplitudes, onset time, and latency were compared between the groups. The visual analog pain scale, Pain Disability Index, and LBP rating scale were used to assess pain in the LBP group before and after the intervention. Results We found an interaction between the LBP and control groups and a main effect from pretest to posttest for only TrA muscle thickness change (F1,38 = 6.57, P = .01). Reductions in all pain measures were observed after training (P < .05). Group differences in peak and mean EMG amplitudes and onset time values for TrA/IO and TA were achieved (P < .05). The RF peak (t38 = −3.12, P = .003) and mean (t38 = −4.12, P = .001) EMG amplitudes were different, but no group

  13. Radiological Interventions for Correction of Central Venous Port Catheter Migrations

    SciTech Connect

    Gebauer, Bernhard Teichgraeber, Ulf Karl; Podrabsky, Petr; Werk, Michael; Haenninen, Enrique Lopez; Felix, Roland

    2007-07-15

    Purpose. The purpose of this study was to evaluate radiological-interventional central venous port catheter corrections in migrated/malpositioned catheter tips. Materials and Methods. Thirty patients with migrated/malpositioned port catheter tips were included in this retrospective analysis. To visualize the catheter patency a contrast-enhanced port catheter series was performed, followed by transfemoral port catheter correction with various 5-F angiographic catheters (pigtail; Sos Omni), gooseneck snares, or combinations thereof. Results. One patient showed spontaneous reposition of the catheter tip. In 27 of 29 patients (93%), radiological-interventional port catheter correction was successful. In two patients port catheter malposition correction was not possible, because of the inability to catch either the catheter tip or the catheter in its course, possibly due to fibrin sheath formation with attachment of the catheter to the vessel wall. No disconnection or port catheter dysfunction was observed after correction. Conclusions. We conclude that in migrated catheter tips radiological-interventional port catheter correction is a minimally invasive alternative to port extraction and reimplantation. In patients with a fibrin sheath and/or thrombosis port catheter correction is often more challenging.

  14. The efficacy of noble metal alloy urinary catheters in reducing catheter-associated urinary tract infection

    PubMed Central

    Aljohi, Alanood Ahmed; Hassan, Hanan Elkefafy; Gupta, Rakesh Kumar

    2016-01-01

    Background: Catheter-associated urinary tract infection (CAUTI) is the most common device-related healthcare-acquired infection. CAUTI can be severe and lead to bacteremia, significant morbidity, prolonged hospital stay, and high antibiotic consumption. Patients and Methods: In this study, we evaluated the CAUTI-reducing efficacy of noble metal alloy catheters in sixty patients (thirty per group) in the Intensive Care Unit (ICU) at the King Fahad Hospital in Saudi Arabia. The study was a single-blinded, randomized, single-centered, prospective investigation that included patients using urinary catheters for 3 days. Results: A 90% relative risk reduction in the rate of CAUTI was observed with the noble metal alloy catheter compared to the standard catheter (10 vs. 1 cases, P = 0.006). When considering both catheter-associated asymptomatic bacteriuria and CAUTI, the relative risk reduction was 83% (12 vs. 2 cases, P = 0.005). In addition to CAUTI, the risk of acquiring secondary bacteremia was lower (100%) for the patients using noble metal alloy catheters (3 cases in the standard group vs. 0 case in the noble metal alloy catheter group, P = 0.24). No adverse events related to any of the used catheters were recorded. Conclusion: Results from this study revealed that noble metal alloy catheters are safe to use and significantly reduce CAUTI rate in ICU patients after 3 days of use. PMID:28057985

  15. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain

    PubMed Central

    Tennfjord, Merete Kolberg; Hilde, Gunvor; Ellström-Engh, Marie; Bø, Kari

    2016-01-01

    Background/aim Diastasis recti abdominis (DRA) is defined as a separation of the 2 muscle bellies of rectus abdominis. To date there is scant knowledge on prevalence, risk factors, and consequences of the condition. The present study aimed to investigate the prevalence of DRA during pregnancy and post partum, presence of possible risk factors, and the occurrence of lumbopelvic pain among women with and without DRA. Methods This prospective cohort study followed 300 first-time pregnant women from pregnancy till 12 months post partum. Data were collected by electronic questionnaire and clinical examinations. DRA was defined as a palpated separation of ≥2 fingerbreadths either 4.5 cm above, at or 4.5 cm below the umbilicus. Women with and without DRA were compared with independent samples Student's t-test and χ2/Fisher exact test, and OR with significance level >0.05. Results Prevalence of DRA was 33.1%, 60.0%, 45.4%, and 32.6% at gestation week 21, 6 weeks, 6 months and 12 months post partum, respectively. No difference in risk factors was found when comparing women with and without DRA. OR showed a greater likelihood for DRA among women reporting heavy lifting ≥20 times weekly (OR 2.18 95% CI 1.05 to 4.52). There was no difference in reported lumbopelvic pain (p=0.10) in women with and without DRA. Conclusions Prevalence of mild DRA was high both during pregnancy and after childbirth. Women with and without DRA reported the same amount of lumbopelvic pain 12 months post partum. PMID:27324871

  16. Catheter-related complications of cancer therapy.

    PubMed

    Greene, J N

    1996-06-01

    Although the management of CVC-related infection appears complex and at times the literature seems to be contradictory, simple guidelines can direct the clinician in a stepwise fashion. Knowledge of the pathogenesis of each organism and the immune status of the host is crucial to decide whether catheter removal or retention is indicated. For example, in general, GNB bacteremia does not immediately prompt catheter removal in a neutropenic patient but does in a nonneutropenic host because of the gastrointestinal source of the former and a primary catheter source in the latter. In summary, as more CVCs are inserted in patients undergoing chemotherapeutic, antimicrobial, transfusional, and nutritional supportive care, novel approaches to prevention and treatment of the associated infectious complications inherent with such devices are needed. A multifaceted approach from impregnated catheters to local catheter-site antisepsis was reviewed. We may find, however, that as simple handwashing between patients is crucial to infection control, so too is a trained catheter-care team using total barrier precautions and ensuring proper local catheter maintenance critical to preventing CVC-related infections.

  17. Principles of tunneled cuffed catheter placement.

    PubMed

    Heberlein, Wolf

    2011-12-01

    Tunneled cuffed catheters provide reliable and instant long-term intravenous access for a large variety of therapeutic purposes, including chemotherapy, parenteral nutrition, and apheresis. The most frequent application is for patients with renal failure as an access device for hemodialysis. In this capacity, the rate of catheter use has remained stable in the United States, despite the promotion of arteriovenous fistulas and arteriovenous grafts. The latter 2 procedures achieve superior longevity and much higher cost-efficiency. Tunneled catheters, however, serve as bridging devices during maturation of newly placed arteriovenous fistulas or as the final option in patients in whom fistulas and grafts have failed. High-quality vascular access is a hallmark of interventional radiology, and its significance for patient care and for our specialty cannot be overestimated. Familiarity with basic concepts of the device and procedural techniques are crucial to achieve successful long-term venous access. The following article demonstrates key concepts of tunneled venous catheter placement by means of dialysis, inasmuch as dialysis catheters represent the most commonly placed tunneled central venous catheters. The principles of placement and techniques utilized, however, are applicable to devices that are used for chemotherapy or parenteral nutrition, such as the Hickman, Broviac, Groshong, or tunneled peripherally inserted central catheters.

  18. [Multifunctional testing of PTCA balloon catheters].

    PubMed

    Kraft, M; Schmitz, H; Schulte, R; Boenick, U

    2000-06-01

    New in vitro measuring methods for balloon catheters used for percutaneous transluminal coronary angioplasty (PTCA) and their verification in a complex test device are presented. This system can mimic all relevant application situations. The central element of the test device is a coronary vessel model matching the physiological situation in terms of geometrical structure and frictional properties. Reactive force sensors are used to measure the application-relevant forces exerted by the catheter on the model vessel walls and accessories, such as guide wire and guiding catheter. To generate a kink-free advancement of the catheter and permit measurement of the active forces, an alternating drive unit has been specially developed. The testing and application of the newly developed methods revealed statistically significant differences between various types of catheter. The test device closes a gap between complex but subjective clinical tests, and individual objective, but application-removed in vitro test setups for PTCA catheters. While the initial prototype had shortcomings with regard to the reproducibility of measurements, successor systems developed for industrial use are now in production. The properties of these measuring systems developed for the benefit of manufacturer and reprocessor of PTCA catheters are discussed.

  19. ATLS: Catheter and tube placement

    NASA Technical Reports Server (NTRS)

    Gosbee, John; Krupa, Debra T.; Pepper, L.; Orsak, Debra

    1991-01-01

    The specific objectives of this experiment are: to evaluate the rack mounted equipment and medical supplies necessary for medical procedures; to evaluate the attachments, mounting points, and inner drawer assemblies for the medical supplies; and to evaluate the procedures for performing medical scenarios. The resources available in the HMF miniracks to accomplish medical scenarios and/or procedures include: medical equipment mounted in the racks; a patch panel with places to attach tubing and catheters; self contained drawers full of critical care medical supplies; and an ALS 'backpack' for deploying supplies. The attachment lines, tubing and associated medical supplies will be deployed and used with the equipment and a patient mannequin. Data collection is provided by direct observations by the inflight experimenters, and analysis of still and video photography.

  20. Catheters for optical coherence tomography

    NASA Astrophysics Data System (ADS)

    Atif, M.; Ullah, H.; Hamza, M. Y.; Ikram, M.

    2011-09-01

    The objective of this review article is to overview technology, clinical evidence, and future applications to date optical coherence tomography (OCT) probes to yield the diagnostic purpose. We have reviewed the designing, construction and working of different categories of OCT probes developed for optical diagnostics having a potential for non invasive and improved detection of different types of cancer as well as other neoplasm. Rotational and balloon catheters, imaging needles and hand-held, linear scanning, multichannel, micro electro mechanical systems (MEMS) technology based, dynamic focusing, forward view imaging, and common path interferometer based probes have been discussed in details. The fiber probes have shown excellent performance for two dimensional and three dimensional higher resolution, cross-sectional imaging of interior and exterior body tissues that can be compared with histopathology to provide the information about the angiogenesis and other lesions in the tissue. The MEMS-technology based probes are found to be more suitable for three dimensional morphological imaging.

  1. 21 CFR 870.1210 - Continuous flush catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1210 Continuous flush catheter. (a) Identification. A continuous flush catheter is an attachment to a catheter-transducer system... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Continuous flush catheter. 870.1210 Section...

  2. 21 CFR 870.1210 - Continuous flush catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1210 Continuous flush catheter. (a) Identification. A continuous flush catheter is an attachment to a catheter-transducer system... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Continuous flush catheter. 870.1210 Section...

  3. 21 CFR 870.1210 - Continuous flush catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1210 Continuous flush catheter. (a) Identification. A continuous flush catheter is an attachment to a catheter-transducer system... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Continuous flush catheter. 870.1210 Section...

  4. 21 CFR 870.1210 - Continuous flush catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1210 Continuous flush catheter. (a) Identification. A continuous flush catheter is an attachment to a catheter-transducer system... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Continuous flush catheter. 870.1210 Section...

  5. 21 CFR 870.1210 - Continuous flush catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1210 Continuous flush catheter. (a) Identification. A continuous flush catheter is an attachment to a catheter-transducer system... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Continuous flush catheter. 870.1210 Section...

  6. Early removal of urinary catheters in patients with thoracic epidural catheters.

    PubMed

    Tripepi-Bova, Kathleen A; Sun, Zhiyuan; Mason, David; Albert, Nancy M

    2013-01-01

    The purpose of this study was to determine whether early removal of urinary catheters in patients with thoracic epidurals resulted in urinary retention (>500 mL by bladder scanner). Patients were given up to 8 hours to void before further intervention. Of 61 patients, only 4 (6.6%) required urinary catheter reinsertion due to urinary retention. Early removal of urinary catheters after thoracic surgery in patients with thoracic epidurals was safe, with minimal urinary retention.

  7. Management and visualization of a kinked epidural catheter

    PubMed Central

    Aslanidis, T; Fileli, A; Pyrgos, P

    2010-01-01

    A lumbar epidural catheter inserted in a 29-year-old woman for labor analgesia. The catheter failed to provide adequate analgesia. Moreover, after labor, it proved difficult to be removed. After computer tomography (CT) and magnetic resonance impedance (MRI) examination the course of the catheter was visible, the entrapped catheter was dislodged intact, revealing a kinking near its distal tip. Kinking of an epidural catheter leading to entrapment is an unusual complication of epidural catheterization. PMID:21311644

  8. Antimicrobial-impregnated catheters for the prevention of catheter-related bloodstream infections.

    PubMed

    Lorente, Leonardo

    2016-05-04

    Central venous catheters are commonly used in critically ill patients. Such catheterization may entail mechanical and infectious complications. The interest in catheter-related infection lies in the morbidity, mortality and costs that it involved. Numerous contributions have been made in the prevention of catheter-related infection and the current review focuses on the possible current role of antimicrobial impregnated catheters to reduce catheter-related bloodstream infections (CRBSI). There is evidence that the use of chlorhexidine-silver sulfadiazine (CHSS), rifampicin-minocycline, or rifampicin-miconazol impregnated catheters reduce the incidence of CRBSI and costs. In addition, there are some clinical circumstances associated with higher risk of CRBSI, such as the venous catheter access and the presence of tracheostomy. Current guidelines for the prevention of CRBSI recommended the use of a CHSS or rifampicin-minocycline impregnated catheter in patients whose catheter is expected to remain in place > 5 d and if the CRBSI rate has not decreased after implementation of a comprehensive strategy to reduce it.

  9. Prevention of central venous catheter-related infections: what works other than impregnated or coated catheters?

    PubMed

    Mermel, Leonard A

    2007-06-01

    Catheter-related bloodstream infections (CRBSI) are a significant cause of morbidity and excess hospital cost. Data from prospective, randomized trials demonstrate that the risk of these infections can be minimized by simple interventions. Changing the behaviour of healthcare workers who insert and care for intravascular catheters is imperative. Creating a culture of patient safety and assuring easy access to the products necessary to maintain strict asepsis during catheter insertion, dressing changes, and when manipulating catheter hubs, will enhance adherence to optimal practice and will reduce the risk posed to the millions of patients in need of such devices.

  10. Antimicrobial-impregnated catheters for the prevention of catheter-related bloodstream infections

    PubMed Central

    Lorente, Leonardo

    2016-01-01

    Central venous catheters are commonly used in critically ill patients. Such catheterization may entail mechanical and infectious complications. The interest in catheter-related infection lies in the morbidity, mortality and costs that it involved. Numerous contributions have been made in the prevention of catheter-related infection and the current review focuses on the possible current role of antimicrobial impregnated catheters to reduce catheter-related bloodstream infections (CRBSI). There is evidence that the use of chlorhexidine-silver sulfadiazine (CHSS), rifampicin-minocycline, or rifampicin-miconazol impregnated catheters reduce the incidence of CRBSI and costs. In addition, there are some clinical circumstances associated with higher risk of CRBSI, such as the venous catheter access and the presence of tracheostomy. Current guidelines for the prevention of CRBSI recommended the use of a CHSS or rifampicin-minocycline impregnated catheter in patients whose catheter is expected to remain in place > 5 d and if the CRBSI rate has not decreased after implementation of a comprehensive strategy to reduce it. PMID:27152256

  11. Management of catheter-related infection.

    PubMed

    Pagani, Jean-Luc; Eggimann, Philippe

    2008-02-01

    Nosocomial infections related to the development of catheter-related infections are a leading cause of morbidity and mortality among critically ill hospitalized patients. Despite important preventive efforts, these infections remain a daily concern for most clinicians. Significant improvements in the knowledge of their pathophysiology and diagnosis allow us to treat them more efficiently. Current practices, such as guidewire exchange of catheters suspected to be the source of clinical sepsis, are supported by indirect evidence only. Infected catheters should systematically be removed, but some of them may be salved by combining systemic and antibiotic-lock treatment. After reviewing some specific therapeutic aspects, we suggest a practical approach to manage catheter-related infections.

  12. Designing a catheter skills training programme.

    PubMed

    Logan, Karen

    Karen Logan describes how a team of continence advisers designed and implemented a training programme that allows local nurses to meet the national occupational standards and competencies in catheterisation and catheter care.

  13. Peripherally inserted central catheter - dressing change

    MedlinePlus

    PICC - dressing change ... You have a peripherally inserted central catheter (PICC). This is a tube that goes into a vein in your arm. It carries nutrients and medicines into your body. It may also ...

  14. FAQs about Catheter-Associated Bloodstream Infections

    MedlinePlus

    ... several weeks. A bloodstream infection can occur when bacteria or other germs travel down a “central line” and enter the blood. If you develop a catheter-associated blood- stream infection you may become ill with fevers and ...

  15. 21 CFR 882.4100 - Ventricular catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...) Identification. A ventricular catheter is a device used to gain access to the cavities of the brain for injection of material into, or removal of material from, the brain. (b) Classification. Class II...

  16. 21 CFR 882.4100 - Ventricular catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...) Identification. A ventricular catheter is a device used to gain access to the cavities of the brain for injection of material into, or removal of material from, the brain. (b) Classification. Class II...

  17. 21 CFR 882.4100 - Ventricular catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...) Identification. A ventricular catheter is a device used to gain access to the cavities of the brain for injection of material into, or removal of material from, the brain. (b) Classification. Class II...

  18. 21 CFR 882.4100 - Ventricular catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...) Identification. A ventricular catheter is a device used to gain access to the cavities of the brain for injection of material into, or removal of material from, the brain. (b) Classification. Class II...

  19. 21 CFR 882.4100 - Ventricular catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...) Identification. A ventricular catheter is a device used to gain access to the cavities of the brain for injection of material into, or removal of material from, the brain. (b) Classification. Class II...

  20. Advanced Imaging Catheter: Final Project Report

    SciTech Connect

    Krulevitch, P; Colston, B; DaSilva, L; Hilken, D; Kluiwstra, J U; Lee, A P; London, R; Miles, R; Schumann, D; Seward, K; Wang, A

    2001-07-20

    Minimally invasive surgery (MIS) is an approach whereby procedures conventionally performed with large and potentially traumatic incisions are replaced by several tiny incisions through which specialized instruments are inserted. Early MIS, often called laparoscopic surgery, used video cameras and laparoscopes to visualize and control the medical devices, which were typically cutting or stapling tools. More recently, catheter-based procedures have become a fast growing sector of all surgeries. In these procedures, small incisions are made into one of the main arteries (e.g. femoral artery in the thigh), and a long thin hollow tube is inserted and positioned near the target area. The key advantage of this technique is that recovery time can be reduced from months to a matter of days. In the United States, over 700,000 catheter procedures are performed annually representing a market of over $350 million. Further growth in this area will require significant improvements in the current catheter technology. In order to effectively navigate a catheter through the tortuous vessels of the body, two capabilities must exist: imaging and positioning. In most cases, catheter procedures rely on radiography for visualization and manual manipulation for positioning of the device. Radiography provides two-dimensional, global images of the vasculature and cannot be used continuously due to radiation exposure to both the patient and physician. Intravascular ultrasound devices are available for continuous local imaging at the catheter tip, but these devices cannot be used simultaneously with therapeutic devices. Catheters are highly compliant devices, and manipulating the catheter is similar to pushing on a string. Often, a guide wire is used to help position the catheter, but this procedure has its own set of problems. Three characteristics are used to describe catheter maneuverability: (1) pushability -- the amount of linear displacement of the distal end (inside body) relative to

  1. Catheter-directed interventions for pulmonary embolism

    PubMed Central

    Zarghouni, Mehrzad; Charles, Hearns W.; Maldonado, Thomas S.

    2016-01-01

    Pulmonary embolism (PE), a potentially life-threatening entity, can be treated medically, surgically, and percutaneously. In patients with right ventricular dysfunction (RVD), anticoagulation alone may be insufficient to restore cardiac function. Because of the morbidity and mortality associated with surgical embolectomy, clinical interest in catheter-directed interventions (CDI) has resurged. We describe specific catheter-directed techniques and the evidence supporting percutaneous treatments. PMID:28123985

  2. Evaluation of antiseptic-impregnated central venous catheters for prevention of catheter-related infection in intensive care unit patients.

    PubMed

    Sheng, W H; Ko, W J; Wang, J T; Chang, S C; Hsueh, P R; Luh, K T

    2000-09-01

    Central venous catheterization represents a significant medical advancement, particularly in the treatment of critical ill. However, there is a high risk of central venous catheters-related infection. A novel antiseptic central venous catheter, made of polyurethane and impregnated with chlorhexidine and silver sulfadiazine, was developed to reduce the risk of catheters-related infection. In this study, we did a randomized clinical study to determine the efficacy by using antiseptic catheters for the prevention of central venous catheters-related infection in the intensive care units. A total of 204 patients with 235 central venous catheters were studied at the surgical intensive care units at National Taiwan University Hospital between November 1998 and June 1999. Participants received either a standard triple-lumen polyurethane catheter or an antiseptic catheter (Arrow International, Reading, Pennsylvania, USA). Both were indistinguishable from each other. Compared to standard polyurethane catheters, antiseptic catheters were less likely to be colonized by microorganisms when they were cultured at the removal (8.0 versus 20.0 colonized catheters per 100 catheters; relative risk 0.34 [95% CI, 0.15 to 0.74]; p<0.01). There was no significant differences between both groups in catheter-related infections (0.9 versus 4.9 infections per 100 catheters; relative risk 0.17 [95% CI, 0.03 to 1.15]; p = 0.07). Gram-positive cocci and fungi were more likely to colonize in the standard polyurethane catheters (p = 0.06 and 0.04, compared to antiseptic catheters respectively). Two of our cases in the control group died directly due to catheter-related candidemia. No adverse reactions such as hypersensitivity or leukopenia were found in the antiseptic catheter group. Our study showed that central venous catheters with antiseptic coating were safe and had less risk of colonization of bacteria and fungi than standard catheters in the critically ill patients.

  3. MR-trackable intramyocardial injection catheter.

    PubMed

    Karmarkar, P V; Kraitchman, D L; Izbudak, I; Hofmann, L V; Amado, L C; Fritzges, D; Young, R; Pittenger, M; Bulte, J W M; Atalar, E

    2004-06-01

    There is growing interest in delivering cellular agents to infarcted myocardium to prevent postinfarction left ventricular remodeling. MRI can be effectively used to differentiate infarcted from healthy myocardium. MR-guided delivery of cellular agents/therapeutics is appealing because the therapeutics can be precisely targeted to the desired location within the infarct. In this study, a steerable intramyocardial injection catheter that can be actively tracked under MRI was developed and tested. The components of the catheter were arranged to form a loopless RF antenna receiver coil that enabled active tracking. Feasibility studies were performed in canine and porcine myocardial infarction models. Myocardial delayed-enhancement (MDE) imaging identified the infarcted myocardium, and real-time MRI was used to guide left ventricular catheterization from a carotid artery approach. The distal 35 cm of the catheter was seen under MRI with a bright signal at the distal tip of the catheter. The catheter was steered into position, the distal tip was apposed against the infarct, the needle was advanced, and a bolus of MR contrast agent and tissue marker dye was injected intramyocardially, as confirmed by imaging and postmortem histology. A pilot study involving intramyocardial delivery of magnetically labeled stem cells demonstrated the utility of the active injection catheter system.

  4. Comparison of a Balloon Guide Catheter and a Non-Balloon Guide Catheter for Mechanical Thrombectomy.

    PubMed

    Velasco, Aglaé; Buerke, Boris; Stracke, Christian P; Berkemeyer, Shoma; Mosimann, Pascal J; Schwindt, Wolfram; Alcázar, Pedro; Cnyrim, Christian; Niederstadt, Thomas; Chapot, René; Heindel, Walter

    2016-07-01

    Purpose To evaluate the effectiveness of mechanical thrombectomy with the use of a stent retriever in acute ischemic stroke, performed by using a balloon guide catheter or non-balloon guide catheter. Materials and Methods In accordance with the institutional review board approval obtained at the two participating institutions, retrospective analysis was performed in 183 consecutive patients treated between 2013 and 2014 for occlusions in the middle cerebral artery or carotid terminus by using a stent retriever with a balloon guide catheter (n = 102) at one center and a non-balloon guide catheter (n = 81) at the other center. Data on procedure duration, number of passes, angiographic findings, type of stent retriever used, and expertise of the operators were collected. Successful recanalization was defined as grade 3 or 2b modified Treatment in Cerebral Ischemia recanalization accomplished in up to three passes. Univariate and multivariate subgroup analyses were conducted to control for the confounding variables of prior thrombolysis, location of occlusion, and operator expertise. Results Successful recanalization with the balloon guide catheter was achieved in 89.2% of thrombectomies (91 of 102) versus 67.9% (55 of 81) achieved with the non-balloon guide catheter (P = .0004). The one-pass thrombectomy rate with the balloon guide catheter was significantly higher than for that with the non-balloon guide catheter (63.7% [65 of 102] vs 35.8% [29 of 81], respectively; P = .001). The procedure duration was significantly shorter by using the balloon guide catheter than the non-balloon guide catheter (median, 20.5 minutes vs 41.0 minutes, respectively; P < .0001). Conclusion The effectiveness of mechanical thrombectomy with stent retrievers in acute ischemic stroke in the anterior circulation in terms of angiographic results and procedure duration was improved when performed in combination with the balloon guide catheter. (©) RSNA, 2016.

  5. EFFECTS OF 2-PAM AND EA 1814 ON NEUROMUSCULAR TRANSMISSION. I. EFFECTS OF 2-PAM AND EA 1814 ON THE FROG RECTUS ABDOMINIS MUSCLE PREPARATION

    DTIC Science & Technology

    Contracture of the isolated frog Rectus abdominis muscle was used to study pharmacological properties of 2-PAM (2-pyridine aldoxime methiodide) and...example, concentrations of 2-PAM in excess of 4 x 10 to the -5th power M potentiate contractures of the frog rectus muscle elicited by acetylcholine...2-PAM inhibits the response to the depolarizing agents, decamethonium and carbamylcholine, which are not susceptible to hydrolysis by the ChE of frog

  6. Evaluation of three-dimensional printing for internal fixation of unstable pelvic fracture from minimal invasive para-rectus abdominis approach: a preliminary report

    PubMed Central

    Zeng, Canjun; Xiao, Jidong; Wu, Zhanglin; Huang, Wenhua

    2015-01-01

    Objective: The aim of this study is to evaluate the efficacy and feasibility of three-dimensional printing (3D printing) assisted internal fixation of unstable pelvic fracture from minimal invasive para-rectus abdominis approach. Methods: A total of 38 patients with unstable pelvic fractures were analyzed retrospectively from August 2012 to February 2014. All cases were treated operatively with internal fixation assisted by three-dimensional printing from minimal invasive para-rectus abdominis approach. Both preoperative CT and three-dimensional reconstruction were performed. Pelvic model was created by 3D printing. Data including the best entry points, plate position and direction and length of screw were obtained from simulated operation based on 3D printing pelvic model. The diaplasis and internal fixation were performed by minimal invasive para-rectus abdominis approach according to the optimized dada in real surgical procedure. Matta and Majeed score were used to evaluate currative effects after operation. Results: According to the Matta standard, the outcome of the diaplasis achieved 97.37% with excellent and good. Majeed assessment showed 94.4% with excellent and good. The imageological examination showed consistency of internal fixation and simulated operation. The mean operation time was 110 minutes, mean intraoperative blood loss 320 ml, and mean incision length 6.5 cm. All patients have achieved clinical healing, with mean healing time of 8 weeks. Conclusion: Three-dimensional printing assisted internal fixation of unstable pelvic fracture from minimal invasive para-rectus abdominis approach is feasible and effective. This method has the advantages of trauma minimally, bleeding less, healing rapidly and satisfactory reduction, and worthwhile for spreading in clinical practice. PMID:26550226

  7. Do various baseline characteristics of transversus abdominis and lumbar multifidus predict clinical outcomes in nonspecific low back pain? A systematic review.

    PubMed

    Wong, Arnold Y L; Parent, Eric C; Funabashi, Martha; Stanton, Tasha R; Kawchuk, Gregory N

    2013-12-01

    Although individual reports suggest that baseline morphometry or activity of transversus abdominis or lumbar multifidus predict clinical outcome of low back pain (LBP), a related systematic review is unavailable. Therefore, this review summarized evidence regarding the predictive value of these muscular characteristics. Candidate publications were identified from 6 electronic medical databases. After review, 5 cohort studies were included. Although this review intended to encompass studies using different muscle assessment methods, all included studies coincidentally used ultrasound imaging. No research investigated the relation between static morphometry and clinical outcomes. Evidence synthesis showed limited evidence supporting poor baseline transversus abdominis contraction thickness ratio as a treatment effect modifier favoring motor control exercise. Limited evidence supported that high baseline transversus abdominis lateral slide was associated with higher pain intensity after various exercise interventions at 1-year follow-up. However, there was limited evidence for the absence of relation between the contraction thickness ratio of transversus abdominis or anticipatory onset of lateral abdominal muscles at baseline and the short- or long-term LBP intensity after exercise interventions. There was conflicting evidence for a relation between baseline percent thickness change of lumbar multifidus during contraction and the clinical outcomes of patients after various conservative treatments. Given study heterogeneity, the small number of included studies and the inability of conventional greyscale B-mode ultrasound imaging to measure muscle activity, our findings should be interpreted with caution. Further large-scale prospective studies that use appropriate technology (ie, electromyography to assess muscle activity) should be conducted to investigate the predictive value of morphometry or activity of these muscles with respect to LBP-related outcomes measures.

  8. [Appropriate and inappropriate use of indwelling urinary catheters].

    PubMed

    Janzen, Jolien; Geerlings, Suzanne E

    2012-01-01

    Many hospitalized patients receive a urinary catheter during their stay. In 21-54% of patients, however, there is no appropriate indication for this. The most significant complication caused by the use of urinary catheters is the development of a urinary tract infection (UTI), one of the most common nosocomial infections. In 71-80% of hospital acquired UTIs a urinary catheter is present. The duration of the presence of a catheter is the major risk factor for catheter-associated UTI. Reducing the number of inappropriate catheterisations is an effective way of preventing catheter-related UTIs. Inappropriate use of indwelling urinary catheters can be reduced by maintaining strict guidelines on justifiable indications for inserting a urinary catheter, verifying daily whether the indication still applies, and by timely removal of the catheter when it is not or no longer needed.

  9. Antibiotic lock for treatment of tunneled hemodialysis catheter bacteremia.

    PubMed

    Maya, Ivan D

    2008-01-01

    Catheter-related bacteremia is a major cause of morbidity and mortality among catheter-dependent hemodialysis patients. Microorganism biofilm matrix formation in the catheter is the pathogenic process of this entity. Administration of systemic antibiotics and removal of the offending catheter is the most logical treatment. This article discusses an alternative option, instillation of an antibiotic-lock solution into the lumen of the catheter plus systemic antibiotic therapy. Recent studies suggest that this strategy could treat the infection and salvage the catheter, thus avoiding the need for further interventional procedures including but not limited to the removal of the catheter, placement of a temporary catheter, and finally placement of a new permanent catheter. The implementation of this effective approach will reduce morbidity and possibly reduce the cost and interventions associated with it.

  10. Reducing inappropriate urinary catheter use: quality care initiatives.

    PubMed

    Buckley, Catherine; Clements, Charlotte; Hopper, Adrian

    Healthcare-acquired urinary infection presents a substantial burden for patients and the healthcare system. Urinary tract infections have not gained the same level of media attention as other healthcare-associated infections, yet interventions to reduce urinary catheter use are one of the top ten recommended patient safety strategies. To improve practice around urinary catheter placement and removal requires interventions to change the expectations and habits of nurses, medical teams and patients regarding the need for a urinary catheter. In the authors' trust, a redesign of the existing urinary catheter device record was undertaken to help avoid unnecessary placement of catheters, and resulted in a reduction of urinary catheters in situ longer than 48 hours. Other strategies included implementation of catheter rounds in a high-usage area, and credit-card-sized education cards. A catheter 'passport' was introduced for patients discharged with a catheter to ensure information for insertion and ongoing use were effectively communicated.

  11. Practical approach to catheter-related bloodstream infections in paediatrics

    PubMed Central

    Robinson, Joan

    2005-01-01

    Catheter-related bloodstream infections (CRBIs) are a common problem in paediatrics. Sterile insertion and proper care of the catheter is likely more important than the type of catheter in determining the rate of CRBIs. The accuracy of the diagnosis of CRBIs can be improved by comparing the time to positivity or the concentration of organisms in blood drawn through the catheter with blood drawn from other sites, or by changing the catheter over a guidewire and culturing the removed catheter. When a CRBI is suspected, the catheter should be removed if it is no longer required, the child is hemodynamically unstable, there are metastatic foci of infection, the infecting organism is Candida or a mycobacterium, or there is a tunnel infection. The necessity for catheter removal is controversial if the infecting organism is Staphylococcus aureus or a Gram-negative organism. In most other situations, the catheter only needs to be removed if bacteremia persists despite appropriate antibiotic use. PMID:19668658

  12. Uptake of drugs by catheters: the influence of the drug molecule on sorption by polyurethane catheters.

    PubMed

    Smith, J C; Davies, M C; Melia, C D; Denyer, S P; Derrick, M R

    1996-08-01

    The sorption of drugs by indwelling intravenous catheters may have clinical consequences both by alteration of the dose received by the patient and by physically affecting the catheter materials themselves which may lead to changes in mechanical properties and biocompatibility. Studies of drug sorption to new catheter materials are therefore important. Pellethane, a polyurethane increasingly used in vascular access catheters, is as yet little studied in terms of its capacity for drug sorption. In this work a range of drugs known to be sorbed by PVC infusion sets were studied with respect to their sorption by Pellethane catheters. Standard lengths of catheter were incubated with solutions of drugs and samples of the solution were taken at intervals, assayed spectrophotometrically and compared with control solutions incubated without catheter. Losses from solution of up to 93% were found after 24 h. A series of highly sorbing and clinically relevant drugs was identified and their uptake was studied until equilibrium had been reached. A correlation was evident between the octanol/water partition coefficient and the fraction of drug taken up from solution at equilibrium, with the more hydrophobic drugs being taken up to a greater extent by the catheter.

  13. Dual-Mode IVUS Catheter for Intracranial Image-Guided Hyperthermia: Feasibility Study

    PubMed Central

    Herickhoff, Carl D.; Grant, Gerald A.; Britz, Gavin W.; Smith, Stephen W.

    2010-01-01

    In this study, we investigated the feasibility of modifying 3-Fr IVUS catheters in several designs to potentially achieve minimally-invasive, endovascular access for image-guided ultrasound hyperthermia treatment of tumors in the brain. Using a plane wave approximation, target frequencies of 8.7 and 3.5 MHz were considered optimal for heating at depths (tumor sizes) of 1 and 2.5 cm, respectively. First, a 3.5-Fr IVUS catheter with a 0.7-mm diameter transducer (30 MHz nominal frequency) was driven at 8.6 MHz. Second, for a low-frequency design, a 220-μm-thick, 0.35 × 0.35-mm PZT-4 transducer—driven at width-mode resonance of 3.85 MHz—replaced a 40-MHz element in a 3.5-Fr coronary imaging catheter. Third, a 5 × 0.5-mm PZT-4 transducer was evaluated as the largest aperture geometry possible for a flexible 3-Fr IVUS catheter. Beam plots and on-axis heating profiles were simulated for each aperture, and test transducers were fabricated. The electrical impedance, impulse response, frequency response, maximum intensity, and mechanical index were measured to assess performance. For the 5 × 0.5-mm transducer, this testing also included mechanically scanning and reconstructing an image of a 2.5-cm-diameter cyst phantom as a preliminary measure of imaging potential. PMID:21041144

  14. Bradycardia during Transradial Cardiac Catheterization due to Catheter Manipulation: Resolved by Catheter Removal

    PubMed Central

    Kumar, Vishesh; Stys, Adam

    2017-01-01

    Purpose. To report the resolution of bradycardia encountered during transradial cardiac catheterization through the catheter pullback technique in two cases. Case Report. A 62-year-old male and an 81-year-old male underwent coronary angiogram to evaluate for coronary artery disease and as a result of positive stress test, respectively. Upon engagement of the FL 3.5 catheter into the ascending aorta through the transradial approach, the first case developed bradycardia with a heart rate of 39 beats per minute. The second case developed profound bradycardia with a heart rate of 25 beats per minute upon insertion of the 5 Fr FL 3.5 catheter near the right brachiocephalic trunk through the right radial access. Conclusion. Bradycardia can be subsided by removal of the catheter during catheter manipulation in patients undergoing transradial coronary angiogram if there is a suspicion of excessive stretching of aortic arch receptors and/or carotid sinus receptors. PMID:28348915

  15. Fourier plane imaging microscopy

    SciTech Connect

    Dominguez, Daniel Peralta, Luis Grave de; Alharbi, Nouf; Alhusain, Mdhaoui; Bernussi, Ayrton A.

    2014-09-14

    We show how the image of an unresolved photonic crystal can be reconstructed using a single Fourier plane (FP) image obtained with a second camera that was added to a traditional compound microscope. We discuss how Fourier plane imaging microscopy is an application of a remarkable property of the obtained FP images: they contain more information about the photonic crystals than the images recorded by the camera commonly placed at the real plane of the microscope. We argue that the experimental results support the hypothesis that surface waves, contributing to enhanced resolution abilities, were optically excited in the studied photonic crystals.

  16. Experience of robotic catheter ablation in humans using a novel remotely steerable catheter sheath

    PubMed Central

    Wallace, Daniel T.; Goldenberg, Alex S.; Peters, Nicholas S.; Davies, D. Wyn

    2008-01-01

    Background A novel remotely controlled steerable guide catheter has been developed to enable precise manipulation and stable positioning of any eight French (Fr) or smaller electrophysiological catheter within the heart for the purposes of mapping and ablation. Objective To report our initial experience using this system for remotely performing catheter ablation in humans. Methods Consecutive patients attending for routine ablation were recruited. Various conventional diagnostic catheters were inserted through the left femoral vein in preparation for treating an accessory pathway (n = 1), atrial flutter (n = 2) and atrial fibrillation (n = 7). The steerable guide catheter was inserted into the right femoral vein through which various irrigated and non-irrigated tip ablation catheters were used. Conventional endpoints of loss of pathway conduction, bidirectional cavotricuspid isthmus block and four pulmonary vein isolation were used to determine acute procedural success. Results Ten patients underwent remote catheter ablation using conventional and/or 3D non-fluoroscopic mapping technologies. All procedural endpoints were achieved using the robotic control system without manual manipulation of the ablation catheter. There was no major complication. A radiation dosimeter positioned next to the operator 2.7 m away from the X-ray source showed negligible exposure despite a mean cumulative dose area product of 7,281.4 cGycm2 for all ten ablation procedures. Conclusions Safe and clinically effective remote navigation of ablation catheters can be achieved using a novel remotely controlled steerable guide catheter in a variety of arrhythmias. The system is compatible with current mapping and ablation technologies Remote navigation substantially reduces radiation exposure to the operator. Electronic supplementary material The online version of this article (doi:10.1007/s10840-007-9184-z) contains supplementary material, which is available to authorized users

  17. Midline catheters: the middle ground of intravenous therapy administration.

    PubMed

    Anderson, N Richard

    2004-01-01

    Evangelical Community Hospital at Lewisburg, Pennsylvania, is a small community hospital with 110 beds. This organization sought a device to bridge between the short peripheral catheter and the peripherally inserted central catheter. The midline catheter provided an answer to this dilemma. However, a literature search for midline catheters yielded only four published articles, and only one of these was related to outcomes. The drugs used and the type of patients treated at Evangelical Community Hospital provided a challenge for the infusion therapist. This article examines the management of the patients who fell into a midlength of stay, and for whom both the short peripheral catheter and the peripherally inserted central catheter were inappropriate.

  18. Malfunctioning central venous catheters in children: a diagnostic approach

    PubMed Central

    Barnacle, Alex; Arthurs, Owen J.; Roebuck, Derek

    2007-01-01

    Central venous access is increasingly becoming the domain of the radiologist, both in terms of the insertion of central venous catheters (CVCs) and in the subsequent management of these lines. This article seeks to provide an overview of the CVC types available for paediatric patients and a more detailed explanation of the spectrum of complications that may lead to catheter malfunction. A standard catheter contrast study or ‘linogram’ technique is described. The normal appearances of such a study and a detailed pictorial review of abnormal catheter studies are provided, together with a brief overview of how information from catheter investigations can guide the management of catheter complications. PMID:17932667

  19. Intravenous catheter for intracorporeal plasma filtration.

    PubMed

    Handley, Harold H; Gorsuch, Rey; Levin, Nathan W; Ronco, Claudio

    2002-01-01

    Future advances in dialysis of end-stage renal disease patients may include improvements in therapeutic continuity and patient mobility. Continuous renal replacement therapies could lead to self-contained, mobile and potentially wearable dialysis units. We investigated an experimental, intravenous slow-continuous plasma separation system (IPSS) as a precursor to direct intravenous hemofiltration. An intracorporeal catheter employs asymmetric hollow fibers to separate blood cells from plasma in vivo. The fibers possess a sieving coefficient of 0.7 microm and remove 99.99% of all platelets. In vivo, catheters sustain an average plasma separation flow rate of 3 ml/min over 22 h, sufficient to remove 2 net liters of water from pigs through an extracorporeal hemofilter. Used catheter fibers are relatively free of protein deposition or clots in situ. In vitro studies suggest that human catheters may perform at 3-4 times the rate of porcine catheters. IPSS is proposed for acute fluid removal in CHF patients refractory to diuretics.

  20. Nonholonomic catheter path reconstruction using electromagnetic tracking

    NASA Astrophysics Data System (ADS)

    Lugez, Elodie; Sadjadi, Hossein; Akl, Selim G.; Fichtinger, Gabor

    2015-03-01

    Catheter path reconstruction is a necessary step in many clinical procedures, such as cardiovascular interventions and high-dose-rate brachytherapy. To overcome limitations of standard imaging modalities, electromagnetic tracking has been employed to reconstruct catheter paths. However, tracking errors pose a challenge in accurate path reconstructions. We address this challenge by means of a filtering technique incorporating the electromagnetic measurements with the nonholonomic motion constraints of the sensor inside a catheter. The nonholonomic motion model of the sensor within the catheter and the electromagnetic measurement data were integrated using an extended Kalman filter. The performance of our proposed approach was experimentally evaluated using the Ascension's 3D Guidance trakStar electromagnetic tracker. Sensor measurements were recorded during insertions of an electromagnetic sensor (model 55) along ten predefined ground truth paths. Our method was implemented in MATLAB and applied to the measurement data. Our reconstruction results were compared to raw measurements as well as filtered measurements provided by the manufacturer. The mean of the root-mean-square (RMS) errors along the ten paths was 3.7 mm for the raw measurements, and 3.3 mm with manufacturer's filters. Our approach effectively reduced the mean RMS error to 2.7 mm. Compared to other filtering methods, our approach successfully improved the path reconstruction accuracy by exploiting the sensor's nonholonomic motion constraints in its formulation. Our approach seems promising for a variety of clinical procedures involving reconstruction of a catheter path.

  1. [Indications for catheter ablation of ventricular tachycardia].

    PubMed

    Deneke, T; Israel, C W; Krug, J; Nentwich, K; Müller, P; Mügge, A; Schade, A

    2013-09-01

    Ventricular tachyarrhythmias (VT) can cause sudden cardiac death. This can be prevented by an implantable cardioverter-defibrillator (ICD) but approximately 25% of patients with an ICD develop electrical storm (≥ 3 VTs within 24 hours) during the course of 4-5 years. This is a life-threatening event even in the presence of an ICD, particularly if incessant VT is present, and may significantly deteriorate the patient's psychological state if multiple shocks are discharged. Catheter ablation of VT has developed into a standard procedure in many specialized electrophysiology centers. Patients with hemodynamically stable and unstable VT are amendable to substrate-based ablation strategies. Catheter ablation can be performed as emergency procedure in patients with electrical storm as well as electively in patients with monomorphic VT stored in ICD memory. In patients with ischemic or non-ischemic cardiomyopathy, VT ablation is complementary to ICD implantation and can reduce the number of ventricular arrhythmia episodes and shocks and should be performed early. In patients with electrical storm, catheter ablation can acutely achieve rhythm stabilization and may improve prognosis in the long term. Further indications for catheter ablation exist in patients with idiopathic VT where catheter ablation represents a curative therapy, and in patients with symptomatic or asymptomatic frequent premature ventricular beats which may improve prognosis in patients with heart failure and cardiac resynchronization therapy.

  2. A neuromuscular strategy to prevent spinal torsion: backward perturbation alters asymmetry of transversus abdominis muscle thickness into symmetry.

    PubMed

    Kim, Yushin; Shim, Jae Kun; Son, Jaebum; Pyeon, Hyo Young; Yoon, Bumchul

    2013-06-01

    Symmetric co-contraction of the transversus abdominis (TrA) muscle is beneficial in terms of increasing trunk stability. The aim of this study was to investigate the symmetry of lateral abdominal muscle thickness during static and dynamic conditions. Fifteen male subjects (27.13 ± 5.51 years old) were instructed to sit on a chair and maintain upright posture. Every individual subject wore a jacket harness that could be backwardly attached to a 9-kg weight through a pulley system. An unexpected drop of the weight induced the transition from static to dynamic condition. The thickness of external oblique, internal oblique, and TrA muscles was measured with ultrasonography. Our results revealed more symmetry of TrA thickness during the dynamic condition (21% vs. 13%, p = 0.019) compared with the static. The symmetric muscle thickness of TrA during the dynamic condition is considered a result of more contraction on the non-dominant side. This phenomenon could be a possible strategy of deep abdominal muscles to prevent spinal torsion during sudden trunk perturbation.

  3. No Difference in Transverse Abdominis Activation Ratio between Healthy and Asymptomatic Low Back Pain Patients during Therapeutic Exercise

    PubMed Central

    Gorbet, Nathaniel; Selkow, Noelle M.; Hart, Joseph M.; Saliba, Susan

    2010-01-01

    Dysfunction of the transverse abdominis (TrA) has been associated with LBP. Several therapeutic exercises are prescribed to help target the TrA. Rehabilitative ultrasound imaging (RUSI) is used to capture activation of the TrA during exercise. The purpose was to examine TrA activation during the ADIM and quadruped exercises between healthy and nonsymptomatic LBP patients. We instructed the subjects how to perform the exercises and measured muscle thickness of the TrA at rest and during the exercises using RUSI. This allowed us to calculate TrA activation ratio during these exercises. We found no significant differences between activation ratios of the two groups during either exercise; however TrA activation during the ADIM was higher than the quadruped exercise. These exercises were capable of activating the TrA, which may be in part due to the verbal instruction they received. These exercises could be used during prevention or rehabilitation programs, since the TrA is activated. PMID:22110965

  4. [Silastic catheters: pinpointing the end tip of the catheter by means of electrocardiographic monitoring].

    PubMed

    Giraldo Lozano, L; Barjau Capdevila, M

    1997-10-01

    The placement of catheters with a silastic center has been a common procedure in neonatal intensive care units for several years. Nonetheless, this procedure, like many others, bears its risks and complications if not properly carried out. The majority of complications, which are described in medical journals, include arrhythmias, myocardiac perforations, thrombosis, hemorrhage in the pleura, etc., and these are related with the catheter and its possible movement inside the blood vessel where it was originally inserted. The usual exploratory procedure to pinpoint the end tip of the catheter has been an ordinary x-ray, but often this x-ray does not allow one to see precisely where the catheter tip is located. This problem is caused by the tiny catheter calibre which does not allow for all the necessary contrast; because of this, it is frequently necessary to administer a radiopaque contrasting sub-stance and then repeat the x-ray in order to ensure that the catheter tip is located exactly where it should be. By means of electrocardiographic monitoring, a three-pronged key with an electrode and a 5.85% sodium chloride solution, it is possible to pinpoint the end tip of the catheter without resorting to an x-ray nor administering a contrasting solution.

  5. Anatomical basis of central venous catheter fracture.

    PubMed

    Jensen, Mark O

    2008-03-01

    Central venous catheter fracture is a rare complication of long-term indwelling subclavian venous access. Subclavian vein access has been the recommended approach for placing central venous catheters. The anatomical landmark method for subclavian access remains a highly successful and nonequipment-dependent method for rapid central access. More recently, the internal jugular vein approach has emerged as the preferred route for long-term central venous access. However, variations in internal jugular vein anatomy make the landmark method less reliable. Use of two-dimensional real-time ultrasound during internal jugular vein access is associated with better success, a lower complication rate, and faster access. A case of central venous catheter fracture initiated an internal review of long-term central venous access procedures. We have converted to a predominantly internal jugular vein approach. This case report and literature review may assist other physicians and institutions in re-evaluating long-term central venous access protocols.

  6. Lesion-specific laser catheters for angioplasty

    NASA Astrophysics Data System (ADS)

    Murphy-Chutorian, Douglas

    1992-08-01

    Since no one laser catheter can treat all types of disease, a new family of `lesion-specific' devices was evaluated with a holmium laser source. Three-hundred-thirty-one patients (avg. 60 years) with symptomatic coronary disease were studied. Average lesion length was 1.2 cm. A 1.4, 1.5, 1.7, or 2.0 mm, tapered-tip or non-tapered, multifiber catheter (Eclipse, Palo Alto, Calif.) was advanced over the wire while emitting 250 - 600 mj/pulse at 5 Hz. Mean percent stenosis decreased from 89% to 57% after lasing with a mean of 140 pulses. Complications were infrequent. Overall procedural success was 95%. The conclusion is that specialized laser catheters delivering holmium laser energy are capable of reducing the severity of coronary stenoses including balloon angioplasty failures and bypass graft failures. Follow up studies are in progress to assess long term efficacy.

  7. Ambulatory setting for peritoneal dialysis catheter placement.

    PubMed

    Maya, Ivan D

    2008-01-01

    A modified fluoroscopic technique by adding ultrasound-assistance ensuring entry into the abdominal cavity and avoiding the risk of epigastric artery injury under direct ultrasound visualization was recently published. This study demonstrated that the technique was minimally invasive and allowed for accurate assessment of entry into the abdominal cavity and avoidance of vascular injury. In the current analysis, we report the impact of this technique on hospital stay during a peritoneal dialysis (PD) catheter insertion. Twenty-six PD catheters have been placed on an outpatient basis using this technique. All catheter insertions were successful. Patients were discharge on the same day of the procedure. There were no procedure-related complication or related to short hospital stay. An ambulatory setting allows for a short hospital stay without compromising patient care. This brief paper explains in detail the pre, peri and postoperative period and follow-up.

  8. Catheter tip force transducer for cardiovascular research

    NASA Technical Reports Server (NTRS)

    Feldstein, C.; Lewis, G. W.; Silver, R. H.; Culler, V. H. (Inventor)

    1976-01-01

    A force transducer for measuring dynamic force activity within the heart of a subject essentially consists of a U-shaped beam of low elastic compliance material. Two lines extend from the beams's legs and a long coil spring is attached to the beam. A strain gauge is coupled to one of the beam's legs to sense deflections thereof. The beam with the tines and most of the spring are surrounded by a flexible tube, defining a catheter, which is insertable into a subject's heart through an appropriate artery. The tines are extractable from the catheter for implantation into the myocardium by pushing on the end of the spring which extends beyond the external end of the catheter.

  9. 21 CFR 870.1230 - Fiberoptic oximeter catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... catheter. (a) Identification. A fiberoptic oximeter catheter is a device used to estimate the oxygen saturation of the blood. It consists of two fiberoptic bundles that conduct light at a desired...

  10. 21 CFR 870.1230 - Fiberoptic oximeter catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... catheter. (a) Identification. A fiberoptic oximeter catheter is a device used to estimate the oxygen saturation of the blood. It consists of two fiberoptic bundles that conduct light at a desired...

  11. 21 CFR 870.1230 - Fiberoptic oximeter catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... catheter. (a) Identification. A fiberoptic oximeter catheter is a device used to estimate the oxygen saturation of the blood. It consists of two fiberoptic bundles that conduct light at a desired...

  12. 21 CFR 870.1230 - Fiberoptic oximeter catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... catheter. (a) Identification. A fiberoptic oximeter catheter is a device used to estimate the oxygen saturation of the blood. It consists of two fiberoptic bundles that conduct light at a desired...

  13. 21 CFR 870.1230 - Fiberoptic oximeter catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... catheter. (a) Identification. A fiberoptic oximeter catheter is a device used to estimate the oxygen saturation of the blood. It consists of two fiberoptic bundles that conduct light at a desired...

  14. Intravascular magnetic resonance imaging using a loopless catheter antenna.

    PubMed

    Ocali, O; Atalar, E

    1997-01-01

    Recently, intravascular catheter probes have been developed to increase signal-to-noise ratio (SNR) for MR imaging of blood vessels. Miniaturization of these catheter probes without degrading their performances is very critical in imaging small vessels such as coronary arteries. Catheter coils have a loop incorporated in their structure and have limitations in physical dimensions and electromagnetic properties. The use of a loopless intravascular catheter antenna is proposed to overcome these problems. The catheter antenna is essentially a dipole, which makes a very thin diameter possible, and its electronic circuitry can be placed outside the blood vessels without performance degradation. The theoretical foundation for the design and operation of the catheter antenna is presented. Several catheter antennae, as small as 1.5 French, were constructed and tested on phantoms and rabbits with great success. The catheter antenna has a simple structure and is easy to design, implement, and operate.

  15. Hemodialysis catheter-associated central venous stenosis.

    PubMed

    Yevzlin, Alexander S

    2008-01-01

    The purpose of this review is to explore the pathophysiology, epidemiology, and interventional treatment of central vein stenosis (CVS) that may result from central vein catheter (CVC) placement. The precise mechanism of CVC-associated CVS remains largely undefined, though anatomic considerations appear to play a prominent pathologic role. The impact of CVC-associated CVS on arteriovenous fistula outcomes is reviewed. The percutaneous treatment of CVS, observation, angioplasty, or angioplasty with stent placement is reviewed, along with potential surgical treatment options. As the treatment outcomes of CVC-associated CVS have been disappointing, catheter avoidance remains the best strategy.

  16. Magnetic Resonance-guided Active Catheter Tracking.

    PubMed

    Wang, Wei

    2015-11-01

    Several advantages of MR imaging compared with other imaging modalities have provided the rationale for increased attention to MR-guided interventions, including its excellent soft tissue contrast, its capability to show both anatomic and functional information, and no use of ionizing radiation. An important aspect of MR-guided intervention is to provide visualization and navigation of interventional devices relative to the surrounding tissues. This article focuses on the methods for MR-guided active tracking in catheter-based interventions. Practical issues about implementation of active catheter tracking in a clinical setting are discussed and several current application examples are highlighted.

  17. [Medial venous catheter or midline (MVC)].

    PubMed

    Carrero Caballero, Ma Carmen; Montealegre Sanz, María; Cubero Pérez, Ma Antonia

    2014-01-01

    Current clinical practice is characterised for importance of the patient's quality of life and the need to reduce the costs of their treatment. We search intravenous therapy alternatives that meet the needs of the patient, reducing the complications associated with the use of venous catheters. Scientific evidence shows that there are midline venous catheters that offer patients and professionals the possibility of extending the duration of infusion therapy, using more venous compatibility materials, and with less risk of infection. The Midlines are becoming in a safe an efficient device for intravenous therapy, continuous and intermittent infusion, provided the necessary care by expert nurses. Midline catheters are peripheral venous access devices between 3 to 10 inches in length (8 to 25 cm). Midlines are usually placed in an upper arm vein, such as the brachial or cephalic, and the distal extreme ends below the level of the axillary line. Midlines catheters implanted in the cephalic or deep basilica veins get more blood flow. This large blood volume justifies the lower risk of mechanical or chemical phlebitis. Midlines are routinely used for two to six weeks. Due that the extrem of these catheters does not extend beyond the axillary line, there are limitations for its use: type of infused drugs, velocity of infusion, etc. In general, solutions that have pH 5 to 9, or an osmolarity less than 500 mOsm are appropriate for infusion through a Midline. Its use is recommended in case of treatments over 7 days with low irritant capacity fluids. According to the Infusion Nurses Society's standards of practice, Midline catheters are appropriate for all intravenous fluids that would normally be administered through a short peripheral IV Importantly, due that the catheter does not pass through the central veins, Midlines can be placed without a chest X-ray to confirm placement. For certain situations, Midlines are suitable for acute units and even for care home settings

  18. Prevention of indwelling catheter-associated urinary tract infections.

    PubMed

    Dailly, Sue

    2011-03-01

    The use of indwelling urethral catheters has become a common aspect of patient care, but they can be a source of infection. Nurses can help to prevent catheter-associated urinary tract infections by using aseptic technique on insertion, following best practice in ongoing care and promptly removing catheters. The urinary catheter assessment and monitoring form (UCAM) is used at the Royal Hampshire County Hospital, Winchester, to remind staff of best practice and promote their early removal.

  19. Echinocandin and ethanol lock therapy treatment of fungal catheter infections.

    PubMed

    Pieroni, Kevin P; Nespor, Colleen; Poole, Robert L; Kerner, John A; Berquist, William E

    2013-03-01

    Ethanol lock therapy has been implemented to prevent infections of central venous catheters as well as to treat infections. Fungal catheter-associated blood stream infections are historically more difficult to treat and have required removal of central venous catheters. We report the largest case series to date, successfully treating 5 of 7 fungal catheter-associated blood stream infections with ethanol lock therapy and systemic echinocandin administration.

  20. Intermittent back pain after central venous catheter placement.

    PubMed

    Rosa, U W; Foreman, M; Willsie-Ediger, S

    1993-01-01

    We report a case of inadvertent azygos placement of a central venous catheter. The patient experienced ill-defined back pain associated with total parenteral nutrition infusion. The catheter malposition remained unrecognized and resulted in extensive diagnostic work-up. Symptoms resolved after the catheter was withdrawn.

  1. 21 CFR 870.1330 - Catheter guide wire.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Catheter guide wire. 870.1330 Section 870.1330...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1330 Catheter guide wire. (a) Identification. A catheter guide wire is a coiled wire that is designed to fit inside...

  2. 21 CFR 870.1330 - Catheter guide wire.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Catheter guide wire. 870.1330 Section 870.1330...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1330 Catheter guide wire. (a) Identification. A catheter guide wire is a coiled wire that is designed to fit inside...

  3. 21 CFR 870.1330 - Catheter guide wire.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Catheter guide wire. 870.1330 Section 870.1330...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1330 Catheter guide wire. (a) Identification. A catheter guide wire is a coiled wire that is designed to fit inside...

  4. 21 CFR 870.1330 - Catheter guide wire.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Catheter guide wire. 870.1330 Section 870.1330...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1330 Catheter guide wire. (a) Identification. A catheter guide wire is a coiled wire that is designed to fit inside...

  5. 21 CFR 870.1330 - Catheter guide wire.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Catheter guide wire. 870.1330 Section 870.1330...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1330 Catheter guide wire. (a) Identification. A catheter guide wire is a coiled wire that is designed to fit inside...

  6. 21 CFR 876.4020 - Fiberoptic light ureteral catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Fiberoptic light ureteral catheter. 876.4020... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4020 Fiberoptic light ureteral catheter. (a) Identification. A fiberoptic light ureteral catheter is a device that consists of...

  7. 21 CFR 876.4020 - Fiberoptic light ureteral catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Fiberoptic light ureteral catheter. 876.4020... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4020 Fiberoptic light ureteral catheter. (a) Identification. A fiberoptic light ureteral catheter is a device that consists of...

  8. 21 CFR 876.4020 - Fiberoptic light ureteral catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Fiberoptic light ureteral catheter. 876.4020... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4020 Fiberoptic light ureteral catheter. (a) Identification. A fiberoptic light ureteral catheter is a device that consists of...

  9. 21 CFR 876.4020 - Fiberoptic light ureteral catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Fiberoptic light ureteral catheter. 876.4020... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4020 Fiberoptic light ureteral catheter. (a) Identification. A fiberoptic light ureteral catheter is a device that consists of...

  10. 21 CFR 876.4020 - Fiberoptic light ureteral catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Fiberoptic light ureteral catheter. 876.4020... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4020 Fiberoptic light ureteral catheter. (a) Identification. A fiberoptic light ureteral catheter is a device that consists of...

  11. 21 CFR 870.1290 - Steerable catheter control system.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Steerable catheter control system. 870.1290... catheter control system. (a) Identification. A steerable catheter control system is a device that is connected to the proximal end of a steerable guide wire that controls the motion of the steerable...

  12. 21 CFR 870.1290 - Steerable catheter control system.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Steerable catheter control system. 870.1290... catheter control system. (a) Identification. A steerable catheter control system is a device that is connected to the proximal end of a steerable guide wire that controls the motion of the steerable...

  13. 21 CFR 868.5350 - Nasal oxygen catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Nasal oxygen catheter. 868.5350 Section 868.5350...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5350 Nasal oxygen catheter. (a) Identification. A nasal oxygen catheter is a device intended to be inserted through a patient's nostril...

  14. 21 CFR 868.5350 - Nasal oxygen catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Nasal oxygen catheter. 868.5350 Section 868.5350...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5350 Nasal oxygen catheter. (a) Identification. A nasal oxygen catheter is a device intended to be inserted through a patient's nostril...

  15. 21 CFR 868.5350 - Nasal oxygen catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Nasal oxygen catheter. 868.5350 Section 868.5350...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5350 Nasal oxygen catheter. (a) Identification. A nasal oxygen catheter is a device intended to be inserted through a patient's nostril...

  16. 21 CFR 868.5350 - Nasal oxygen catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nasal oxygen catheter. 868.5350 Section 868.5350...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5350 Nasal oxygen catheter. (a) Identification. A nasal oxygen catheter is a device intended to be inserted through a patient's nostril...

  17. 21 CFR 868.5350 - Nasal oxygen catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Nasal oxygen catheter. 868.5350 Section 868.5350...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5350 Nasal oxygen catheter. (a) Identification. A nasal oxygen catheter is a device intended to be inserted through a patient's nostril...

  18. 21 CFR 870.1350 - Catheter balloon repair kit.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Catheter balloon repair kit. 870.1350 Section 870...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1350 Catheter balloon repair kit. (a) Identification. A catheter balloon repair kit is a device used to repair or replace...

  19. 21 CFR 870.1350 - Catheter balloon repair kit.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Catheter balloon repair kit. 870.1350 Section 870...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1350 Catheter balloon repair kit. (a) Identification. A catheter balloon repair kit is a device used to repair or replace...

  20. 21 CFR 870.1350 - Catheter balloon repair kit.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Catheter balloon repair kit. 870.1350 Section 870...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1350 Catheter balloon repair kit. (a) Identification. A catheter balloon repair kit is a device used to repair or replace...

  1. 21 CFR 868.5120 - Anesthesia conduction catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia conduction catheter. 868.5120 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5120 Anesthesia conduction catheter. (a) Identification. An anesthesia conduction catheter is a flexible tubular device used to...

  2. 21 CFR 868.5120 - Anesthesia conduction catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Anesthesia conduction catheter. 868.5120 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5120 Anesthesia conduction catheter. (a) Identification. An anesthesia conduction catheter is a flexible tubular device used to...

  3. 21 CFR 884.6110 - Assisted reproduction catheters.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Assisted reproduction catheters. 884.6110 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6110 Assisted reproduction catheters. (a) Identification. Assisted reproduction catheters are devices used in...

  4. 21 CFR 884.6110 - Assisted reproduction catheters.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Assisted reproduction catheters. 884.6110 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6110 Assisted reproduction catheters. (a) Identification. Assisted reproduction catheters are devices used in...

  5. 21 CFR 884.6110 - Assisted reproduction catheters.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Assisted reproduction catheters. 884.6110 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6110 Assisted reproduction catheters. (a) Identification. Assisted reproduction catheters are devices used in...

  6. 21 CFR 884.6110 - Assisted reproduction catheters.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Assisted reproduction catheters. 884.6110 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6110 Assisted reproduction catheters. (a) Identification. Assisted reproduction catheters are devices used in...

  7. 21 CFR 884.6110 - Assisted reproduction catheters.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Assisted reproduction catheters. 884.6110 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6110 Assisted reproduction catheters. (a) Identification. Assisted reproduction catheters are devices used in...

  8. 21 CFR 870.1240 - Flow-directed catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Flow-directed catheter. 870.1240 Section 870.1240...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1240 Flow-directed catheter. (a) Identification. A flow-directed catheter is a device that incorporates a gas-filled balloon...

  9. Serendipitous detection of an errant central venous catheter

    SciTech Connect

    Orzel, J.A.; Romdall, K.; Griep, R.

    1985-09-01

    The inappropriate placement of a patient's central venous catheter in the pleural space by the serendipitous injection of Tc-99m labeled red blood cells through the catheter during a GI bleeding study was discovered. Position and patency of central venous lines can be incidentally evaluated by using existing central venous catheters for administration of radiopharmaceuticals during radionuclide imaging studies.

  10. 21 CFR 868.5120 - Anesthesia conduction catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Anesthesia conduction catheter. 868.5120 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5120 Anesthesia conduction catheter. (a) Identification. An anesthesia conduction catheter is a flexible tubular device used to...

  11. 21 CFR 868.5120 - Anesthesia conduction catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Anesthesia conduction catheter. 868.5120 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5120 Anesthesia conduction catheter. (a) Identification. An anesthesia conduction catheter is a flexible tubular device used to...

  12. 21 CFR 868.5120 - Anesthesia conduction catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Anesthesia conduction catheter. 868.5120 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5120 Anesthesia conduction catheter. (a) Identification. An anesthesia conduction catheter is a flexible tubular device used to...

  13. Continuous bilateral TAP block in patient with prior abdominal surgery.

    PubMed

    Lima, Isabel Flor de; Linda, Filipe; dos Santos, Ângela; Lages, Neusa; Correia, Carlos

    2013-01-01

    We present as an option for epidural analgesia and intravenous opioid infusion a clinical case of transversus abdominis plane (TAP) block, with bilateral placement of catheter for postoperative analgesia after exploratory laparotomy performed in a patient with previous abdominal surgery and heart, kidney and liver failure.

  14. Axial Plane Optical Microscopy

    PubMed Central

    Li, Tongcang; Ota, Sadao; Kim, Jeongmin; Wong, Zi Jing; Wang, Yuan; Yin, Xiaobo; Zhang, Xiang

    2014-01-01

    We present axial plane optical microscopy (APOM) that can, in contrast to conventional microscopy, directly image a sample's cross-section parallel to the optical axis of an objective lens without scanning. APOM combined with conventional microscopy simultaneously provides two orthogonal images of a 3D sample. More importantly, APOM uses only a single lens near the sample to achieve selective-plane illumination microscopy, as we demonstrated by three-dimensional (3D) imaging of fluorescent pollens and brain slices. This technique allows fast, high-contrast, and convenient 3D imaging of structures that are hundreds of microns beneath the surfaces of large biological tissues. PMID:25434770

  15. SNAP focal plane

    SciTech Connect

    Lampton, Michael L.; Kim, A.; Akerlof, C.W.; Aldering, G.; Amanullah, R.; Astier, P.; Barrelet, E.; Bebek, C.; Bergstrom, L.; Berkovitz, J.; Bernstein, G.; Bester, M.; Bonissent, A.; Bower, C.; Carithers Jr., W.C.; Commins, E.D.; Day, C.; Deustua, S.E.; DiGennaro,R.; Ealet, A.; Ellis, R.S.; Eriksson, M.; Fruchter, A.; Genat, J.-F.; Goldhaber, G.; Goobar, A.; Groom, D.; Harris, S.E.; Harvey, P.R.; Heetderks, H.D.; Holland, S.E.; Huterer, D.; Karcher, A.; Kolbe, W.; Krieger, B.; Lafever, R.; Lamoureux, J.; Levi, M.E.; Levin, D.S.; Linder,E.V.; Loken, S.C.; Malina, R.; Massey, R.; McKay, T.; McKee, S.P.; Miquel, R.; Mortsell, E.; Mostek, N.; Mufson, S.; Musser, J.; Nugent, P.; Oluseyi, H.; Pain, R.; Palaio, N.; Pankow, D.; Perlmutter, S.; Pratt, R.; Prieto, E.; Refregier, A.; Rhodes, J.; Robinson, K.; Roe, N.; Sholl, M.; Schubnell, M.; Smadja, G.; Smoot, G.; Spadafora, A.; Tarle, G.; Tomasch,A.; von der Lippe, H.; Vincent, R.; Walder, J.-P.; Wang, G.

    2002-07-29

    The proposed SuperNova/Acceleration Probe (SNAP) mission will have a two-meter class telescope delivering diffraction-limited images to an instrumented 0.7 square-degree field sensitive in the visible and near-infrared wavelength regime. We describe the requirements for the instrument suite and the evolution of the focal plane design to the present concept in which all the instrumentation--visible and near-infrared imagers, spectrograph, and star guiders--share one common focal plane.

  16. Behavior of the Linea Alba During a Curl-up Task in Diastasis Rectus Abdominis: An Observational Study.

    PubMed

    Lee, Diane; Hodges, Paul W

    2016-07-01

    Study Design Cross-sectional repeated measures. Background Rehabilitation of diastasis rectus abdominis (DRA) generally aims to reduce the inter-rectus distance (IRD). We tested the hypothesis that activation of the transversus abdominis (TrA) before a curl-up would reduce IRD narrowing, with less linea alba (LA) distortion/deformation, which may allow better force transfer between sides of the abdominal wall. Objectives This study investigated behavior of the LA and IRD during curl-ups performed naturally and with preactivation of the TrA. Methods Curl-ups were performed by 26 women with DRA and 17 healthy control participants using a natural strategy (automatic curl-up) and with TrA preactivation (TrA curl-up). Ultrasound images were recorded at 2 points above the umbilicus (U point and UX point). Ultrasound measures of IRD and a novel measure of LA distortion (distortion index: average deviation of the LA from the shortest path between the recti) were compared between 3 tasks (rest, automatic curl-up, TrA curl-up), between groups, and between measurement points (analysis of variance). Results Automatic curl-up by women with DRA narrowed the IRD from resting values (mean U-point between-task difference, -1.19 cm; 95% confidence interval [CI]: -1.45, -0.93; P<.001 and mean UX-point between-task difference, -0.51 cm; 95% CI: -0.69, -0.34; P<.001), but LA distortion increased (mean U-point between-task difference, 0.018; 95% CI: 0.0003, 0.041; P = .046 and mean UX-point between-task difference, 0.025; 95% CI: 0.004, 0.045; P = .02). Although TrA curl-up induced no narrowing or less IRD narrowing than automatic curl-up (mean U-point difference between TrA curl-up versus rest, -0.56 cm; 95% CI: -0.82, -0.31; P<.001 and mean UX-point between-task difference, 0.02 cm; 95% CI: -0.22, 0.19; P = .86), LA distortion was less (mean U-point between-task difference, -0.025; 95% CI: -0.037, -0.012; P<.001 and mean UX-point between-task difference, -0.021; 95% CI: -0.038, -0

  17. Ultraminiature manometer-tipped cardiac catheter

    NASA Technical Reports Server (NTRS)

    Coon, G. W.

    1967-01-01

    Miniature diaphragm-type capacitance transducer capable of being mounted on the end of a cardiac catheter has been developed for measurement of intravascular pressures. The transducer can be inserted in small ducts /arteries and veins/ without disturbing the flow characteristics. It is very useful for making measurements in babies.

  18. Peripherally inserted central catheters. Intravenous Nurses Society.

    PubMed

    1997-01-01

    The Intravenous Nurses Society (INS) recognizes the need for uniform terminology for peripherally inserted central catheters (PICCs) to encourage standardization for indications, care, and maintenance strategies for these devices. It also recognizes the need for recommendations regarding the choice, use, management, and discontinuation of PICCs to promote positive patient outcomes and enhance patient comfort, safety, and satisfaction.

  19. Lymphatic Leak Complicating Central Venous Catheter Insertion

    SciTech Connect

    Barnacle, Alex M. Kleidon, Tricia M.

    2005-12-15

    Many of the risks associated with central venous access are well recognized. We report a case of inadvertent lymphatic disruption during the insertion of a tunneled central venous catheter in a patient with raised left and right atrial pressures and severe pulmonary hypertension, which led to significant hemodynamic instability. To our knowledge, this rare complication is previously unreported.

  20. 21 CFR 870.5175 - Septostomy catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Septostomy catheter. 870.5175 Section 870.5175 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... enlarge the atrial septal defect found in the heart of certain infants. (b) Classification. Class...

  1. 21 CFR 870.5175 - Septostomy catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Septostomy catheter. 870.5175 Section 870.5175 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... enlarge the atrial septal defect found in the heart of certain infants. (b) Classification. Class...

  2. 21 CFR 870.5175 - Septostomy catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Septostomy catheter. 870.5175 Section 870.5175 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... enlarge the atrial septal defect found in the heart of certain infants. (b) Classification. Class...

  3. 21 CFR 870.5175 - Septostomy catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Septostomy catheter. 870.5175 Section 870.5175 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... enlarge the atrial septal defect found in the heart of certain infants. (b) Classification. Class...

  4. 21 CFR 870.5175 - Septostomy catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Septostomy catheter. 870.5175 Section 870.5175 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... enlarge the atrial septal defect found in the heart of certain infants. (b) Classification. Class...

  5. [Femoral venous catheter: an unusual complication].

    PubMed

    Garcia, P; Mora, A; Trambert, P; Maler, E; Courant, P

    2000-08-01

    We report an erratic course of a venous femoral catheter which was in the abdominal cavity in a patient with an haemoperitoneum and an hepatic injury. This complication led to an inefficiency of the transfusion and a worsening of the haemoperitoneum.

  6. Left ventricular volumetric conductance catheter for rats.

    PubMed

    Ito, H; Takaki, M; Yamaguchi, H; Tachibana, H; Suga, H

    1996-04-01

    Left ventricular (LV) volume (V) is an essential parameter for assessment of the cardiac pump function. Measurement of LVV in situ by a conductance catheter method has been widely used in dogs and humans but not yet in small experimental animals such as rats. We instituted a miniaturized six-electrode conductance catheter (3-F) for rat LVV measurement and its signal processing apparatus. We compared stroke volumes (SVs) simultaneously measured with this conductance catheter introduced into the LV through the apex and an electromagnetic flow probe placed on the ascending aorta during gradual decreases in LVV by an inferior vena caval occlusion. A high and linear correlation (r = 0.982) was obtained between these differently measured by SVs pooled from six rats. In another group of three rats, LV pressure was simultaneously measured with a 3-F catheter-tip micromanometer introduced into the LV through the apex. We obtained the slope of the end-systolic pressure-volume (P-V) relationship (Emax) by a gradual ascending aortic occlusion. After administration of propranolol, Emax obviously decreased with no change in volume intercept of the P-V relationship. The conductance volumetry proved to be useful in rats.

  7. Individuals with chronic low back pain do not modulate the level of transversus abdominis muscle contraction across different postures.

    PubMed

    Miura, Takuya; Yamanaka, Masanori; Ukishiro, Kengo; Tohyama, Harukazu; Saito, Hiroshi; Samukawa, Mina; Kobayashi, Takumi; Ino, Takumi; Takeda, Naoki

    2014-12-01

    The aim of this study was to evaluate the thickness of the transversus abdominis (TrA) muscle in three basic postures in subjects with and without chronic low back pain. Subjects were classified into a chronic low back pain group (n = 27) and a healthy control group (n = 23). The thickness of the TrA muscle was measured at rest and during the abdominal drawing-in manoeuvre (ADIM) in supine, sitting and standing postures using B-mode ultrasound imaging. Contraction ratio (TrA thickness during the ADIM/TrA thickness at rest) was calculated for each posture. At rest, the TrA thickness in the sitting and standing postures was significantly greater than in the supine posture (p < 0.017) in the control group, but similar in all three postures in the low back pain group. TrA thickness was similar in the low back pain and control group in all three postures. During the ADIM, TrA thickness was significantly greater in the control group than in the chronic low back pain group in all three postures. The contraction ratio was also significantly higher in the control group than in the chronic low back pain group in all three postures. These results indicate that the automatic postural contraction of the TrA observed in the control subjects in the sitting and standing postures was not demonstrated in subjects with chronic low back pain. The present study revealed the one aspect of different response of the TrA muscle to changing posture between two groups.

  8. Causes and nursing countermeasures in pediatric PICC catheter complications.

    PubMed

    Xiang, Mingli; Li, Na; Yi, Lan; Liu, Bin

    2016-01-01

    To analyze the complications and nursing countermeasures of PICC (Peripherally Inserted Central Catheter) catheters using children PICC catheter technique 40 cases, complications were observed, and analyze the original causes, in order to propose a solution. There were 10 cases of catheter blockage, 5 cases of catheter infection, 6 cases of phlebitis, 5 cases of puncture difficulties, 2 cases of poor feeding tube, 2 cases of bleeding puncture site with the continuous exploration and research of nursing intervention, the production of clinical complications from PICC has been used in children were greatly reduced.

  9. Precise measurement of planeness.

    PubMed

    Schulz, G; Schwider, J

    1967-06-01

    Interference methods are reviewed-particularly those developed at the German Academy of Sciences in Berlin-with which the deviations of an optically flat surface from the ideal plane can be measured with a high degree of exactness. One aid to achieve this is the relative methods which measure the differences in planeness between two surfaces. These are then used in the absolute methods which determine the absolute planeness of a surface. This absolute determination can be effected in connection with a liquid surface, or (as done by the authors) only by suitable evaluation of relative measurements between unknown plates in various positional combinations. Experimentally, one uses two- or multiple-beam interference fringes of equal thickness(1) or of equal inclination. The fringes are observed visually, scanned, or photographed, and in part several wavelengths or curves of equal density (Aquidensiten) are employed. The survey also brings the following new methods: a relative method, where, with the aid of fringes of superposition, the fringe separation is subdivided equidistantly thus achieving an increase of measuring precision, and an absolute method which determines the deviations of a surface from ideal planeness along arbitrary central sections, without a liquid surface, from four relative interference photographs.

  10. Plane Jane(s).

    ERIC Educational Resources Information Center

    Greenman, Geri

    2001-01-01

    Describes an assignment that was used in an advanced drawing class in which the students created self-portraits, breaking up their images using planes and angles to suggest their bone structure. Explains that the students also had to include three realistic portions in their drawings. (CMK)

  11. Serratus Anterior Plane Block to Address Post-thoracotomy and Chest Tube-related Pain: A Report on 3 Cases.

    PubMed

    Chu, George M; Jarvis, G Craig

    2017-03-16

    In this case report, the serratus anterior plane block was used in conjunction with multilevel continuous thoracic paravertebral blocks (TPVB) and general anesthesia in 3 thoracotomy cases. All blocks were accompanied by use of catheters that allowed continuous local anesthetic infusions and intermittent local anesthetic bolus injections to address postoperative pain. In all 3 patients, the serratus anterior plane block provided analgesia for chest tube-related pain that was not provided by the TPVB alone.

  12. Validation of the Accuracy and Reliability of Culturing Intravascular Catheter Segments

    DTIC Science & Technology

    1992-11-24

    catheters located in central veins of adult surgical and medical intensive care patients were cultured. Any type of central venous catheter was accepted for...20 to 92 years). All catheters were central venous catheters, including 76 triple lumen catheters, 60 Swan-Ganz pulmonary artery catheters, 54 Cordis...RT, Kruse JA, Thill-Baharozian MC, Carlson RW. Triple-vs. Single-Lumen Central Venous Catheters: A prospective study in a critically ill population

  13. Parameter Plane Design Method

    DTIC Science & Technology

    1989-03-01

    Th usr a toente aninteer a thca sms b esta 1 Fp-ocsing 2. Enter P1 values, lwgt, ldig - > 9 Table I give us proper values. Table 1. PARAMETER TABLE...necessary and identify by block number) In this thesis a control systems analysis package is developed using parameter plane methods. It is an interactive...designer is able to choose values of the parameters which provide a good compromise between cost and dynamic behavior. 20 Distribution Availability of

  14. Catheter-related infections: diagnosis and intravascular treatment.

    PubMed

    Bouza, E; Burillo, A; Muñoz, P

    2001-11-01

    The diagnosis of catheter-related infections relies on the presence of clinical manifestations of infection and the evidence of colonization of the catheter tip by bacteria, mycobacteria or fungi. The reference method to confirm the latter requires the withdrawal of the catheter for culturing, which frequently turns out to be inconvenient, unnecessary and costly. New methods try to avoid these inconveniences and to assess the presence of tip colonization without withdrawal. One of these methods uses quantitative blood cultures with a jump (> or = 5) in colony counts between blood obtained from the catheter lumen and simultaneously from a peripheral vein. It has a high sensitivity (>80%) and specificity (94%-100%) but is cumbersome and requires both an easy backflow of blood in the catheter and the existence of bacteremia. Cytocentrifugation and acridine orange staining of blood withdrawn from an infected catheter lumen has a sensitivity and a specificity of over 90% for the diagnosis of tip colonization. "Superficial cultures" consist in the semiquantitative culture of the hub, of the skin surrounding the catheter entrance and of the first (1 cm) subcutaneous portion of the catheter after swabbing. Sensitivity of this method is >90% and specificity is >80%, and positive and negative predictive values for catheters (considering together those with and without clinical data of infection) are 66% and 97%, respectively. Endoluminal brushing has turned out to be an impractical and unreliable procedure, at least in our experience. New methods based on the speed of bacterial growth to detectable levels of microorganisms in conventional blood cultures are a new and interesting way of assessing catheter-related infections. Besides, as use of antimicrobial-coated catheters becomes more prevalent, the existing definitions of catheter colonization and catheter-related infection may need to be modified, because such coatings may lead to false-negative culture results. Many

  15. Rehabilitation and Return to Sport Following Surgical Repair of the Rectus Abdominis and Adductor Longus in a Professional Basketball Player: A Case Report.

    PubMed

    Short, Steven M; Anloague, Philip A; Strack, Donald S

    2016-08-01

    Study Design Case report. Background Acute traumatic avulsion of the rectus abdominis and adductor longus is rare. Chronic groin injuries, often falling under the athletic pubalgia spectrum, have been reported to be more common. There is limited evidence detailing the comprehensive rehabilitation and return to sport of an athlete following surgical or conservative treatment of avulsion injuries of the pubis or other sports-related groin pathologies. Case Description A 29-year-old National Basketball Association player sustained a contact injury during a professional basketball game. This case report describes a unique clinical situation specific to professional sport, in which a surgical repair of an avulsed rectus abdominis and adductor longus was combined with a multimodal impairment- and outcomes-based rehabilitation program. Outcomes The patient returned to in-season competition at 5 weeks postoperation. Objective measures were tracked throughout rehabilitation and compared to baseline assessments. Measures such as the Copenhagen Hip and Groin Outcome Score and numeric pain-rating scale revealed progress beyond the minimal important difference. Discussion This case report details the clinical reasoning and evidence-informed interventions involved in the return to elite sport. Detailed programming and objective assessment may assist in achieving desired outcomes ahead of previously established timelines. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2016;46(8):697-706. Epub 3 Jul 2016. doi:10.2519/jospt.2016.6352.

  16. Free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps for breast reconstruction: a systematic review of flap complication rates and donor-site morbidity.

    PubMed

    Sailon, Alexander M; Schachar, Jeffrey S; Levine, Jamie P

    2009-05-01

    Free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps represent increasingly popular options for breast reconstruction. Although several retrospective, small-scale studies comparing these flaps have been published, most have failed to find a significant difference in flap complication rates or donor-site morbidity. We systematically reviewed the current literature, and subsequently pooled and analyzed data from included studies. Included studies reported flap complications and/or donor site morbidities for both flap types. Eight studies met the inclusionary criteria. For flap complications, there was a statistically significant difference between deep inferior epigastric perforator and free transverse rectus abdominis myocutaneous flaps in fat necrosis rates (25.5 +/- 0.49 vs. 11.3% +/- 0.41%, P < 0.001) and total necrosis rates (4.15 +/- 0.08 vs. 1.59% +/- 0.08%, P = 0.044). Partial necrosis rates were not statistically significant (3.54 +/- 0.07 vs. 1.60% +/- 0.07%, P = 0.057). For donor-site morbidity, there was no statistically significant difference in abdominal bulge (8.07 +/- 0.23 vs. 11.25% +/- 0.29%, P = 0.28). Multicenter, prospective studies are needed to further investigate differences between these flap options.

  17. Validation of catheter semiquantitative culture technique for nonstaphylococcal organisms.

    PubMed Central

    Dooley, D P; Garcia, A; Kelly, J W; Longfield, R N; Harrison, L

    1996-01-01

    The catheter semiquantitative culture roll tip technique has been validated as a discriminator between non-catheter-related bacteremias and catheter-related bacteremias (CRBs) caused by Staphylococcus species. However, this technique has not been specifically validated when used for the evaluation of catheters infected with organisms other than staphylococci. We reviewed catheters that had been submitted for semiquantitative roll tip culture as well as hospital records to determine clinical correlates of infection. Local infection and CRB were defined by standard criteria. Catheter-related sepsis (CRS) was defined as fever, leukocytosis, or hypotension which resolved with catheter removal, without another source of infection. For 195 catheters from 93 patients, gram-negative rods and enterococci were present on 36, fungi were on 25, Corynebacterium species were on 5, Bacillus species were on 3, Staphylococcus species were on 79, and 41 demonstrated no growth. Of 21 episodes of CRB or CRS due to nonstaphylococcal organisms, only 1 (questionable) episode was due to a catheter with < 15 CFU (P < 0.05). Eleven of these 21 episodes of CRB or CRS were due to gram-negative rods and enterococci, of which only the questionable episode was due to a catheter with < 15 CFU. Nine of these 21 episodes of CRB or CRS were due to fungi, none of which were associated with a catheter with < 15 CFU. The data for Staphylococcus species recapitulated published data (none of 21 CRB or CRS episodes were associated with catheters with < 15 CFU) and validated this retrospective technique. The data presented in this study validate the use of the semiquantitative culture technique for the evaluation of catheter-related infections caused by organisms other than staphylococci. PMID:8789025

  18. Pancreas tumor interstitial pressure catheter measurement

    NASA Astrophysics Data System (ADS)

    Nieskoski, Michael D.; Gunn, Jason; Marra, Kayla; Trembly, B. Stuart; Pogue, Brian W.

    2016-03-01

    This paper highlights the methodology in measuring interstitial pressure in pancreatic adenocarcinoma tumors. A Millar Mikrotip pressure catheter (SPR-671) was used in this study and a system was built to amplify and filter the output signal for data collection. The Millar pressure catheter was calibrated prior to each experiment in a water column at 37°C, range of 0 to 60 inH2O (112 mmHg), resulting in a calibration factor of 33 mV / 1 inH2O. The interstitial pressures measured in two orthotopically grown pancreatic adenocarcinoma tumor were 57 mmHg and 48 mmHg, respectively. Verteporfin uptake into the pancreatic adenocarcinoma tumor was measured using a probe-based experimental dosimeter.

  19. Urgent peritoneal dialysis or hemodialysis catheter dialysis.

    PubMed

    Lok, Charmaine E

    2016-03-01

    Worldwide, there is a steady incident rate of patients with end-stage kidney disease (ESKD) who require renal replacement therapy. Of these patients, approximately one-third have an "unplanned" or "urgent" start to dialysis. This can be a very challenging situation where patients have either not had adequate time for education and decision making regarding dialysis modality and appropriate dialysis access, or a decision was made and plans were altered due to unforeseen circumstances. Despite such unplanned starts, clinicians must still consider the patient's ESKD "life-plan", which includes the best initial dialysis modality and access to suit the patient's individual goals and their medical, social, logistic, and facility circumstances. This paper will discuss the considerations of peritoneal dialysis and a peritoneal dialysis catheter access and hemodialysis and central venous catheter access in patients who require an urgent start to dialysis.

  20. Monopole antennas for microwave catheter ablation

    SciTech Connect

    Labonte, S.; Blais, A.; Legault, S.R.; Ali, H.O.; Roy, L.

    1996-10-01

    The authors study the characteristics of various monopole antennas for microwave catheter ablation of the endocardium. The investigation is done with a computer model based on the finite-element method in the frequency domain. Three monopole geometries are considered: open-tip, dielectric-tip, and metal-tip. Calculations are made for the magnetic field, the reflection coefficient and the power deposition pattern of the antennas immersed in normal saline. The theoretical results are compared with measurements performed on prototypes and good agreement is obtained. The antenna characteristics suggest that the metal-tip monopole best fulfills the requirements of catheter ablation. The computer model is then used to compare metal-tip monopoles of different dimensions and to determine design trade-offs.

  1. Baclofen pump catheter leakage after migration of the abdominal catheter in a pediatric patient with spasticity.

    PubMed

    Dastgir, Amer; Ranalli, Nathan J; MacGregor, Theresa L; Aldana, Philipp R

    2015-09-01

    The authors report an unusual case of intrathecal baclofen withdrawal due to the perforation and subsequent leakage of a baclofen pump catheter in a patient with spastic cerebral palsy. A 15-year-old boy underwent an uncomplicated placement of an intrathecal baclofen pump for the treatment of spasticity due to cerebral palsy. After excellent control of symptoms for 3 years, the patient presented to the emergency department with increasing tremors following a refill of his baclofen pump. Initial evaluation consisted of radiographs of the pump and catheter, which appeared normal, and a successful aspiration of CSF from the pump's side port. A CT dye study revealed a portion of the catheter directly overlying the refill port and extravasation of radiopaque dye into the subfascial pocket anterior to the pump. During subsequent revision surgery, a small puncture hole in the catheter was seen to be leaking the drug. The likely cause of the puncture was an inadvertent perforation of the catheter by a needle during the refilling of the pump. This case report highlights a unique complication in a patient with an intrathecal baclofen pump. Physicians caring for these patients should be aware of this rare yet potential complication in patients presenting with baclofen withdrawal symptoms.

  2. Soft robotic concepts in catheter design: an on-demand fouling-release urinary catheter.

    PubMed

    Levering, Vrad; Wang, Qiming; Shivapooja, Phanindhar; Zhao, Xuanhe; López, Gabriel P

    2014-10-01

    Infectious biofilms are problematic in many healthcare-related devices and are especially challenging and ubiquitous in urinary catheters. This report presents an on-demand fouling-release methodology to mechanically disrupt and remove biofilms, and proposes this method for the active removal of infectious biofilms from the previously inaccessible main drainage lumen of urinary catheters. Mature Proteus mirabilis crystalline biofilms detach from silicone elastomer substrates upon application of strain to the substrate, and increasing the strain rate increases biofilm detachment. The study presents a quantitative relationship between applied strain rate and biofilm debonding through an analysis of biofilm segment length and the driving force for debonding. Based on this mechanism, hydraulic and pneumatic elastomer actuation is used to achieve surface strain selectively within the lumen of prototypes of sections of a fouling-release urinary catheter. Proof-of-concept prototypes of sections of active, fouling-release catheters are constructed using techniques typical to soft robotics including 3D printing and replica molding, and those prototypes demonstrate release of mature P. mirabilis crystalline biofilms (e.g., ≈90%) from strained surfaces. These results provide a basis for the development of a new urinary catheter technology in which infectious biofilms are effectively managed through new methods that are entirely complementary to existing approaches.

  3. Incidence of phlebitis associated with the use of peripheral IV catheter and following catheter removal

    PubMed Central

    Urbanetto, Janete de Souza; Peixoto, Cibelle Grassmann; May, Tássia Amanda

    2016-01-01

    ABSTRACT Objective: to investigate the incidence of phlebitis and its association with risk factors when using peripheral IV catheters (PIC) and following their removal - (post-infusion phlebitis) in hospitalized adults. Method: a cohort study of 171 patients using PIC, totaling 361 punctures. Sociodemographic variables and variables associated with the catheter were collected. Descriptive and analytical statistical analyses were performed. Results: average patient age was 56.96 and 51.5% of the sample population was male. The incidence of phlebitis was 1.25% while using PIC, and 1.38% post-infusion. The incidence of phlebitis while using PIC was associated with the length of time the catheter remained in place, whereas post-infusion phlebitis was associated with puncture in the forearm. Ceftriaxone, Clarithromycin and Oxacillin are associated with post-infusion phlebitis. Conclusions: this study made it possible to investigate the association between risk factors and phlebitis during catheter use and following its removal. The frequency of post-infusion phlebitis was larger than the incidence of phlebitis with the catheter in place, with Phlebitis Grade III and II being the most frequently found in each of these situations, respectively. Aspects related to post-infusion phlebitis can be explained, given the limited number of studies addressing this theme from this perspective. PMID:27508916

  4. a Subminiature Scintillation Detector for Catheter Operation

    NASA Astrophysics Data System (ADS)

    Scafè, R.; Montani, L.; Burgio, N.; Iurlaro, G.; Santagata, A.; Ciavola, C.; Alonge, G.

    2006-04-01

    The feasibility of a subminiature scintillation detector to be inserted in a catheter for lesion localization in nuclear medicine SPECT has been studied. Measurements on a simple laboratory setup have been performed and compared with Monte Carlo results. Further simulations, at 30keV and 140keV, concerning a configuration reproducing severe clinical conditions have shown poor lesion detectability. Several factors affecting the response have to be investigated to improve the capability of lesion localization characterizing such detector.

  5. 3D localization of electrophysiology catheters from a single x-ray cone-beam projection

    SciTech Connect

    Robert, Normand Polack, George G.; Sethi, Benu; Rowlands, John A.; Crystal, Eugene

    2015-10-15

    Purpose: X-ray images allow the visualization of percutaneous devices such as catheters in real time but inherently lack depth information. The provision of 3D localization of these devices from cone beam x-ray projections would be advantageous for interventions such as electrophysiology (EP), whereby the operator needs to return a device to the same anatomical locations during the procedure. A method to achieve real-time 3D single view localization (SVL) of an object of known geometry from a single x-ray image is presented. SVL exploits the change in the magnification of an object as its distance from the x-ray source is varied. The x-ray projection of an object of interest is compared to a synthetic x-ray projection of a model of said object as its pose is varied. Methods: SVL was tested with a 3 mm spherical marker and an electrophysiology catheter. The effect of x-ray acquisition parameters on SVL was investigated. An independent reference localization method was developed to compare results when imaging a catheter translated via a computer controlled three-axes stage. SVL was also performed on clinical fluoroscopy image sequences. A commercial navigation system was used in some clinical image sequences for comparison. Results: SVL estimates exhibited little change as x-ray acquisition parameters were varied. The reproducibility of catheter position estimates in phantoms denoted by the standard deviations, (σ{sub x}, σ{sub y}, σ{sub z}) = (0.099 mm,  0.093 mm,  2.2 mm), where x and y are parallel to the detector plane and z is the distance from the x-ray source. Position estimates (x, y, z) exhibited a 4% systematic error (underestimation) when compared to the reference method. The authors demonstrated that EP catheters can be tracked in clinical fluoroscopic images. Conclusions: It has been shown that EP catheters can be localized in real time in phantoms and clinical images at fluoroscopic exposure rates. Further work is required to characterize

  6. Catheter-Related Mortality among ESRD Patients

    PubMed Central

    Wasse, Haimanot

    2010-01-01

    Hemodialysis access-related complications remain one of the most important sources of morbidity and cost among persons with end-stage renal disease, with total annual costs exceeding $1 billion annually. In this context, the creation and maintenance of an effective hemodialysis vascular access is essential for safe and adequate hemodialysis therapy. Multiple reports have documented the type of vascular access used for dialysis and associated risk of infection and mortality. Undoubtedly, the central venous catheter (CVC) is associated with the greatest risk of infection-related and all-cause mortality compared with the autogenous arteriovenous fistula (AVF) or synthetic graft (AVG). The AVF has the lowest risk of infection, longer patency rates, greater quality of life, and lower all-cause mortality compared with the AVG or CVC. It is for these reasons that the National Kidney Foundation’s Kidney Disease Outcome Quality Initiative Clinical Practice Guidelines for Vascular Access recommend the early placement and use of the AVF among at least 50% of incident hemodialysis patients. This report presents catheter-related mortality and calls for heightened awareness of catheter-related complications. PMID:19000119

  7. Flow Structure Associated with Hemodialysis Catheters

    NASA Astrophysics Data System (ADS)

    Foust, Jason

    2005-11-01

    Insertion of a hemodialysis catheter into the superior vena cava (SVC) gives rise to complex flow patterns, which arise from the simultaneous injection and extraction of blood through different holes (ports) of the catheter. Techniques of high-image-density particle image velocimetry are employed in a scaled-up water facility. This approach allows characterization of both the instantaneous and time-averaged flow structure due to generic classes of side hole geometries. The trajectory of the injection jet is related to the ratio of the initial jet velocity to the mainstream velocity through the SVC, and to the type of distortion of the jet cross-section. Furthermore, the mean and fluctuating velocity and vorticity fields are determined. Significant turbulent stresses develop rapidly in the injection jet, which can impinge upon the wall of the simulated SVC. Immediately downstream of the injection hole, a recirculation cell of low velocity exists adjacent to the catheter surface. These and other representations of the flow structure are first evaluated for a steady throughflow, then for the case of a pulsatile waveform in the SVC, which matches that of a normal adult.

  8. Comparison between qualitative and semiquantitative catheter-tip cultures: laboratory diagnosis of catheter-related infection in newborns

    PubMed Central

    Marconi, Camila; de Lourdes RS Cunha, Maria; Lyra, João C; Bentlin, Maria R; Batalha, Jackson EN; Sugizaki, Maria Fátima; Rugolo, Lígia MSS

    2008-01-01

    This prospective study evaluated semiquantitative and qualitative catheter-culture methods for diagnosis of catheter-related infection (CRI) in newborns. Catheter tips from newborns admitted to the Neonatal Unit of the University Hospital of the Botucatu Medical School, UNESP were included in the study. Catheter cultures were performed with both semiquantitative and qualitative techniques. For CRI diagnosis, microorganisms isolated from catheter cultures and from peripheral blood cultures were identified and submitted to agent susceptibility test. The gold standard was the certain CRI diagnosis when same microorganism (specie and profile of susceptibility to agents) was isolated from both catheter tips and peripheral blood culture. A total of 85 catheters from 63 newborns were included in the study. The semiquantitative culture method, despite presenting lower sensitivity (90%), showed higher specificity (71%) when compared to 100% of sensitivity and 60% of specificity in the qualitative method. The identification of the microorganisms obtained from the catheter cultures showed a prevalence of coagulase-negative staphylococci (CNS) species. The specie Staphylococcus epidermidis (77.5%) was the prevalent in the catheters with positive semiquantitative cultures. Among 11 episodes with CRI diagnosis, 8 (72.7%) were associated with CNS species, of which 6 were S. epidermidis. Two episodes of CRI by S. aureus and one by Candida parapsilosis were also detected. The semiquantitative catheter-culture method showed advantages for CRI diagnosis in newborns when compared to the conservative qualitative method. PMID:24031213

  9. Value of Superficial Cultures for Prediction of Catheter-Related Bloodstream Infection in Long-Term Catheters: a Prospective Study

    PubMed Central

    Martín-Rabadán, P.; Echenagusia, A.; Camúñez, F.; Rodríguez-Rosales, G.; Simó, G.; Echenagusia, M.; Bouza, E.

    2013-01-01

    Cultures taken from the skin and from the hubs of short-term central venous catheters can help us to predict catheter-related bloodstream infections (C-RBSIs). The value of these cultures for such predictions has not been assessed in long-term catheters. Our objective was to assess the value of superficial cultures for the prediction of C-RBSI among patients with long-term catheters. Over a 2-year period, we prospectively obtained cultures from the skin overlying reservoir ports (group A) and from the skin insertion site and hubs of all tunneled catheters (group B). This routine was performed by vascular and interventional radiologists immediately before catheter removal (irrespective of the reason for withdrawal). Swabs were processed semiquantitatively. Catheter tips from both groups were cultured using Maki's semiquantitative technique and sonication. We also performed cultures of the reservoir ports at different sites. C-RBSI was defined as the isolation of the same species of microorganism(s) both in the colonized catheter and in at least 1 peripheral blood culture. We included 372 catheters (group A, 223; group B, 149) during the study period. The catheter colonization rate was 23.4% (87/372), and 28 patients had C-RBSI. Validity index values for the capacity of surface cultures to predict C-RBSI in groups A and B were, respectively, as follows: sensitivity, 23.5% and 45.5%; specificity, 59.7% and 63.0%; positive predictive value, 4.6% and 8.9%; and negative predictive value, 90.4% and 93.5%. Superficial cultures of patients with long-term catheters could help us to rule out the catheter as the portal of entry of bloodstream infections. Superficial cultures (from skin and hubs) proved to be a useful conservative diagnostic tool for ruling out C-RBSI among patients with long-term tunneled catheters and totally implantable venous access ports. PMID:23850957

  10. Investigation of catheter curvature and genetic algorithms in conductance catheter optimization.

    PubMed

    Thaijiam, C; Gale, T J

    2007-01-01

    Catheter curvature affects accuracy of intra-ventricular blood volume measurement when using conductance catheter techniques, especially with irregular geometries, such as in the right ventricle. To investigate this effect, we present results from using different curved catheter configurations and different numbers of electrodes in a simple Finite Element model. It was found that there is an apparent increase in accuracy with curvature, due to greater linearity in the field in the region of the measurement electrodes, which are located farther from the source electrodes as curvature increases. Also, optimization using Genetic Algorithms is presented as a method to find the optimal distribution of measurement electrodes. We plan to extend these results to develop improved electrode configurations for using in blood volume measurement in the right ventricle.

  11. [Biodegradable catheters and urinary stents. When?

    PubMed

    Soria, F; Morcillo, E; López de Alda, A; Pastor, T; Sánchez-Margallo, F M

    2016-10-01

    One of the main wishes in the field of urinary catheters and stents is to arm them with biodegradable characteristics because we consider a failure of these devices the need for retrieval, the forgotten catheter syndrome as well as the adverse effects permanent devices cause after fulfilling their aim. The efforts focused in new designs, coatings and biomaterials aim to increase the biocompatibility of theses internal devices. Lately, there have been correct advances to answer the main challenges regarding biodegradable ureteral devices. Thus, modulation of the rate of degradation has been achieved thanks to new biomaterials and the use of copolymers that enable to choose the time of permanence as it is programmed with conventional double J catheters. Biocompatibility has improved with the use of new polymers that adapt better to the urine. Finally, one of the main problems is elimination of degraded fragments and experimentally it has be demonstrated that new designs elicit controlled degradation, from distal to proximal; using stranding and combination of copolymers degradation may be caused by dilution, reducing fragmentation to the last stages of life of the prosthesis. Moreover, it has been demonstrated that biodegradable catheters potentially may cause less urinary tract infection, less encrustation and predictably they will diminish catheter morbidity, since their degradation process reduces adverse effects. Regarding the development of biodegradable urethral stents, it is necessary to find biomaterials that enable maintaining their biomechanical properties in the long term, keeping open the urethral lumen both in patients with BPH and urethral stenosis. Modulation of the time of degradation of the prosthesis has been achieved, but the appearance of urothelial hyperplasia is still a constant in the initial phases after implantation. The development of drug eluting stents, anti-proliferative or anti-inflammatory, as well as biodegradable stents biocoated is a

  12. Blocked urinary catheters: can they be better managed?

    PubMed

    Gibney, Linda E

    2016-08-11

    This article discusses one of the problems associated with urinary catheterisation. It focuses on catheter blockage and explains the effects of this on patients and the health service and aims to guide nurses in their management of this complex issue. The length of time a catheter remains functional is unique to the individual and imperative to good catheter care. Coupled with this the cause of the blockage needs to be identified before a treatment plan can be formulated. Encrustation is identified as a major problem and the reliability of using the pH value of urine to monitor is discussed. Adequate fluid intake is essential for catheter management and the benefits of citrate drinks are highlighted. The treatment regime of catheter maintenance solution is examined and while this may be an option for some patients the suggestion of proactive catheter changes would appear to be the most appropriate.

  13. [Infection associated with hemodialysis and peritoneal dialysis catheters].

    PubMed

    Fariñas, María Carmen; García-Palomo, José Daniel; Gutiérrez-Cuadra, Manuel

    2008-10-01

    Catheter-related infections in hemodialysis (HD) and peritoneal dialysis (PD) are one of the most common causes of morbidity and mortality in patients with end-stage renal disease. Staphylococcus aureus in HD patients and S. aureus and Pseudomonas aeruginosa in PD patients are the most common causative organisms isolated. Currently, the diagnostic tests with highest yield in suspected catheter-related infection in HD patients have not been established, and tests used for central venous catheters (CVC) in general are applied. Management of the infected HD catheter and the use of antimicrobial therapy are similar to the measures used for other CVCs, with some specific recommendations. Peritonitis is the most severe complication in PD patients. Improving hygiene conditions in catheter insertion, treatment of S. aureus nasal carriers, regular treatment of the catheter's exit site, and antibiotic lock therapy have been associated with a reduction of infectious episodes in HD and PD patients.

  14. Practical Aspects of Nontunneled and Tunneled Hemodialysis Catheters

    PubMed Central

    Clark, Edward; Kappel, Joanne; MacRae, Jennifer; Dipchand, Christine; Hiremath, Swapnil; Kiaii, Mercedeh; Lok, Charmaine; Moist, Louise; Oliver, Matthew; Miller, Lisa M.

    2016-01-01

    Nontunneled hemodialysis catheters (NTHCs) are typically used when vascular access is required for urgent renal replacement therapy. The preferred site for NTHC insertion in acute kidney injury is the right internal jugular vein followed by the femoral vein. When aided by real-time ultrasound, mechanical complications related to NTHC insertion are significantly reduced. The preferred site for tunneled hemodialysis catheters placement is the right internal jugular vein followed by the left internal jugular vein. Ideally, the catheter should be inserted on the opposite side of a maturing or planned fistula/graft. Several dual-lumen, large-diameter catheters are available with multiple catheter tip designs, but no one catheter has shown significant superior performance. PMID:28270920

  15. Practical Aspects of Nontunneled and Tunneled Hemodialysis Catheters.

    PubMed

    Clark, Edward; Kappel, Joanne; MacRae, Jennifer; Dipchand, Christine; Hiremath, Swapnil; Kiaii, Mercedeh; Lok, Charmaine; Moist, Louise; Oliver, Matthew; Miller, Lisa M

    2016-01-01

    Nontunneled hemodialysis catheters (NTHCs) are typically used when vascular access is required for urgent renal replacement therapy. The preferred site for NTHC insertion in acute kidney injury is the right internal jugular vein followed by the femoral vein. When aided by real-time ultrasound, mechanical complications related to NTHC insertion are significantly reduced. The preferred site for tunneled hemodialysis catheters placement is the right internal jugular vein followed by the left internal jugular vein. Ideally, the catheter should be inserted on the opposite side of a maturing or planned fistula/graft. Several dual-lumen, large-diameter catheters are available with multiple catheter tip designs, but no one catheter has shown significant superior performance.

  16. Evaluation of two coated catheters in intermittent self-catheterization.

    PubMed

    Pascoe, G; Clovis, S

    Intermittent self-catheterization (ISC) has addressed the problems of mechanical or functional urological voiding since the 1970s. Patient quality of life is enhanced by the increased independence and security offered by ISC (Lapides et al, 1972). A randomized, comparative crossover study was undertaken in two centres to evaluate the performance of SpeediCath (Coloplast) and Lofric (Astra Tech) catheters. A total of 27 subjects were recruited, all of whom had been performing ISC more than twice a day for longer than 3 months with a coated catheter. Each catheter was used for 1 week to assess catheter performance and acceptability. There were no significant differences recorded for the performance of each catheter. However, SpeediCath demonstrated favourable statistical significance in relation to ease of use, speed of use, and the concept of water as an integral part of the packaging of the catheter.

  17. Central venous catheter placement: where is the tip?

    PubMed

    Ibrahim, George M

    2012-09-01

    The insertion of central venous catheters is a common bedside procedure performed in intensive care units. Here, we present a case of an 82-year-old man who underwent insertion of a central venous catheter in the internal jugular vein without perceived complications. Postprocedural radiographs showed rostral migration of the catheter, and computed tomography performed coincidentally showed cannulation of the jugular bulb at the level of the jugular foramen. To our knowledge, this is the first report to document migration of a central venous catheter from the internal jugular vein into the dural sinuses, as confirmed by computed tomography. The case highlights the importance of acquiring postprocedural radiographs for all insertions of central venous catheters to confirm catheter placement.

  18. Conceptual Design and Procedure for an Autonomous Intramyocardial Injection Catheter.

    PubMed

    Cheng, Weyland; Law, Peter

    2016-12-07

    This article discusses existing catheter systems and proposes a conceptual design and procedure for an autonomous cellinjection catheter for the purpose of transferring committed myogenic or undifferentiated stem cells into the infarct boundary zones of the left ventricle. Operation of existing catheters used for cell delivery is far from optimal. Commercial injection catheters available are hand-held devices operated manually by means of tip deflection and torque capabilities. Interventionists require a hefty learning curve and often encounter difficulties in catheter stabilization and infarct detection, resulting in lengthy operation times and non-precise injections. We examined current technologies and proposed a design incorporating robotic positional control, feedback signals, and an adaptable operational sequence to overcome these problems. The design provides the basis for the construction of a robotic catheter that is able to autonomously assist the physician in transferring myogenic cells to the left ventricle infarct boundary zones.

  19. Is it feasible to diagnose catheter-related candidemia without catheter withdrawal?

    PubMed

    Fernández-Cruz, Ana; Martín-Rabadán, Pablo; Suárez-Salas, Marisol; Rojas-Wettig, Loreto; Pérez, María Jesús; Guinea, Jesús; Guembe, María; Peláez, Teresa; Sánchez-Carrillo, Carlos; Bouza, Emilio

    2014-07-01

    Many bloodstream infections (BSI) in patients with central venous catheters (CVC) are not catheter-related (CR). Assessment of catheter involvement without catheter withdrawal has not been studied in candidemia. We assessed the value of conservative techniques to evaluate catheters as the origin of candidemia in patients with CVC in a prospective cohort study (superficial Gram stain and culture, Kite technique (Gram stain and culture of the first 1 cm blood drawn from the CVC), proportion of positive blood cultures (PPBCs), differential time to positivity (DTP), and minimal time to positivity (MTP)). All catheters were cultured at withdrawal. From June 2008 to January 2012, 22 cases fulfilled the inclusion criteria. CR-candidemia (CRC) was confirmed in 10. Validity values for predicting CRC were: superficial Gram stain (S, 30%; Sp, 81.83%; PPV, 60%; NPV, 56.3%; Ac, 57.1%), superficial cultures (S, 40%; Sp, 75%; PPV, 57.1%; NPV, 60%; Ac, 59.1%), Kite Gram stain (S, 33.3%; Sp, 66.7%; PPV, 50%; NPV, 50%; Ac, 50%), Kite culture (S, 80%; Sp, 66.7%; PPV, 66.7%; NPV, 80%; Ac, 72.7%), PPBC (S, 50%; Sp, 41.7%; PPV, 41.7%; NPV, 50.0%; Ac, 45.5%), DTP (S, 100%; Sp, 33.3%; PPV, 55.6%; NPV, 100%; Ac, 63.6%), and MTTP (S, 70%; Sp, 58.3%; PPV, 58.3%; NPV, 70%; Ac, 63.6%). While combinations of two tests improved sensitivity and NPV, more than two tests did not improve validity values. Classic tests to assess CR-BSI caused by bacteria cannot be reliably used to diagnose CRC. Combinations of tests could be useful, but more and larger studies are required.

  20. Initial Experience and Feasibility of the New Low-Profile Stingray Catheter as Part of the Antegrade Dissection and Re-Entry Revascularization Strategy for Coronary Chronic Total Occlusions

    PubMed Central

    Maeremans, Joren; Palmers, Pieter-Jan; Dens, Joseph

    2017-01-01

    Case series Patient: Male, 77 • Male, 57 • Male, 73 Final Diagnosis: Coronary chronic total occlusion Symptoms: Angina pectoris Medication: — Clinical Procedure: Percutaneous coronary intervention of coronary chronic total occlusions Specialty: Cardiology Objective: Unusual setting of medical care Background: During antegrade dissection re-entry (ADR) of chronic total occlusions (CTO), the first-generation Stingray catheter requires the use of large-bore guides (sheathless 7.5 Fr or 8 Fr), which increases the risk for access site-related complications and compromises radial approaches. Smaller guiding sizes necessitate long guidewires (e.g., 300 cm) or guidewire extensions for catheter advancement or removal. However, friction between guides and the Stingray catheter can result in unstable guidewire position or unintentional removal. Furthermore, failure to deliver the catheter at the distal re-entry zone is a common problem. To overcome issues of deliverability and reduce the need for pre-dilatations, with its inherent risk of creating subintimal hematomas, the Stingray low-profile (LP) balloon catheter was developed. Case Report: We describe 3 cases of successful application of the novel Stingray LP catheter during ADR. In all cases, 7 Fr guiding catheters were successfully used in combination with the device. The lower profile facilitated a good exchange and delivery of the device, without the need for balloon pre-dilatations in 2 cases. This resulted in a limited subintimal plane, enabling a smooth puncture into the true lumen. One case presented with extreme levels of calcification and tortuosity, resulting in a high degree of friction, despite the lower catheter profile. No in-hospital coronary or access site-related complications occurred. Conclusions: This case report illustrates the feasibility of the Stingray LP catheter for the treatment of CTOs via the ADR technique. The lower profile of the catheter potentially increases the deliverability

  1. Initial Experience and Feasibility of the New Low-Profile Stingray Catheter as Part of the Antegrade Dissection and Re-Entry Revascularization Strategy for Coronary Chronic Total Occlusions.

    PubMed

    Maeremans, Joren; Palmers, Pieter-Jan; Dens, Joseph

    2017-01-31

    BACKGROUND During antegrade dissection re-entry (ADR) of chronic total occlusions (CTO), the first-generation Stingray catheter requires the use of large-bore guides (sheathless 7.5 Fr or 8 Fr), which increases the risk for access site-related complications and compromises radial approaches. Smaller guiding sizes necessitate long guidewires (e.g., 300 cm) or guidewire extensions for catheter advancement or removal. However, friction between guides and the Stingray catheter can result in unstable guidewire position or unintentional removal. Furthermore, failure to deliver the catheter at the distal re-entry zone is a common problem. To overcome issues of deliverability and reduce the need for pre-dilatations, with its inherent risk of creating subintimal hematomas, the Stingray low-profile (LP) balloon catheter was developed. CASE REPORT We describe 3 cases of successful application of the novel Stingray LP catheter during ADR. In all cases, 7 Fr guiding catheters were successfully used in combination with the device. The lower profile facilitated a good exchange and delivery of the device, without the need for balloon pre-dilatations in 2 cases. This resulted in a limited subintimal plane, enabling a smooth puncture into the true lumen. One case presented with extreme levels of calcification and tortuosity, resulting in a high degree of friction, despite the lower catheter profile. No in-hospital coronary or access site-related complications occurred. CONCLUSIONS This case report illustrates the feasibility of the Stingray LP catheter for the treatment of CTOs via the ADR technique. The lower profile of the catheter potentially increases the deliverability, safety, and exchangeability of the device.

  2. Automatic Reconstruction of Catheters in CT Based Bracytherapy Treatment Planning

    DTIC Science & Technology

    2007-11-02

    backward of the current slice (+ and – z direction in the DICOM definition8) and (d) catheter loop option. E. Description of parameters 1.In...and +z direction according to the DICOM definition8. The backward searching algorithm is given below. Input data: PC - center of the catheter...prostate, breast, cervix, brain, chest, scapula, skin, neck and glioblastoma implants, and one phantom implant with three looped plastic catheters

  3. The Aerodynamic Plane Table

    NASA Technical Reports Server (NTRS)

    Zahm, A F

    1924-01-01

    This report gives the description and the use of a specially designed aerodynamic plane table. For the accurate and expeditious geometrical measurement of models in an aerodynamic laboratory, and for miscellaneous truing operations, there is frequent need for a specially equipped plan table. For example, one may have to measure truly to 0.001 inch the offsets of an airfoil at many parts of its surface. Or the offsets of a strut, airship hull, or other carefully formed figure may require exact calipering. Again, a complete airplane model may have to be adjusted for correct incidence at all parts of its surfaces or verified in those parts for conformance to specifications. Such work, if but occasional, may be done on a planing or milling machine; but if frequent, justifies the provision of a special table. For this reason it was found desirable in 1918 to make the table described in this report and to equip it with such gauges and measures as the work should require.

  4. Fourier plane image amplifier

    DOEpatents

    Hackel, L.A.; Hermann, M.R.; Dane, C.B.; Tiszauer, D.H.

    1995-12-12

    A solid state laser is frequency tripled to 0.3 {micro}m. A small portion of the laser is split off and generates a Stokes seed in a low power oscillator. The low power output passes through a mask with the appropriate hole pattern. Meanwhile, the bulk of the laser output is focused into a larger stimulated Brillouin scattering (SBS) amplifier. The low power beam is directed through the same cell in the opposite direction. The majority of the amplification takes place at the focus which is the fourier transform plane of the mask image. The small holes occupy large area at the focus and thus are preferentially amplified. The amplified output is now imaged onto the multichip module where the holes are drilled. Because of the fourier plane amplifier, only about 1/10th the power of a competitive system is needed. This concept allows less expensive masks to be used in the process and requires much less laser power. 1 fig.

  5. Fourier plane image amplifier

    DOEpatents

    Hackel, Lloyd A.; Hermann, Mark R.; Dane, C. Brent; Tiszauer, Detlev H.

    1995-01-01

    A solid state laser is frequency tripled to 0.3 .mu.m. A small portion of the laser is split off and generates a Stokes seed in a low power oscillator. The low power output passes through a mask with the appropriate hole pattern. Meanwhile, the bulk of the laser output is focused into a larger stimulated Brillouin scattering (SBS) amplifier. The low power beam is directed through the same cell in the opposite direction. The majority of the amplification takes place at the focus which is the fourier transform plane of the mask image. The small holes occupy large area at the focus and thus are preferentially amplified. The amplified output is now imaged onto the multichip module where the holes are drilled. Because of the fourier plane amplifier, only .about.1/10th the power of a competitive system is needed. This concept allows less expensive masks to be used in the process and requires much less laser power.

  6. Endoluminal dilation technique to remove "stuck" tunneled hemodialysis catheters.

    PubMed

    Ryan, Stephen E; Hadziomerovic, Adnan; Aquino, Jose; Cunningham, Ian; O'Kelly, Kevin; Rasuli, Pasteur

    2012-08-01

    Most tunneled catheters can be easily removed after the retention cuff is dissected. Occasionally, these catheters can become resistant to removal even after application of potentially hazardous forceful traction. In addition, an infected catheter may cause life-threatening septicemia. Several methods have been described for their extraction, some of which may be available only in tertiary-care facilities. The present report describes the successful extraction of five such "stuck" catheters by using a recently described technique of endoluminal dilation. The technique appears safe and straightforward and can be performed in any interventional suite while allowing preservation of venous access.

  7. Multifunctional Catheters Combining Intracardiac Ultrasound Imaging and Electrophysiology Sensing

    PubMed Central

    Stephens, Douglas N.; Cannata, Jonathan; Liu, Ruibin; Zhao, Jian Zhong; Shung, K. Kirk; Nguyen, Hien; Chia, Raymond; Dentinger, Aaron; Wildes, Douglas; Thomenius, Kai E.; Mahajan, Aman; Shivkumar, Kalyanam; Kim, Kang; O’Donnell, Matthew; Nikoozadeh, Amin; Oralkan, Omer; Khuri-Yakub, Pierre T.; Sahn, David J.

    2015-01-01

    A family of 3 multifunctional intracardiac imaging and electrophysiology (EP) mapping catheters has been in development to help guide diagnostic and therapeutic intracardiac EP procedures. The catheter tip on the first device includes a 7.5 MHz, 64-element, side-looking phased array for high resolution sector scanning. The second device is a forward-looking catheter with a 24-element 14 MHz phased array. Both of these catheters operate on a commercial imaging system with standard software. Multiple EP mapping sensors were mounted as ring electrodes near the arrays for electrocardiographic synchronization of ultrasound images and used for unique integration with EP mapping technologies. To help establish the catheters’ ability for integration with EP interventional procedures, tests were performed in vivo in a porcine animal model to demonstrate both useful intracardiac echocardiographic (ICE) visualization and simultaneous 3-D positional information using integrated electroanatomical mapping techniques. The catheters also performed well in high frame rate imaging, color flow imaging, and strain rate imaging of atrial and ventricular structures. The companion paper of this work discusses the catheter design of the side-looking catheter with special attention to acoustic lens design. The third device in development is a 10 MHz forward-looking ring array that is to be mounted at the distal tip of a 9F catheter to permit use of the available catheter lumen for adjunctive therapy tools. PMID:18986948

  8. Latex anaphylaxis caused by a Swan-Ganz catheter.

    PubMed

    Sekiya, Kiyoshi; Watai, Kentaro; Taniguchi, Masami; Mitsui, Chihiro; Fukutomi, Yuma; Tanimoto, Hidenori; Kawaura, Noriyuki; Akiyama, Kazuo

    2011-01-01

    A 78-year-old woman visited the division of cardiovascular disease in our hospital. She underwent a cardiac catheter examination, and a Swan-Ganz catheter was inserted. Several minutes later, she developed anaphylactic shock. She had no past history of latex allergy, but did have a banana allergy. Skin prick tests showed a positive reaction to an extract of latex gloves and an extract of the balloon of a Swan-Ganz catheter. Anaphylactic shock caused by the latex balloon of a Swan-Ganz catheter was diagnosed. It is necessary to pay attention to not only latex allergy but also fruit allergies with a cross-reactivity to latex.

  9. [Incidence and risk factors for infections from hemodialysis catheters].

    PubMed

    Jean, G

    2001-01-01

    We report here a revue of hemodialysis catheter-related infections data published since 1985. The reported prevalence of bacteremia is 1 to 20% of catheters, and incidence is 0.72 to 9/1000 catheter-days. Local infection is reported in 6 to 63% of catheters and in 1 to 5/1000 catheter-days. Tunneled catheters and implantables chambers reported less infection rate. The most severe complication is endocarditis (4% rate). Death occurs in 8 to 20% of cases. Reported microbial data show that Staphylococcus aureus (SA) is responsible for most infections ahead of non-aureus Staphylococcus. SA skin colonisation is a risk factor for catheter colonisation and the first step of infection. On the other hand, the host immunity impairment in hemodialysis patients seems a significant risk factor. Iron overload, specially after blood transfusions, older age, diabetes mellitus, low serum albumin level, previous history of bacteremia and immunosuppressive treatment have been frequently involved. Other catheter-related factors are time of use, absence of tunnel and use for parenteral nutrition. Nurses plans, dressing type and frequency, nurses work experience are also important. In spite of recent progress in risk factor understanding, hemodialysis-related infection remains frequent. Multicentre studies are necessary to better evaluated care protocols and new catheter material.

  10. Assessment of dimensions and image quality of coronary contrast catheters from cineangiograms.

    PubMed

    Reiber, J H; Kooijman, C J; den Boer, A; Serruys, P W

    1985-01-01

    In the quantitative assessment of coronary arterial dimensions from coronary cineangiograms, the contrast catheter is usually used as a scaling device, requiring the definition of the catheter contours by semi- or fully automated contour detection procedures. The image quality of the x-ray radiated catheter is dependent on the catheter material, concentration of the contrast agent in the catheter, and kilovoltage of the x-ray source. The effects of these variables on the image quality and accuracy of the size-measurement of the filmed catheters were studied for four different catheter materials: woven dacron (wd), polyvinylchloride (pv), polyurethane (pu), and nylon. The following parameters were studied: measured size, image contrast, and average brightness gradient along the edges of the displayed catheters. The average differences of the angiographically measured size with the true size for the wd, pv, pu, and nylon catheters were +0.2, -3.2, -3.5, and +9.8%, respectively. The image contrast at various fillings of the catheters was roughly identical for the wd, pv, and pu catheters, and significantly lower for the nylon catheter. Image gradient was highest for the wd catheter, followed by the pv and pu catheters, and lowest for the nylon catheter. From these data it may be concluded that the woven dacron catheter is most suitable for quantitative coronary angiographic studies. The polyvinylchloride and polyurethane catheters perform about equally well but slightly less than the woven dacron catheter. The nylon catheter should not be used for such quantitative studies.

  11. Pulmonary artery catheter entrapment in cardiac surgery: a simple percutaneous solution.

    PubMed

    Divakaran, Vijay; Caldera, Angel; Stephens, Jack; Gonzalez, Rafael

    2015-10-01

    Pulmonary artery catheter entrapment is a reported complication after cardiac surgery from inadvertent suturing of the catheter to the vena-caval wall during surgery. This article reports a simple percutaneous technique to retrieve the trapped catheter.

  12. NASA Connect: 'Plane Weather'

    NASA Technical Reports Server (NTRS)

    1999-01-01

    Excerpt from the NASA Connect show 'Plane Weather' This clip explains what high and low pressure weather systems are, and how they form. Weather affects our daily lives. The elements of weather: rain, wind, fog, ice and snow affect the operation and flight of an airplane. In this program, NASA and FAA researchers will introduce students to math, science, and weather; demonstrate how these elements influence flight; and show how NASA and FAA research is used to limit the effects of these elements on flight. Students will examine: the tools, techniques, and technologies used by engineers and scientists to detect these and other climatological factors affecting aircraft in flight. The lesson and classroom experiment will involve students in the scientific process and emphasizing problem solving, measurement, and reasoning skills.

  13. NASA Connect: 'Plane Weather'

    NASA Technical Reports Server (NTRS)

    1999-01-01

    Excerpt from the NASA Connect show 'Plane Weather' This clip explains what high and low pressure weather systems are, and how these affect weather patterns. Weather affects our daily lives. The elements of weather: rain, wind, fog, ice and snow affect the operation and flight of an airplane. In this program, NASA and FAA researchers will introduce students to math, science, and weather; demonstrate how these elements influence flight; and show how NASA and FAA research is used to limit the effects of these elements on flight. Students will examine: the tools, techniques, and technologies used by engineers and scientists to detect these and other climatological factors affecting aircraft in flight. The lesson and classroom experiment will involve students in the scientific process and emphasizing problem solving, measurement, and reasoning skills.

  14. Improved method for the detection of catheter colonization and catheter-related bacteremia in newborns.

    PubMed

    Martín-Rabadán, P; Pérez-García, F; Zamora Flores, E; Nisa, E S; Guembe, M; Bouza, E

    2017-04-01

    Accurate diagnosis of catheter-related bloodstream infection (CRBSI) is mandatory for hospital infection control. Peripherally inserted central venous catheters (PICCs) are widely used in intensive care units, but studies about procedures for detection of colonization are scarce in neonates. We sequentially processed 372 PICCs by 2 methods, first by the standard roll-plate (RP) technique and then by rubbing catheters on a blood agar plate after being longitudinally split (LS). With both techniques, we detected 133 colonized PICCs. Ninety-four events of CRBSI were diagnosed. The sensitivity, specificity, positive predictive value, and negative predictive value for detection of CRBSI were 58.5%, 92.8%, 73.3%, and 86.9%, respectively, for RP technique and 96.8%, 88.5%, 74.0%, and 98.8%, respectively, for LS technique. The LS technique increased the proportion of detected CRBSI by 38.3%. Neonatal PICC tips should be cultured after cutting them open. This technique is simple and sensitive to detect catheter colonization and also to diagnose CRBSI.

  15. Innovations in Balloon Catheter Technology in Rhinology.

    PubMed

    D'Anza, Brian; Sindwani, Raj; Woodard, Troy D

    2017-03-31

    Since being introduced more than 10 years ago, balloon catheter technology (BCT) has undergone several generations of innovations. From construction to utilization, there has been a myriad of advancements in balloon technology. The ergonomics of the balloon dilation systems have improved with a focus on limiting the extra assembly. "Hybrid" BCT procedures have shown promise in mucosal preservation, including treating isolated complex frontal disease. Multiple randomized clinical trials report improved long-term outcomes in stand-alone BCT, including in-office use. The ever-expanding technological innovations ensure BCT will be a key component in the armamentarium of the modern sinus surgeon.

  16. Central venous catheter-related bloodstream infections: improving post-insertion catheter care.

    PubMed

    Shapey, I M; Foster, M A; Whitehouse, T; Jumaa, P; Bion, J F

    2009-02-01

    Patients with central venous catheters (CVCs) are at increased risk of bloodstream infections and sepsis-related death. CVC-related bloodstream infections (CRBSIs) are costly and account for a significant proportion of hospital-acquired infections. The aim of this audit was to assess current practice and staff knowledge of CVC post-insertion care and therefore identify aspects of CVC care with potential for improvement. We conducted a prospective audit over 28 consecutive days at a university teaching hospital investigating current practice of CVC post-insertion care in wards with high CVC usage. A multiple choice questionnaire on best practice of CVC insertion and care was distributed among clinical staff. Rates of breaches in catheter care and CRBSIs were calculated and statistical significance assumed when P<0.05. Data was recorded from 151 CVCs in 106 patients giving a total of 721 catheter days. In all, 323 breaches in care were identified giving a failure rate of 44.8%, with significant differences between intensive care unit (ICU) and non-ICU wards (P<0.001). Dressings (not intact) and caps and taps (incorrectly placed) were identified as the major lapses in CVC care with 158 and 156 breaches per 1000 catheter days, respectively. During the study period four CRBSIs were identified, producing a CRBSI rate of 5.5 per 1000 catheter days (95% confidence interval: 0.12-10.97). There are several opportunities to improve CVC post-insertion care. Future interventions to improve reliability of care should focus on implementing best practice rather than further education.

  17. Duration and Adverse Events of Non-cuffed Catheter in Patients With Hemodialysis

    ClinicalTrials.gov

    2014-10-09

    Renal Failure Chronic Requiring Hemodialysis; Central Venous Catheterization; Inadequate Hemodialysis Blood Flow; Venous Stenosis; Venous Thrombosis; Infection Due to Central Venous Catheter; Central Venous Catheter Thrombosis

  18. Comparison of fat necrosis between zone II and zone III in pedicled transverse rectus abdominis musculocutaneous flaps: a prospective study of 400 consecutive cases.

    PubMed

    Kim, Eun Key; Lee, Taik Jong; Eom, Jin Sup

    2007-09-01

    Fat necrosis in transverse rectus abdominis musculocutaneous (TRAM) flap is considered to be mainly affected by blood supply. This prospective study compares the incidence of fat necrosis between zones II and III in 400 consecutive patients who had undergone unipedicled TRAM flap breast reconstruction. Fifty-eight patients (14.5%) suffered from fat necrosis, and 7 had 2 separate nodules. Fifty-four occurred in zone II, 10 in zone III, and 1 in zone I. The incidence of fat necrosis in zone II was significantly higher than in zone III (P < 0.001). The weight of the mastectomy specimen and the relative amount of zone II tissue included in the flap had positive correlation with the incidence of fat necrosis. This result implies relatively poor perfusion of zone II compared with zone III.

  19. A magnetic-resonance-imaging-compatible remote catheter navigation system.

    PubMed

    Tavallaei, Mohammad Ali; Thakur, Yogesh; Haider, Syed; Drangova, Maria

    2013-04-01

    A remote catheter navigation system compatible with magnetic resonance imaging (MRI) has been developed to facilitate MRI-guided catheterization procedures. The interventionalist's conventional motions (axial motion and rotation) on an input catheter - acting as the master - are measured by a pair of optical encoders, and a custom embedded system relays the motions to a pair of ultrasonic motors. The ultrasonic motors drive the patient catheter (slave) within the MRI scanner, replicating the motion of the input catheter. The performance of the remote catheter navigation system was evaluated in terms of accuracy and delay of motion replication outside and within the bore of the magnet. While inside the scanner bore, motion accuracy was characterized during the acquisition of frequently used imaging sequences, including real-time gradient echo. The effect of the catheter navigation system on image signal-to-noise ratio (SNR) was also evaluated. The results show that the master-slave system has a maximum time delay of 41 ± 21 ms in replicating motion; an absolute value error of 2 ± 2° was measured for radial catheter motion replication over 360° and 1.0 ± 0.8 mm in axial catheter motion replication over 100 mm of travel. The worst-case SNR drop was observed to be 2.5%.

  20. Difficulty in the removal of epidural catheter for labor analgesia

    PubMed Central

    Hajnour, Mohamed S.; Khokhar, Rashid Saeed; Ejaz, Abdul Aziz Ahmed; Al Zahrani, Tariq; Kanchi, Naveed Uddin

    2017-01-01

    For labor pain management epidural analgesia is a popular and an effective method. Difficult removal of epidural catheters occasionally occurs, and several maneuvers have been recommended. The purpose of this article is to raise awareness of the problem of retained epidural catheter fragments and identify the potential impact of complications. PMID:28217071

  1. Device for Catheter Placement of External Ventricular Drain

    PubMed Central

    Ann, Jae-Min; Oh, Jae-Sang; Yoon, Seok-Mann

    2016-01-01

    To introduce a new device for catheter placement of an external ventricular drain (EVD) of cerebrospinal fluid (CSF). This device was composed of three portions, T-shaped main body, rectangular pillar having a central hole to insert a catheter and an arm pointing the tragus. The main body has a role to direct a ventricular catheter toward the right or left inner canthus and has a shallow longitudinal opening to connect the rectangular pillar. The arm pointing the tragus is controlled by back and forth movement and turn of the pillar attached to the main body. Between April 2012 and December 2014, 57 emergency EVDs were performed in 52 patients using this device in the operating room. Catheter tip located in the frontal horn in 52 (91.2%), 3rd ventricle in 2 (3.5%) and in the wall of the frontal horn of the lateral ventricle in 3 EVDs (5.2%). Small hemorrhage along to catheter tract occurred in 1 EVD. CSF was well drained through the all EVD catheters. The accuracy of the catheter position and direction using this device were 91% and 100%, respectively. This device for EVD guides to provide an accurate position of catheter tip safely and easily. PMID:27226870

  2. 21 CFR 870.2870 - Catheter tip pressure transducer.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Catheter tip pressure transducer. 870.2870 Section... pressure transducer. (a) Identification. A catheter tip pressure transducer is a device incorporated into... change in relation to changes in blood pressure. These changes are transmitted to accessory equipment...

  3. 21 CFR 870.2870 - Catheter tip pressure transducer.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Catheter tip pressure transducer. 870.2870 Section... pressure transducer. (a) Identification. A catheter tip pressure transducer is a device incorporated into... change in relation to changes in blood pressure. These changes are transmitted to accessory equipment...

  4. 21 CFR 870.2870 - Catheter tip pressure transducer.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Catheter tip pressure transducer. 870.2870 Section... pressure transducer. (a) Identification. A catheter tip pressure transducer is a device incorporated into... change in relation to changes in blood pressure. These changes are transmitted to accessory equipment...

  5. Tracheal gas insufflation: catheter effectiveness determined by expiratory flush volume.

    PubMed

    Ravenscraft, S A; Shapiro, R S; Nahum, A; Burke, W C; Adams, A B; Nakos, G; Marini, J J

    1996-06-01

    Used adjunctively during mechanical ventilation, tracheal gas insufflation (TGI) improves CO2 elimination, principally by decreasing effective anatomic dead space. Continuing lung deflation at end- expiration raises the end-expiratory C02 concentration within the proximal airway, and could theoretically reduce the efficiency of a given catheter flow. To test this possibility, we designed a series of experiments that examined the influence of TGI delivery patterns on the efficiency of CO2 elimination. Using a gating device, catheter flow was delivered selectively during desired portions of expiration. Paralyzed, ventilated dogs were studied at short and extended inspiratory time fractions (TI/TT) with inspiratory tidal volume and ventilator frequency held constant. The expiratory flush volume, not the pattern of gas delivery, determined the observed decline in PaCO2, provided that the end-expiratory period was included in the catheter flush period. Despite continuing end-expiratory lung deflation (extended TI/TT), catheter effectiveness remained the same at matched expiratory flush volumes. To determine if enhanced distal mixing at the higher catheter flows required during the extended TI/TT (to match expiratory flush volume) masked a decrease in efficiency, we repeated the experiment with a tip-inverted catheter. We again found that matched catheter delivered expiratory volumes were similarly effective. With or without ongoing lung deflation, the volume of gas flushed during the expiratory period determined the effectiveness of TGI, provided that inspired minute ventilation remains unchanged and end-expiration is included in the catheter flush period.

  6. Diagnosis of intra vascular catheter-related infection.

    PubMed

    Cicalini, S; Palmieri, F; Noto, P; Boumis, E; Petrosillo, N

    2002-01-01

    The use of central vascular catheters (CVC) is associated with a substantial number of complications, amongst which infections predominate. A diagnosis of CVC-related infection usually requires catheter removal for culture. Semiquantitative (roll-plate method) and quantitative methods (flush, vortex, centrifugation or sonication methods) are the most reliable diagnostic methodologies requiring catheter removal, because of their greater specificity. The roll-plate method is the simplest and most commonly used technique. This method only samples the external surface of the catheter, and is particularly indicated for recently inserted catheters in which extraluminal colonisation is the primary mechanism of infection. Luminal culture techniques, such as the quantitative methods, may be more relevant for catheters that have been in place for a long period of time. However, in up to 85% of removed CVC the culture is negative, and other diagnostic techniques that do not require catheter removal have been proposed, including paired quantitative blood cultures, endoluminal brushing, and differential time to positivity (DTP) of paired blood cultures. DTP, that compares the time to positivity for qualitative cultures of blood samples simultaneously drawn from the CVC and a peripheral vein, appears to be the most reliable in the routine clinical practice since many hospitals use automatic devices for qualitative blood culture positivity detection. More recently catheter-sparing direct diagnostic methods, which include Gram stain and acridin-orange leucocyte cytospin (AOLC) test, appeared to be especially useful because of the rapidity of results and the ability to distinguish different microorganisms, allowing early targeted antimicrobial therapy.

  7. Urinary catheters: history, current status, adverse events and research agenda.

    PubMed

    Feneley, Roger C L; Hopley, Ian B; Wells, Peter N T

    2015-01-01

    For more than 3500 years, urinary catheters have been used to drain the bladder when it fails to empty. For people with impaired bladder function and for whom the method is feasible, clean intermittent self-catheterization is the optimal procedure. For those who require an indwelling catheter, whether short- or long-term, the self-retaining Foley catheter is invariably used, as it has been since its introduction nearly 80 years ago, despite the fact that this catheter can cause bacterial colonization, recurrent and chronic infections, bladder stones and septicaemia, damage to the kidneys, the bladder and the urethra, and contribute to the development of antibiotic resistance. In terms of medical, social and economic resources, the burden of urinary retention and incontinence, aggravated by the use of the Foley catheter, is huge. In the UK, the harm resulting from the use of the Foley catheter costs the National Health Service between £1.0-2.5 billion and accounts for ∼2100 deaths per year. Therefore, there is an urgent need for the development of an alternative indwelling catheter system. The research agenda is for the new catheter to be easy and safe to insert, either urethrally or suprapubically, to be retained reliably in the bladder and to be withdrawn easily and safely when necessary, to mimic natural physiology by filling at low pressure and emptying completely without damage to the bladder, and to have control mechanisms appropriate for all users.

  8. Migration of Indwelling Central Venous Catheter and Fatal Hydrothorax

    PubMed Central

    Jabeen, Shagufta; Murtaza, Ghulam; Hanif, Muhammad Zubair; Morabito, Antonino; Khalil, Basem

    2013-01-01

    Central venous catheter complications can be related to insertion, indwelling, or extraction. Most of the times, immediate complications are anticipated and managed; whereas, delayed complications can go unnoticed. In the case discussed here, migration and dislodgement of catheter tip resulted in delayed hydrothorax and sudden death of a 9-month-old female infant. PMID:25755966

  9. Central venous access for haemodialysis using the Hickman catheter.

    PubMed

    Cappello, M; De Pauw, L; Bastin, G; Prospert, F; Delcour, C; Thaysse, C; Dhaene, M; Vanherweghem, J L; Kinnaert, P

    1989-01-01

    One hundred and seven Hickman catheters for haemodialysis were inserted in 90 end-stage chronic renal failure patients, and were used for 1-448 days (median 45 days). Sixty-nine per cent of the patients were treated without any problem for 1-165 days (median 34 days). Clinically evident complications occurred in 44 catheters inserted in 28 patients, and included outflow obstruction (16.8% of the catheters) and thrombosis (13.1% of the catheters). However, many episodes of clotting or insufficient flow could be corrected by simple manoeuvres. Other less frequent complications were recorded: sepsis, mainly in patients with increased risk factors (4.1% of the catheters), laceration of the catheter (3.7%) and occasional cases of jugular-vein phlebitis, transient palsy of a vocal cord, haematoma of the wound, and bleeding of the cutaneous orifice. No clinical sign of subclavian or innominate-vein thrombosis was observed. Nevertheless, a prospective study conducted in 50 asymptomatic patients demonstrated a 12% rate of anomalies of the venous system, although two-thirds of these alterations were mild and had no consequence. When the present series is compared to the results obtained with currently available percutaneous haemodialysis catheters, it is concluded that the Hickman catheter is a safe, comfortable and efficient vascular access device.

  10. Balloon catheter dilatation and thrombectomy for acute aortoiliac occlusion

    PubMed Central

    Archie, Joseph P.

    1981-01-01

    A case of acute distal aortic thrombosis in an elderly high-risk patient was successfully managed with intraoperative thrombectomy and balloon catheter dilatation of the common iliac arteries. Balloon catheter dilatation may be indicated prior to bypass grafting in high-risk patients with acute aortoiliac thrombosis. PMID:15216181

  11. Urinary catheters: history, current status, adverse events and research agenda

    PubMed Central

    Feneley, Roger C. L.; Hopley, Ian B.; Wells, Peter N. T.

    2015-01-01

    Abstract For more than 3500 years, urinary catheters have been used to drain the bladder when it fails to empty. For people with impaired bladder function and for whom the method is feasible, clean intermittent self-catheterization is the optimal procedure. For those who require an indwelling catheter, whether short- or long-term, the self-retaining Foley catheter is invariably used, as it has been since its introduction nearly 80 years ago, despite the fact that this catheter can cause bacterial colonization, recurrent and chronic infections, bladder stones and septicaemia, damage to the kidneys, the bladder and the urethra, and contribute to the development of antibiotic resistance. In terms of medical, social and economic resources, the burden of urinary retention and incontinence, aggravated by the use of the Foley catheter, is huge. In the UK, the harm resulting from the use of the Foley catheter costs the National Health Service between £1.0–2.5 billion and accounts for ∼2100 deaths per year. Therefore, there is an urgent need for the development of an alternative indwelling catheter system. The research agenda is for the new catheter to be easy and safe to insert, either urethrally or suprapubically, to be retained reliably in the bladder and to be withdrawn easily and safely when necessary, to mimic natural physiology by filling at low pressure and emptying completely without damage to the bladder, and to have control mechanisms appropriate for all users. PMID:26383168

  12. Femoral venous catheters: a safe alternative for delivering parenteral alimentation.

    PubMed

    Friedman, B; Kanter, G; Titus, D

    1994-04-01

    Femoral vein catheterization is an alternative method of obtaining central venous access. Placement of femoral venous catheters (FVCs) is possible in the majority of patients, suitable for most indications, and associated with a low complication rate during insertion. We wished to determine the incidence of infections or other complications resulting when parenteral nutrition was delivered through FVCs. Fifty-two patients were followed from a hospital-wide population including patients in the critical care units. Triple-lumen catheters were placed by using the sterile Seldinger technique, and sites were examined daily for inflammation. Bacteriologic surveillance was accomplished by submitting the catheter tip for semiquantitative cultures. If catheter line sepsis was suspected, blood samples for cultures were drawn through the catheter and peripherally. The rate of occurrence of colonized catheters was 9.6% (five of 52), and catheter sepsis was found in one case (1.9%). Other than inflammation at six (11.5%) of 52 catheter sites, noninfectious complications of FVCs were not found. On the basis of these findings, we consider FVC-delivered parenteral alimentation a safe and effective alternative to other forms of central venous access.

  13. New tools in diagnosing catheter-related infections.

    PubMed

    Blot, F; Nitenberg, G; Brun-Buisson, C

    2000-07-01

    Clinical criteria alone are insufficient to allow a diagnosis of intravascular catheter-related sepsis (CRS). A definite diagnosis of CRS usually requires removal of the catheter for quantitative catheter tip culture. However, only about 15-25% of central venous catheters (CVC) removed because infection is suspected actually prove to be infected, and the diagnosis is always retrospective. Other diagnostic tests, such as differential quantitative blood cultures from samples taken simultaneously from the catheter and a peripheral vein, have been proposed to avoid unjustified removal of the catheter and the potential risks associated with the placement of a new catheter at a new site: a central-to-peripheral blood culture colony count ratio of 5:1 to 10:1 is considered indicative of CRS. Despite its high specificity, the latter diagnostic technique is not routinely used in clinical practice because of its complexity and cost. The measurement of the differential time to positivity between hub blood (taken from the catheter port) and peripheral blood cultures might be a reliable tool facilitating the diagnosis of CRS in situ. In an in vitro study, we found a strong relationship between the inoculum size of various microorganisms and the time to positivity of cultures. When the times to positivity of cultures of blood taken simultaneously from central and peripheral veins in patients with and without CRS were examined, we found that earlier positivity of central vs peripheral vein blood cultures was highly correlated with CRS. Using a cut-off value of +120 min, the "differential time to positivity" of the paired blood samples, defined as time to positivity of the peripheral blood minus that of the hub blood culture, had 91% specificity and 94% sensitivity for the diagnosis of CRS. This method may be coupled with other techniques that have high negative predictive value, such as skin cultures at the catheter exit site. This diagnostic test can be proposed for routine

  14. Catheter-Based Sensing In The Airways

    NASA Astrophysics Data System (ADS)

    Fouke, J. M.; Saunders, K. G.

    1988-04-01

    Studies attempting to define the role of the respiratory tract in heating and humidifying inspired air point to the need for sensing many variables including airway wall and airstream temperatures, humidity, and surface fluid pH and osmolarity. In order to make such measurements in vivo in human volunteers, catheter based technologies must be exploited both to assure subject safety and subject comfort. Miniturization of the electrodes or sensors becomes a top priority. This paper describes the use of thin-film microelectronic technology to fabricate a miniature, flexible sensor which can be placed directly onto the surface of the airway to measure the electrical conductance of the fluids present. From this information the osmolarity of the surface fluid was calculated. Physiologic evaluation of the device and corroboration of the calculations was performed in mongrel dogs. We also describe the successful application of current thermistor technology for the thermal mapping of the airways in humans in order to characterize the dynamic intrathoracic events that occur during breathing. The thermal probe consisted of a flexible polyvinyl tube that contained fourteen small thermistors fixed into the catheter. Data have been obtained in dozens of people, both normal subjects and asthmatic patients, under a variety of interventions. These data have substantively advanced the study of asthma, a particularly troublesome chronic obstructive pulmonary disorder.

  15. The stuck central venous catheter: a word of caution.

    PubMed

    Makhija, Neeti; Choudhury, Minati; Kiran, Usha; Chowdhury, Ujjwal

    2008-10-01

    The placement of central venous catheter (CVC) through internal jugular vein is not free from potential hazards. We report two cases of triple lumen central venous catheter, placed into right internal jugular vein, which got entrapped in patients who had undergone mitral valve replacement. The entrapment of catheter went unnoticed until the time of removal. Subsequent investigations, mechanism of entrapment, prevention, and removal is described. To conclude, we encountered an unusual cause of stuck central venous catheter, in the left atrial suture line. Removal of central venous catheter requires utmost care, and should never be done by forceful traction in the postoperative cardiac surgical patients, as it may lead to disruption of suture lines or rupture of vessels.

  16. Medical catheters thermally manipulated by fiber optic bundles

    DOEpatents

    Chastagner, Philippe

    1992-01-01

    A maneuverable medical catheter comprising a flexible tube having a functional tip. The catheter is connected to a control source. The functional tip of the catheter carries a plurality of temperature activated elements arranged in parallel and disposed about the functional tip and held in spaced relation at each end. These elements expand when they are heated. A plurality of fiber optic bundles, each bundle having a proximal end attached to the control source and a distal end attached to one of the elements carry light into the elements where the light is absorbed as heat. By varying the optic fiber that is carrying the light and the intensity of the light, the bending of the elements can be controlled and thus the catheter steered. In an alternate embodiment, the catheter carries a medical instrument for gathering a sample of tissue. The instrument may also be deployed and operated by thermal expansion and contraction of its moving parts.

  17. Medical catheters thermally manipulated by fiber optic bundles

    DOEpatents

    Chastagner, P.

    1992-10-06

    A maneuverable medical catheter comprising a flexible tube having a functional tip is described. The catheter is connected to a control source. The functional tip of the catheter carries a plurality of temperature activated elements arranged in parallel and disposed about the functional tip and held in spaced relation at each end. These elements expand when they are heated. A plurality of fiber optic bundles, each bundle having a proximal end attached to the control source and a distal end attached to one of the elements carry light into the elements where the light is absorbed as heat. By varying the optic fiber that is carrying the light and the intensity of the light, the bending of the elements can be controlled and thus the catheter steered. In an alternate embodiment, the catheter carries a medical instrument for gathering a sample of tissue. The instrument may also be deployed and operated by thermal expansion and contraction of its moving parts. 10 figs.

  18. [Management of intravascular catheters for prevention of perioperative cross infections].

    PubMed

    Okubo, Takashi; Ohara, Eiko; Nakamura, Akishige; Takeyama, Hiromitsu; Manabe, Tadao

    2004-11-01

    Bloodstream infection derived from an intravascular catheter occupies an important position among the various types of nosocomial infection. It is therefore necessary to establish a system for preventing catheter infection not only as measures for each separate infection, but also for the entire hospital. Catheter infections are mainly caused by contamination of the connecting part of a transfusion line during the infusion of drug solution as well as by contamination of the part of the catheter inserted. Consequently, the greatest possible care should be taken in the preparation of aseptic transfusion and the prevention of contamination when connecting a transfusion line. In particular, there are problems with three-way stopcocks, management of hubs, frequency of transfusion line exchange, fat emulsion injection method, and blood preparation. It is most important to consider effective nutritional management methods that do not require the insertion of a central venous catheter.

  19. The male experience of ISC with a silicone catheter.

    PubMed

    Logan, Karen

    Since its introduction in the 1970s, intermittent self-catheterisation (ISC) has become more common and should be considered the method of choice for draining retained urine. The realisation for male patients that they require catheterisation can be associated with a significant physical and psychological burden (Shaw and Logan, 2013). This article describes a UK multi-centre patient satisfaction survey evaluating the features of a male ISC silicone catheter. The survey was aimed at determining patient preferences and perceptions of learning ISC with the intermittent catheter to evaluate if a silicone catheter is acceptable and user friendly. This information is intended to be used to expand the knowledge base around catheter selection and help guide nurses who offer a choice of catheters when teaching ISC to patients.

  20. The Utilization of Long Nylon Catheters for Prolonged Intravenous Infusions

    PubMed Central

    Roy, Ronald B.; Wilkinson, R. H.; Bayliss, C. E.

    1967-01-01

    A study of 300 patients receiving intravenous therapy showed that 90 had associated phlebitis. Because of this high rate of complications, the use of long plastic catheters, with the tip located in a large central vessel, was investigated. One hundred and one catheters were inserted into the basilic vein through a cut-down. The patients were divided into four groups: infusions lasting one to seven days, eight to 14 days, 15 to 28 days and 29 days or longer. The most common complication was obstruction of the catheter with clotted blood. In four patients the catheters had to be removed because of phlebitis; two were pulled out by the patients themselves. Infection was not observed. Two factors probably contributed to the successful infusions: the composition of the plastic catheters (nylon) and the location of the tip in a large central vessel. ImagesFig. 1Fig. 2Fig. 3 PMID:6017172

  1. Intra-bronchial migration of peritoneal catheter of lumboperitoneal shunt

    PubMed Central

    Kawahara, Takashi; Yanagi, Masakazu; Hirano, Hirofumi; Arita, Kazunori

    2015-01-01

    Background: A rare case of intra-bronchial migration of peritoneal catheter of lumboperitoneal (LP) shunt was treated under the bronchoscopic and fluoroscopic observation. Case Description: A 71-year-old man, who underwent LP shunt installation due to idiopathic normal pressure hydrocephalus a year before, presented with history of high fever and sputum production. Roentgenography and computed tomography of the chest revealed migration of distal end of the peritoneal catheter into the left main bronchus. Migrated catheter was gently extracted through the abdominal wound incision under the bronchoscopic and fluoroscopic observation. Contrast material infused into the catheter did not spread into the pleural cavity. The patient was free of the symptoms within 2 postoperative weeks. Moreover, he underwent the ventriculo-peritoneal shunt surgery 1-month later. Conclusion: This is the first case of the migration of peritoneal catheter of LP shunt into the main bronchus. PMID:26962468

  2. Temperature measurement within myocardium during in vitro RF catheter ablation.

    PubMed

    Cao, H; Vorperian, V R; Tsai, J Z; Tungjitkusolmun, S; Woo, E J; Webster, J G

    2000-11-01

    While most commercial ablation units and research systems can provide catheter tip temperature during ablation, they do not provide information about the temperature change inside the myocardium, which determines the lesion size. We present the details of a flow simulation and temperature measurement system, which allows the monitoring of the temperature change inside the myocardium during in vitro radio frequency (RF) cardiac catheter ablation at different blood flow rates to which the catheter site may be exposed. We set up a circulation system that simulated different blood flow rates of 0 to 5 L/min at 37 degrees C. We continuously measured the temperature at the catheter tip using the built-in thermistor and inside the myocardium using a three-thermocouple probe. The system provides a means for further study of the temperature inside myocardium during RF catheter ablation under different flow conditions and at different penetration depths.

  3. Management of Dysfunctional Catheters and Tubes Inserted by Interventional Radiology

    PubMed Central

    Huang, Steven Y.; Engstrom, Bjorn I.; Lungren, Matthew P.; Kim, Charles Y.

    2015-01-01

    Minimally invasive percutaneous interventions are often used for enteral nutrition, biliary and urinary diversion, intra-abdominal fluid collection drainage, and central venous access. In most cases, radiologic and endoscopic placement of catheters and tubes has replaced the comparable surgical alternative. As experience with catheters and tubes grows, it becomes increasingly evident that the interventional radiologist needs to be an expert not only on device placement but also on device management. Tube dysfunction represents the most common complication requiring repeat intervention, which can be distressing for patients and other health care professionals. This manuscript addresses the etiologies and solutions to leaking and obstructed feeding tubes, percutaneous biliary drains, percutaneous catheter nephrostomies, and drainage catheters, including abscess drains. In addition, we will address the obstructed central venous catheter. PMID:26038615

  4. An Effective Technique for Enhancing an Intrauterine Catheter Fetal Electrocardiogram

    NASA Astrophysics Data System (ADS)

    Horner, Steven L.; Holls, William M.

    2003-12-01

    Physician can obtain fetal heart rate, electrophysiological information, and uterine contraction activity for determining fetal status from an intrauterine catheters electrocardiogram with the maternal electrocardiogram canceled. In addition, the intrauterine catheter would allow physicians to acquire fetal status with one non-invasive to the fetus biosensor as compared to invasive to the fetus scalp electrode and intrauterine pressure catheter used currently. A real-time maternal electrocardiogram cancellation technique of the intrauterine catheters electrocardiogram will be discussed along with an analysis for the methods effectiveness with synthesized and clinical data. The positive results from an original detailed subjective and objective analysis of synthesized and clinical data clearly indicate that the maternal electrocardiogram cancellation method was found to be effective. The resulting intrauterine catheters electrocardiogram from effectively canceling the maternal electrocardiogram could be used for determining fetal heart rate, fetal electrocardiogram electrophysiological information, and uterine contraction activity.

  5. In vitro evaluation of the impact of silver coating on Escherichia coli adherence to urinary catheters.

    PubMed

    Ogilvie, Adam T; Brisson, Brigitte A; Singh, Ameet; Weese, J Scott

    2015-05-01

    A silver-coated urinary catheter was compared to a non-silver-coated urinary catheter for the ability to reduce adherence of 6 isolates of Escherichia coli. Catheters were incubated with E. coli strains for 0, 24, 48, and 72 h. Broth was sampled at all time points to determine CFU/mL. Catheters were subjected to sonication to determine adhered bacteria at all time points, and scanning electron microscopy (SEM) to semi-quantitatively assess biofilm formation. Silver-coated catheters had significantly less adhered bacteria than non-silver-coated catheters at times 24, 48, and 72 h. Subjectively, silver-coated urinary catheters had less biofilm formation than non-silver-coated urinary catheters as assessed by SEM. Silver coating of catheters was associated with reduced adherence of E. coli in an in vitro evaluation. Testing of catheters in dogs in vivo is required to determine if there is a reduction in catheter-associated urinary tract infections.

  6. Comparison of Heparin-Coated and Conventional Split-Tip Hemodialysis Catheters

    SciTech Connect

    Clark, Timothy W. I. Jacobs, David; Charles, Hearns W.; Kovacs, Sandor; Aquino, Theresa; Erinjeri, Joseph; Benstein, Judith A.

    2009-07-15

    Catheter coatings have the potential to decrease infection and thrombosis in patients with chronic dialysis catheters. We report our midterm experience with a heparin-coated dialysis catheter. This retrospective, case-control study was approved by our Institutional Review Board. A total of 88 tunneled dialysis catheters were inserted over a 13-month period via the internal jugular vein. Thirty-eight uncoated split-tip catheters and 50 heparin-coated catheters were inserted. Primary catheter patency was compared between the two groups using the log rank test, with infection and/or thrombosis considered as catheter failures. Dialysis parameters during the first and last dialysis sessions, including pump speed, actual blood flow, and arterial port pressures, were compared using unpaired t-tests. Primary patency of the uncoated catheters was 86.0 {+-} 6.5% at 30 days and 76.1 {+-} 8.9% at 90 days. Primary patency of heparin-coated catheters was 92.0 {+-} 6.2% at 30 days and 81.6 {+-} 8.0% at 90 days (p = 0.87, log rank test). Infection requiring catheter removal occurred in four patients with uncoated catheters and two patients with heparin-coated catheters (p = 0.23). Catheter thrombosis requiring catheter replacement or thrombolysis occurred in one patient with an uncoated catheter and two patients with heparin-coated catheters (p = 0.9). No differences in catheter function during hemodialysis were seen between the two groups. In conclusion, the heparin-coated catheter did not show a significantly longer patency compared to the uncoated catheter. The flow characteristics of this device were comparable to those of the conventional uncoated catheter. A demonstrable benefit of the heparin-coated catheter in randomized trials is needed before a recommendation for routine implementation can be made.

  7. Comparison of heparin-coated and conventional split-tip hemodialysis catheters.

    PubMed

    Clark, Timothy W I; Jacobs, David; Charles, Hearns W; Kovacs, Sandor; Aquino, Theresa; Erinjeri, Joseph; Benstein, Judith A

    2009-07-01

    Catheter coatings have the potential to decrease infection and thrombosis in patients with chronic dialysis catheters. We report our midterm experience with a heparin-coated dialysis catheter. This retrospective, case-control study was approved by our Institutional Review Board. A total of 88 tunneled dialysis catheters were inserted over a 13-month period via the internal jugular vein. Thirty-eight uncoated split-tip catheters and 50 heparin-coated catheters were inserted. Primary catheter patency was compared between the two groups using the log rank test, with infection and/or thrombosis considered as catheter failures. Dialysis parameters during the first and last dialysis sessions, including pump speed, actual blood flow, and arterial port pressures, were compared using unpaired t-tests. Primary patency of the uncoated catheters was 86.0 +/- 6.5% at 30 days and 76.1 +/- 8.9% at 90 days. Primary patency of heparin-coated catheters was 92.0 +/- 6.2% at 30 days and 81.6 +/- 8.0% at 90 days (p = 0.87, log rank test). Infection requiring catheter removal occurred in four patients with uncoated catheters and two patients with heparin-coated catheters (p = 0.23). Catheter thrombosis requiring catheter replacement or thrombolysis occurred in one patient with an uncoated catheter and two patients with heparin-coated catheters (p = 0.9). No differences in catheter function during hemodialysis were seen between the two groups. In conclusion, the heparin-coated catheter did not show a significantly longer patency compared to the uncoated catheter. The flow characteristics of this device were comparable to those of the conventional uncoated catheter. A demonstrable benefit of the heparin-coated catheter in randomized trials is needed before a recommendation for routine implementation can be made.

  8. Central venous catheters in neonates: from simple monolumen to port catheter.

    PubMed

    Caruselli, Marco; Carboni, Laura; Franco, Federica; Torino, Giovanni; Camilletti, Gianfranco; Piattellini, Gianmarco; Giretti, Roberto; Pagni, Raffaella

    2011-01-01

    The use of central venous catheters (CVCs) represents an important step in the management of the surgical, onco-hematology and critically ill patients. CVCs in neonates, like in adult patients, are mainly used to infuse hyperosmolar solutions, to take blood samples and for hemodynamic monitoring. The need for CVCs is higher in neonates than in adults. Poor peripheral access and the high demand for IV access and blood samples are already valuable indications for a CVC.

  9. Protecting short-term intravascular ear catheters in healthy rabbits.

    PubMed

    Sampieri, Francesca; Orchard, Rekha N; Antonopoulos, Aphroditi J; Hamilton, Donald L

    2012-01-20

    Researchers may place a catheter in the ear vessel of a rabbit for a short period of time in order to collect repeated blood samples without extensive restraint of the animal. Maintaining such a catheter in a healthy rabbit can be challenging, as the animal may scratch at the ear, removing the catheter or forming a large hematoma that might impede blood sampling. The authors developed a technique for protecting the indwelling catheter by cutting a section of moleskin to the same shape as the ear and gluing it to the surface of the ear and the catheter. They applied this technique to collect multiple blood samples during 12-h periods from nine rabbits in a pharmacokinetics study. Catheters remained patent in five rabbits for 12 h, in two rabbits for 8 h, in one rabbit for 6 h and in one rabbit for 4 h. This technique allowed for collection of repeated blood samples and prevented the rabbits from interfering with the catheter while allowing them to move freely during the sampling period.

  10. Nephrologists Hate the Dialysis Catheters: A Systemic Review of Dialysis Catheter Associated Infective Endocarditis

    PubMed Central

    Sharma, Kavita

    2017-01-01

    A 53-year-old Egyptian female with end stage renal disease, one month after start of hemodialysis via an internal jugular catheter, presented with fever and shortness of breath. She developed desquamating vesiculobullous lesions, widespread on her body. She was in profound septic shock and broad spectrum antibiotics were started with appropriate fluid replenishment. An echocardiogram revealed bulky leaflets of the mitral valve with a highly mobile vegetation about 2.3 cm long attached to the anterior leaflet. CT scan of the chest, abdomen, and pelvis showed bilateral pleural effusions in the chest, with triangular opacities in the lungs suggestive of infarcts. There was splenomegaly with triangular hypodensities consistent with splenic infarcts. Blood cultures repeatedly grew Candida albicans. Despite parenteral antifungal therapy, the patient deteriorated over the course of 5 days. She died due to a subsequent cardiac arrest. Systemic review of literature revealed that the rate of infection varies amongst the various types of accesses, and it is well documented that AV fistulas have a much less rate of infection in comparison to temporary catheters. All dialysis units should strive to make a multidisciplinary effort to have a referral process early on, for access creation, and to avoid catheters associated morbidity.

  11. Distributed parameter statics of magnetic catheters.

    PubMed

    Tunay, Ilker

    2011-01-01

    We discuss how to use special Cosserat rod theory for deriving distributed-parameter static equilibrium equations of magnetic catheters. These medical devices are used for minimally-invasive diagnostic and therapeutic procedures and can be operated remotely or controlled by automated algorithms. The magnetic material can be lumped in rigid segments or distributed in flexible segments. The position vector of the cross-section centroid and quaternion representation of an orthonormal triad are selected as DOF. The strain energy for transversely isotropic, hyperelastic rods is augmented with the mechanical potential energy of the magnetic field and a penalty term to enforce the quaternion unity constraint. Numerical solution is found by 1D finite elements. Material properties of polymer tubes in extension, bending and twist are determined by mechanical and magnetic experiments. Software experiments with commercial FEM software indicate that the computational effort with the proposed method is at least one order of magnitude less than standard 3D FEM.

  12. Is the pulmonary artery catheter useful?

    PubMed

    Murphy, Glenn S; Nitsun, Martin; Vender, Jeffery S

    2005-03-01

    In the United States more than 1.5 million pulmonary artery catheters (PACs) are inserted each year. Of these, approximately 55% are placed in high-risk surgical and trauma patients. Most clinicians believe that PAC use is beneficial in guiding therapy and may improve outcome. Despite these beliefs and hundreds of published articles related to PACs, appropriate use and impact on outcome remain unclear. A review of the current literature reveals conflicting data and significant flaws in most study designs. Inadequate sample size, lack of randomization, lack of standardization of therapies to PAC data, and deficiencies in user knowledge all significantly limit interpretation of clinical trials. Despite these deficiencies and the need for better-designed investigations, it is the opinion of the authors that access to hemodynamic data provided by the PAC, coupled with accurate interpretation of the data, may lead to reduced perioperative morbidity and mortality.

  13. Catheter ablation of fascicular ventricular tachycardia.

    PubMed

    Ramprakash, B; Jaishankar, S; Rao, Hygriv B; Narasimhan, C

    2008-08-01

    Fascicular ventricular tachycardia (VT) is an idiopathic VT with right bundle branch block morphology and left-axis deviation occuring predominantly in young males. Fascicular tachycardia has been classified into three subtypes namely, left posterior fascicular VT, left anterior fascicular VT and upper septal fascicular VT. The mechanism of this tachycardia is believed to be localized reentry close to the fascicle of the left bundle branch. The reentrant circuit is composed of a verapamil sensitive zone, activated antegradely during tachycardia and the fast conduction Purkinje fibers activated retrogradely during tachycardia recorded as the pre Purkinje and the Purkinje potentials respectively. Catheter ablation is the preferred choice of therapy in patients with fascicular VT. Ablation is carried out during tachycardia, using conventional mapping techniques in majority of the patients, while three dimensional mapping and sinus rhythm ablation is reserved for patients with nonmappable tachycardia.

  14. A statistical model of catheter motion from interventional x-ray images: application to image-based gating

    NASA Astrophysics Data System (ADS)

    Panayiotou, M.; King, A. P.; Ma, Y.; Housden, R. J.; Rinaldi, C. A.; Gill, J.; Cooklin, M.; O'Neill, M.; Rhode, K. S.

    2013-11-01

    The motion and deformation of catheters that lie inside cardiac structures can provide valuable information about the motion of the heart. In this paper we describe the formation of a novel statistical model of the motion of a coronary sinus (CS) catheter based on principal component analysis of tracked electrode locations from standard mono-plane x-ray fluoroscopy images. We demonstrate the application of our model for the purposes of retrospective cardiac and respiratory gating of x-ray fluoroscopy images in normal dose x-ray fluoroscopy images, and demonstrate how a modification of the technique allows application to very low dose scenarios. We validated our method on ten mono-plane imaging sequences comprising a total of 610 frames from ten different patients undergoing radiofrequency ablation for the treatment of atrial fibrillation. For normal dose images we established systole, end-inspiration and end-expiration gating with success rates of 100%, 92.1% and 86.9%, respectively. For very low dose applications, the method was tested on the same ten mono-plane x-ray fluoroscopy sequences without noise and with added noise at signal to noise ratio (SNR) values of √50, √10, √8, √6, √5, √2 and √1 to simulate the image quality of increasingly lower dose x-ray images. The method was able to detect the CS catheter even in the lowest SNR images with median errors not exceeding 2.6 mm per electrode. Furthermore, gating success rates of 100%, 71.4% and 85.7% were achieved at the low SNR value of √2, representing a dose reduction of more than 25 times. Thus, the technique has the potential to extract useful information whilst substantially reducing the radiation exposure.

  15. The effect of elastic modulus on ablation catheter contact area

    NASA Astrophysics Data System (ADS)

    Camp, Jon J.; Linte, Cristian A.; Rettmann, Maryam E.; Sun, Deyu; Packer, Douglas L.; Robb, Richard A.; Holmes, David R.

    2015-03-01

    Cardiac ablation consists of navigating a catheter into the heart and delivering RF energy to electrically isolate tissue regions that generate or propagate arrhythmia. Besides the challenges of accurate and precise targeting of the arrhythmic sites within the beating heart, limited information is currently available to the cardiologist regarding intricate electrodetissue contact, which directly impacts the quality of produced lesions. Recent advances in ablation catheter design provide intra-procedural estimates of tissue-catheter contact force, but the most direct indicator of lesion quality for any particular energy level and duration is the tissue-catheter contact area, and that is a function of not only force, but catheter pose and material elasticity as well. In this experiment, we have employed real-time ultrasound (US) imaging to determine the complete interaction between the ablation electrode and tissue to accurately estimate contact, which will help to better understand the effect of catheter pose and position relative to the tissue. By simultaneously recording tracked position, force reading and US image of the ablation catheter, the differing material properties of polyvinyl alcohol cryogel[1] phantoms are shown to produce varying amounts of tissue depression and contact area (implying varying lesion quality) for equivalent force readings. We have shown that the elastic modulus significantly affects the surface-contact area between the catheter and tissue at any level of contact force. Thus we provide evidence that a prescribed level of catheter force may not always provide sufficient contact area to produce an effective ablation lesion in the prescribed ablation time.

  16. Steerable Catheter Microcoils for Interventional MRI: Reducing Resistive Heating

    PubMed Central

    Bernhardt, Anthony; Wilson, Mark W.; Settecase, Fabio; Evans, Leland; Malba, Vincent; Martin, Alastair J.; Saeed, Maythem; Roberts, Timothy P. L.; Arenson, Ronald L.; Hetts, Steven W.

    2010-01-01

    PURPOSE To assess resistive heating of microwires used for remote catheter steering in interventional magnetic resonance imaging. To investigate the use of alumina to facilitate heat transfer to saline flowing in the catheter lumen. MATERIALS AND METHODS A microcoil was fabricated using a laser lathe onto polyimide-tipped or alumina-tipped endovascular catheters. In vitro testing was performed in a 1.5 T MR system using a vessel phantom, body RF coil, and steady state pulse sequence. Resistive heating was measured with water flowing over a polyimide tip catheter, or saline flowing through the lumen of an alumina-tip catheter. Preliminary in vivo testing in porcine common carotid arteries was conducted with normal blood flow or after arterial ligation when current was applied to an alumnia-tip catheter for up to 5 minutes. RESULTS After application of up to 1 W of DC power, clinically significant temperature increases were noted with the polyimide-tip catheter: 23°C/W at zero flow, 13°C/W at 0.28 cc/s, and 7.9°C/W at 1 cc/s. Using the alumina-tip catheter, the effluent temperature rise using the lowest flow rate (0.12 cc/s) was 2.3°C/W. In vivo testing demonstrated no thermal injury to vessel walls at normal and zero arterial flow. CONCLUSION Resistive heating in current carrying wire pairs can be dissipated by saline coolant flowing within the lumen of a catheter tip composed of material that facilitates heat transfer. PMID:21075017

  17. Antibiofilm surface functionalization of catheters by magnesium fluoride nanoparticles

    PubMed Central

    Lellouche, Jonathan; Friedman, Alexandra; Lahmi, Roxanne; Gedanken, Aharon; Banin, Ehud

    2012-01-01

    The ability of bacteria to colonize catheters is a major cause of infection. In the current study, catheters were surface-modified with MgF2 nanoparticles (NPs) using a sonochemical synthesis protocol described previously. The one-step synthesis and coating procedure yielded a homogenous MgF2 NP layer on both the inside and outside of the catheter, as analyzed by high resolution scanning electron microscopy and energy dispersive spectroscopy. The coating thickness varied from approximately 750 nm to 1000 nm on the inner walls and from approximately 450 nm to approximately 580 nm for the outer wall. The coating consisted of spherical MgF2 NPs with an average diameter of approximately 25 nm. These MgF2 NP-modified catheters were investigated for their ability to restrict bacterial biofilm formation. Two bacterial strains most commonly associated with catheter infections, Escherichia coli and Staphylococcus aureus, were cultured in tryptic soy broth, artificial urine and human plasma on the modified catheters. The MgF2 NP-coated catheters were able to significantly reduce bacterial colonization for a period of 1 week compared to the uncoated control. Finally, the potential cytotoxicity of MgF2 NPs was also evaluated using human and mammalian cell lines and no significant reduction in the mitochondrial metabolism was observed. Taken together, our results indicate that the surface modification of catheters with MgF2 NPs can be effective in preventing bacterial colonization and can provide catheters with long-lasting self-sterilizing properties. PMID:22419866

  18. Designing and testing of backflow-free catheters.

    PubMed

    Ivanchenko, O; Ivanchenko, V

    2011-06-01

    Convection-enhanced delivery (CED) is a drug delivery technique used to target specific regions of the central nervous system (CNS) for the treatment of neurodegenerative diseases and cancer while bypassing the blood-brain barrier (BBB). The application of CED is limited by low volumetric flow rate infusions in order to prevent the possibility of backflow. Consequently, a small convective flow produces poor drug distribution inside the treatment region, which can render CED treatment ineffective. Novel catheter designs and CED protocols are needed in order to improve the drug distribution inside the treatment region and prevent backflow. In order to develop novel backflow-free catheter designs, the impact of the micro-fluid injection into deformable porous media was investigated experimentally as well as numerically. Fluid injection into the porous media has a considerable effect on local transport properties such as porosity and hydraulic conductivity because of the local media deformation. These phenomena not only alter the bulk flow velocity distribution of the micro-fluid flow due to the changing porosity, but significantly modify the flow direction, and even the volumetric flow distribution, due to induced local hydraulic conductivity anisotropy. These findings help us to design backflow-free catheters with safe volumetric flow rates up to 10 μl/min. A first catheter design reduces porous media deformation in order to improve catheter performance and control an agent volumetric distribution. A second design prevents the backflow by reducing the porosity and hydraulic conductivity along a catheter's shaft. A third synergistic catheter design is a combination of two previous designs. Novel channel-inducing and dual-action catheters, as well as a synergistic catheter, were successfully tested without the occurrence of backflow and are recommended for future animal experiments.

  19. Percutaneous catheter drainage of pancreatic pseudocysts.

    PubMed

    Adams, D B; Harvey, T S; Anderson, M C

    1991-01-01

    Pancreatic pseudocysts represent a complication of severe pancreatic inflammatory disease. Although operative drainage is the cornerstone of therapy for pseudocysts, we have undertaken percutaneous catheter drainage in a selected group of 28 patients over a six-year period (1982-88). This represents 42 per cent of pseudocyst patients managed by the senior author and 1.7 per cent of admissions for pancreatitis at the Medical University Hospitals during that period of time. There were 26 men and two women with an age range of 26-66 years (mean = 42.1). Twenty-six patients had alcohol abuse as the cause of pancreatitis; two were due to surgical trauma. Nondilated pancreatic ducts were demonstrated in 25 patients. Six had pancreatic ascites associated with pseudocysts. Four had previous operative drainage (2 internal and 2 external drainage procedures). Five patients received octreotide acetate, a synthetic peptide which mimics the action of somatostatin, in an attempt to aid closure of external fistulas. The mean length of catheter drainage was 48 days (range 7-210 days). Eight (29%) patients developed procedure-related complications (1 pneumothorax, 1 sheared guidewire, six drain tract infections). There was no mortality. Successful resolution of pseudocysts was achieved in 26 patients (93%). Two patients subsequently had elective caudal pancreaticojejunostomy (CPJ), and one lateral pancreaticojejunostomy (LPJ) to drain obstructed pancreatic ducts. One patient has required repeat external drainage. Percutaneous external drainage is successful in pseudocyst eradication. When underlying pancreatic pathology remains uncorrected, elective surgical decompression of obstructed, dilated ducts may be necessary.

  20. Percutaneous Untying of a Knot in a Retained Swan-Ganz Catheter

    SciTech Connect

    Bhatti, Waqar A.; Sinha, Sankar; Rowlands, Peter

    2000-03-15

    A patient was referred to us with a tightly knotted Swan-Ganz catheter. The catheter could not be removed by conventional simple methods. We describe a minimally invasive means of removal of the catheter using an Amplatz gooseneck snare and an angioplasty balloon. This allowed the catheter to be removed without trauma.

  1. Retrograde catheterization of the urinary bladder in healthy male goats by use of angiographic catheters.

    PubMed

    Reppert, Emily J; Streeter, Robert N; Simpson, Katharine M; Taylor, Jared D

    2016-11-01

    OBJECTIVE To identify and evaluate 3 types of angiographic catheters for retrograde urinary bladder catheterization in healthy male goats. ANIMALS 12 sexually intact yearling Alpine-cross bucks. PROCEDURES Three 5F angiographic catheters of the same length (100 cm) and diameter (0.17 cm) but differing in curvature at the tip were labeled A (straight tip), B (tip bent in 1 place), and C (tip bent in 2 places). During a single anesthetic episode, attempts were made to blindly pass each catheter into the urinary bladder of each goat. Order of catheters used was randomized, and the veterinarian passing the catheter was blinded as to catheter identity. The total number of attempts at catheter passage and the total number of successful attempts were recorded. RESULTS Catheter A was unsuccessfully passed in all 12 goats, catheter B was successfully passed in 8 goats, and catheter C was successfully passed in 4 goats. The success rate for catheter B was significantly greater than that for catheter A; however, no significant difference was identified between catheters B and C or catheters A and C. CONCLUSIONS AND CLINICAL RELEVANCE 2 angiographic catheters were identified that could be successfully, blindly advanced in a retrograde direction into the urinary bladder of healthy sexually intact male goats. Such catheters may be useful for determining urethral patency, emptying the urinary bladder, and instilling chemolysing agents in goats with clinical obstructive urolithiasis.

  2. Patency of Femoral Tunneled Hemodialysis Catheters and Factors Predictive of Patency Failure

    SciTech Connect

    Burton, Kirsteen R.; Guo, Lancia L. Q.; Tan, Kong T.; Simons, Martin E.; Sniderman, Kenneth W.; Kachura, John R.; Beecroft, John R.; Rajan, Dheeraj K.

    2012-12-15

    Purpose: To determine the patency rates of and factors associated with increased risk of patency failure in patients with femoral vein tunneled hemodialysis catheters. Methods: All femoral tunneled catheter insertions from 1996 to 2006 were reviewed, during which time 123 catheters were inserted. Of these, 66 were exchanges. Patients with femoral catheter failure versus those with femoral catheter patency were compared. Confounding factors, such as demographic and procedural factors, were incorporated and assessed using univariate and multivariable Cox proportional hazards regression analyses. Results: Mean catheter primary patency failure time was 96.3 days (SE 17.9 days). Primary patency at 30, 60, 90, and 180 days was 53.8%, 45.4%, 32.1%, and 27.1% respectively. Crude rates of risk of catheter failure did not suggest a benefit for patients receiving catheters introduced from one side versus the other, but more cephalad location of catheter tip was associated with improved patency. Multivariate analysis showed that patients whose catheters were on the left side (p = 0.009), were of increasing age at the time of insertion (p = 0.002) and that those who had diabetes (p = 0.001) were at significantly greater risk of catheter failure. The catheter infection rate was 1.4/1000 catheter days. Conclusion: Patients who were of a more advanced age and had diabetes were at greater risk of femoral catheter failure, whereas those who received femoral catheters from the right side were less at risk of catheter failure.

  3. Ion beam sputter-etched ventricular catheter for hydrocephalus shunt

    NASA Technical Reports Server (NTRS)

    Banks, B. A. (Inventor)

    1983-01-01

    A cerebrospinal fluid shunt in the form of a ventricular catheter for controlling the condition of hydrocephalus by relieving the excessive cerebrospinal fluid pressure is described. A method for fabrication of the catheter and shunting the cerebral fluid from the cerebral ventricles to other areas of the body is also considered. Shunt flow failure occurs if the ventricle collapse due to improper valve function causing overdrainage. The ventricular catheter comprises a multiplicity of inlet microtubules. Each microtubule has both a large openings at its inlet end and a multiplicity of microscopic openings along its lateral surfaces.

  4. Pericardial effusion associated with an appropriately placed umbilical venous catheter.

    PubMed

    Sehgal, A; Cook, V; Dunn, M

    2007-05-01

    Central venous catheterization is widely used in neonatal intensive care units to support tiny preterm babies. Pericardial effusion (PCE) and cardiac tamponade are uncommon but potentially fatal complications of percutaneous, umbilical and surgically placed central venous catheters related to intracardiac position or migration. This report describes a case of PCE arising from fluid infused via umbilical venous catheter. The case study highlights two important aspects: one, occurrence of PCE in a baby with satisfactory position of the umbilical catheter, and second, the life-saving application of basic echocardiography by bedside caregivers for the diagnosis and treatment of this critical condition.

  5. [Use of peripheral catheters: too much to learn].

    PubMed

    Capdevila, Josep A

    2013-03-01

    Frequently incident complications due to the use of peripheral catheters are considered not relevant. However, recently multiple observational studies have demonstrated its role causing nosocomial bacteraemia. Guidelines about prevention of catheter-related infection are focused in central lines instead of peripheral ones. This approach causes an important lack of knowledge about the best manner to manipulate peripheral lines. Risk factors related to the development of a peripheral phlebitis, its clinical relevance and doubts related to prevention are presented and discussed in this article. The main objective is to alert about the importance of peripheral catheters in the prevention of nosocomial infection.

  6. Cardiac Magnetic Resonance for Evaluating Catheter Related FDG Avidity

    PubMed Central

    Gage, Kenneth L.; Berman, Claudia G.; Montilla-Soler, Jaime L.

    2016-01-01

    A 53-year-old female with a history of metastatic left arm melanoma presented for F(18) fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) which showed a moderately FDG avid focus at her port catheter tip near the cavoatrial junction. Although catheter tip related FDG avidity has previously been suggested to be bland thrombus or infection, melanoma can metastasize to unusual locations including the superior vena cava. In addition, the patient had an elevated risk of anticoagulation due to a history of hemorrhagic brain metastases. Therefore, confirmatory cardiac magnetic resonance (CMR) was obtained and findings were consistent with bland catheter-related thrombus. PMID:27867676

  7. Peripheral venous catheter fracture with embolism into the pulmonary artery

    PubMed Central

    Ammari, Chady; Campisi, Alessio; D’Andrea, Rocco

    2016-01-01

    Peripheral vein catheterization is generally considered a harmless procedure. Venous catheter rupture associated with pulmonary embolism is an unlikely but potentially serious complication. We report a case of a peripheral venous catheter (PVC) fracture with pulmonary artery embolization in the left lower lobe treated successfully by a surgical approach. The positioning of a PVC is not always a harmless procedure. Every time there are difficulties in positioning or in removal of a catheter device, it should be carefully inspected to verify integrity. The advisability of removal of these small foreign bodies is debated; percutaneous retrieval is preferred, while surgery should be discussed case by case. PMID:28149586

  8. Color Doppler Imaging of Cardiac Catheters Using Vibrating Motors

    PubMed Central

    Reddy, Kalyan E.; Light, Edward D.; Rivera, Danny J.; Kisslo, Joseph A.; Smith, Stephen W.

    2010-01-01

    We attached a miniature motor rotating at 11,000 rpm onto the proximal end of cardiac electrophysiological (EP) catheters in order to produce vibrations at the tip which were then visualized by color Doppler on ultrasound scanners. We imaged the catheter tip within a vascular graft submerged in a water tank using the Volumetrics Medical Imaging 3D scanner, the Siemens Sonoline Antares 2D scanner, and the Philips ie33 3D ultrasound scanner with TEE probe. The vibrating catheter tip was visualized in each case though results varied with the color Doppler properties of the individual scanner. PMID:19514134

  9. [ARS mingendi cum instrumentis, probes: candelette, minugie, catheters].

    PubMed

    Serarcangeli, C; Rispoli, G

    2001-01-01

    The Museum of History of Medicine of the University of Rome "La Sapienza" has a rich collection of probes and metal catheters, some of which in surgical kits. Tracing the history of catheters, the authors follow the technical evolution in the field of urology techniques, also highlighting the intelligent craft of artisans, surgeons, barbers - and the industrial effort to ameliorate techniques. The use and the crafting of these instruments are to be related to new knowledge in the fields of urethral, vesical and prostatic occlusion. Italian contribution of the field is stressed, highlighting the original experience of Michele Troja, who invented and diffused metal catheters covered in caouthouc.

  10. Epidural catheter design: history, innovations, and clinical implications.

    PubMed

    Toledano, Roulhac D; Tsen, Lawrence C

    2014-07-01

    Epidural catheters have evolved during the past several decades, as clinicians and manufacturers have sought to influence the quality of analgesia and anesthesia and reduce the incidence of catheter-related complications. This evolution has allowed a transformation from single-shot to continuous-infusion techniques and resulted in easier passage into the epidural space, more extensive medication distribution, and ultimately, improved patient satisfaction. Particular catheter features, including the materials used, tip design, and orifice number and arrangement, have been associated with specific outcomes and provide direction for future development.

  11. Preventing catheter-associated urinary tract infections in the intensive care unit.

    PubMed

    Chenoweth, Carol; Saint, Sanjay

    2013-01-01

    Urinary tract infection remains one of the most common healthcare-associated infections in the intensive care unit and predominantly occurs in patients with indwelling urinary catheters. Duration of catheterization is the most important risk factor for developing catheter-associated urinary tract infection (CAUTI). General strategies for preventing CAUTI include measures such as adherence to hand hygiene. Targeted strategies for preventing CAUTI include limiting the use and duration of urinary catheters, using aseptic technique for catheter insertion, and adhering to proper catheter care. Anti-infective catheters may be considered in some settings. Successful implementation of these measures has decreased urinary catheter use and CAUTI.

  12. Anatomical Consideration in Catheter Ablation of Idiopathic Ventricular Arrhythmias.

    PubMed

    Yamada, Takumi; Kay, G Neal

    2016-01-01

    Idiopathic ventricular arrhythmias (VAs) are ventricular tachycardias (VTs) or premature ventricular contractions (PVCs) with a mechanism that is not related to myocardial scar. The sites of successful catheter ablation of idiopathic VA origins have been progressively elucidated and include both the endocardium and, less commonly, the epicardium. Idiopathic VAs usually originate from specific anatomical structures such as the ventricular outflow tracts, aortic root, atrioventricular (AV) annuli, papillary muscles, Purkinje network and so on, and exhibit characteristic electrocardiograms based on their anatomical background. Catheter ablation of idiopathic VAs is usually safe and highly successful, but can sometimes be challenging because of the anatomical obstacles such as the coronary arteries, epicardial fat pads, intramural and epicardial origins, AV conduction system and so on. Therefore, understanding the relevant anatomy is important to achieve a safe and successful catheter ablation of idiopathic VAs. This review describes the anatomical consideration in the catheter ablation of idiopathic VAs.

  13. [Cardiac tamponade after withdrawal of a peripheral access central catheter].

    PubMed

    García-Galiana, E; Sanchis-Gil, V; Martínez-Navarrete, M Á

    2015-03-01

    Central venous catheterization is a very common technique, although its complications can be multiple and sometimes fatal. A case is presented of cardiac tamponade by parenteral nutrition a few hours after moving a central venous catheter peripherally inserted a few days before. The diagnosis was made by echocardiography, and an emergency pericardiocentesis was performed, achieving complete recovery of the patient. Peripherally inserted central venous catheters are more likely to change their position secondary to the movements of the patient's arm, thus it is important to use soft catheters, make sure the tip lies above the carina to avoid perforation of the pericardial reflexion, and fix it well to the skin. Diagnosis must be made as soon as possible, given the high mortality rate of this complication, and the essential diagnostic tool is echocardiography. Elective treatment consists of early catheter withdrawal and emergency pericardiocentesis.

  14. Thermal and hydrodynamic modelling of active catheters for interventional radiology.

    PubMed

    Marchandise, Emilie; Flaud, Patrice; Royon, Laurent; Blanc, Raphaël; Szewczyk, Jérome

    2011-07-01

    Interventional radiologists desire to improve their operating tools such as catheters. Active catheters in which the tip is moved using shape memory alloy actuators activated using the Joule effect present a promising approach for easier navigation in the small vessels. However, the increase in temperature caused by this Joule effect must be controlled in order to prevent damage to blood cells and tissues. This paper is devoted to the simulation and experimental validation of a fluid-thermal model of an active catheter prototype. Comparisons between computer-predicted and experimentally measured temperatures are presented for both experiments in air and water at 37°C. Good agreement between the computational and experimental results is found, demonstrating the validity of the developed computer model. These comparisons enable us to highlight some important issues in the modelling process and to determine the optimal current for the activation of the catheter.

  15. Sonographically guided placement of intravenous catheters in minipigs.

    PubMed

    Pinkernelle, Jens; Raschzok, Nathanael; Teichgräber, Ulf K M

    2009-07-01

    Many procedures in minipigs require establishment of reliable deep venous access with a large-bore catheter. In animal experiments, such catheters are typically implanted surgically. In clinical settings, however, ultrasound imaging is routinely used to facilitate safe, minimally invasive puncture of deep vessels. The authors describe a technique for using ultrasound guidance to puncture and cannulate the minipig femoral vein. They carried out the procedure in six minipigs for the purpose of injecting contrast agents for subsequent imaging scans. The procedure was ultimately successful in all pigs, took 10 min on average and resulted in no physiological complications. In one minipig, however, a 10-cm-long catheter became dislodged from the femoral vein; use of a longer (25-cm-long) catheter was optimal for establishing reliable intravenous access.

  16. Review of advanced catheter technologies in radiation oncology brachytherapy procedures

    PubMed Central

    Zhou, Jun; Zamdborg, Leonid; Sebastian, Evelyn

    2015-01-01

    The development of new catheter and applicator technologies in recent years has significantly improved treatment accuracy, efficiency, and outcomes in brachytherapy. In this paper, we review these advances, focusing on the performance of catheter imaging and reconstruction techniques in brachytherapy procedures using magnetic resonance images and electromagnetic tracking. The accuracy of catheter reconstruction, imaging artifacts, and other notable properties of plastic and titanium applicators in gynecologic treatments are reviewed. The accuracy, noise performance, and limitations of electromagnetic tracking for catheter reconstruction are discussed. Several newly developed applicators for accelerated partial breast irradiation and gynecologic treatments are also reviewed. New hypofractionated high dose rate treatment schemes in prostate cancer and accelerated partial breast irradiation are presented. PMID:26203277

  17. Catheters: instrumental advancements in biomedical applications of optical fibers.

    PubMed

    de Lima, Carlos J; Moreira, Leonardo M; Lyon, Juliana P; Villaverde, Antonio B; Pacheco, Marcos T T

    2009-07-01

    This review is focused on the advancements in biomedical engineering regarding the elaboration of new prototypes of optical fiber catheters to be applied in spectroscopic analysis, such as Raman and fluorescence spectroscopy. Our group has contributed to the development of new prototypes with interesting properties, such as side-viewing signal excitation and collection, distal tip with bending control, and Raman scattering minimization from the optical fiber. In addition, several groups have contributed to other new catheter-improving properties of this spectroscopic device. However, a relatively small number of studies has been published in the literature, due to industrial interest in this interdisciplinary and multidisciplinary area. To our knowledge, no review that has focused on the applications of catheters to several modes of spectroscopy has been published. In this work we revised this topic, analyzing the advancements and limitations of the recent biomedical catheters.

  18. Guidelines for the management of intravascular catheter-related infections.

    PubMed

    Mermel, L A; Farr, B M; Sherertz, R J; Raad, I I; O'Grady, N; Harris, J S; Craven, D E

    2001-01-01

    These guidelines from the Infectious Diseases Society of America (IDSA), the American College of Critical Care Medicine (for the Society of Critical Care Medicine), and the Society for Healthcare Epidemiology of America contain recommendations for the management of adults and children with, and diagnosis of infections related to, peripheral and nontunneled central venous catheters (CVCs), pulmonary artery catheters, tunneled central catheters, and implantable devices. The guidelines, written for clinicians, contain IDSA evidence-based recommendations for assessment of the quality and strength of the data. Recommendations are presented according to the type of catheter, the infecting organism, and the associated complications. Intravascular catheter-related infections are a major cause of morbidity and mortality in the United States. Coagulase-negative staphylococci, Staphylococcus aureus, aerobic gram-negative bacilli, and Candida albicans most commonly cause catheter-related bloodstream infection. Management of catheter-related infection varies according to the type of catheter involved. After appropriate cultures of blood and catheter samples are done, empirical i.v. antimicrobial therapy should be initiated on the basis of clinical clues, the severity of the patient's acute illness, underlying disease, and the potential pathogen(s) involved. In most cases of nontunneled CVC-related bacteremia and fungemia, the CVC should be removed. For management of bacteremia and fungemia from a tunneled catheter or implantable device, such as a port, the decision to remove the catheter or device should be based on the severity of the patient's illness, documentation that the vascular-access device is infected, assessment of the specific pathogen involved, and presence of complications, such as endocarditis, septic thrombosis, tunnel infection, or metastatic seeding. When a catheter-related infection is documented and a specific pathogen is identified, systemic antimicrobial

  19. Review of advanced catheter technologies in radiation oncology brachytherapy procedures.

    PubMed

    Zhou, Jun; Zamdborg, Leonid; Sebastian, Evelyn

    2015-01-01

    The development of new catheter and applicator technologies in recent years has significantly improved treatment accuracy, efficiency, and outcomes in brachytherapy. In this paper, we review these advances, focusing on the performance of catheter imaging and reconstruction techniques in brachytherapy procedures using magnetic resonance images and electromagnetic tracking. The accuracy of catheter reconstruction, imaging artifacts, and other notable properties of plastic and titanium applicators in gynecologic treatments are reviewed. The accuracy, noise performance, and limitations of electromagnetic tracking for catheter reconstruction are discussed. Several newly developed applicators for accelerated partial breast irradiation and gynecologic treatments are also reviewed. New hypofractionated high dose rate treatment schemes in prostate cancer and accelerated partial breast irradiation are presented.

  20. Three Dimensional Modeling of an MRI Actuated Steerable Catheter System.

    PubMed

    Liu, Taoming; Cavuşoğlu, M Cenk

    2014-01-01

    This paper presents the three dimensional kinematic modeling of a novel steerable robotic ablation catheter system. The catheter, embedded with a set of current-carrying micro-coils, is actuated by the magnetic forces generated by the magnetic field of the MRI scanner. This paper develops a 3D model of the MRI actuated steerable catheter system by using finite differences approach. For each finite segment, a quasi-static torque-deflection equilibrium equation is calculated using beam theory. By using the deflection displacements and torsion angles, the kinematic modeling of the catheter system is derived. The proposed models are evaluated by comparing the simulation results of the proposed model with the experimental results of a proof-of-concept prototype.

  1. Three Dimensional Modeling of an MRI Actuated Steerable Catheter System

    PubMed Central

    Liu, Taoming; Çavuşoğlu, M. Cenk

    2014-01-01

    This paper presents the three dimensional kinematic modeling of a novel steerable robotic ablation catheter system. The catheter, embedded with a set of current-carrying micro-coils, is actuated by the magnetic forces generated by the magnetic field of the MRI scanner. This paper develops a 3D model of the MRI actuated steerable catheter system by using finite differences approach. For each finite segment, a quasi-static torque-deflection equilibrium equation is calculated using beam theory. By using the deflection displacements and torsion angles, the kinematic modeling of the catheter system is derived. The proposed models are evaluated by comparing the simulation results of the proposed model with the experimental results of a proof-of-concept prototype. PMID:25328804

  2. Loss of catheter locking solution caused by fluid density.

    PubMed

    Polaschegg, Hans-Dietrich

    2005-01-01

    The avoidance of clotting in catheter lumina between treatments usually entails locking with an anticoagulant solution such as heparin. In a previous work, it was shown that approximately 20% of locking solution flows from the catheter during instillation of the lock equal in volume to the lumen volume. Furthermore, the locking solution may spill into the blood stream under the influence of gravity. This work investigates the influence of density and viscosity of the locking solution on the volume and speed of locking solution loss from the catheter lumen. A large fraction of the catheter locking solution spills under the influence of gravity if the locking solution's density is higher than the fluid it spills to (blood). Locking solution lost is replaced by blood. Viscosity delays this process, but at 90 minutes after injection, the loss is completed even when highly viscous lock solutions are used. Slow administration of the lock has negligible influence upon the dynamics of the loss.

  3. Anatomical Consideration in Catheter Ablation of Idiopathic Ventricular Arrhythmias

    PubMed Central

    Kay, G Neal

    2016-01-01

    Idiopathic ventricular arrhythmias (VAs) are ventricular tachycardias (VTs) or premature ventricular contractions (PVCs) with a mechanism that is not related to myocardial scar. The sites of successful catheter ablation of idiopathic VA origins have been progressively elucidated and include both the endocardium and, less commonly, the epicardium. Idiopathic VAs usually originate from specific anatomical structures such as the ventricular outflow tracts, aortic root, atrioventricular (AV) annuli, papillary muscles, Purkinje network and so on, and exhibit characteristic electrocardiograms based on their anatomical background. Catheter ablation of idiopathic VAs is usually safe and highly successful, but can sometimes be challenging because of the anatomical obstacles such as the coronary arteries, epicardial fat pads, intramural and epicardial origins, AV conduction system and so on. Therefore, understanding the relevant anatomy is important to achieve a safe and successful catheter ablation of idiopathic VAs. This review describes the anatomical consideration in the catheter ablation of idiopathic VAs. PMID:28116086

  4. Dosimetric equivalence of nonstandard HDR brachytherapy catheter patterns

    SciTech Connect

    Cunha, J. A. M.; Hsu, I-C.; Pouliot, J.

    2009-01-15

    Purpose: To determine whether alternative high dose rate prostate brachytherapy catheter patterns can result in similar or improved dose distributions while providing better access and reducing trauma. Materials and Methods: Standard prostate cancer high dose rate brachytherapy uses a regular grid of parallel needle positions to guide the catheter insertion. This geometry does not easily allow the physician to avoid piercing the critical structures near the penile bulb nor does it provide position flexibility in the case of pubic arch interference. This study used CT datasets with 3 mm slice spacing from ten previously treated patients and digitized new catheters following three hypothetical catheter patterns: conical, bi-conical, and fireworks. The conical patterns were used to accommodate a robotic delivery using a single entry point. The bi-conical and fireworks patterns were specifically designed to avoid the critical structures near the penile bulb. For each catheter distribution, a plan was optimized with the inverse planning algorithm, IPSA, and compared with the plan used for treatment. Irrelevant of catheter geometry, a plan must fulfill the RTOG-0321 dose criteria for target dose coverage (V{sub 100}{sup Prostate}>90%) and organ-at-risk dose sparing (V{sub 75}{sup Bladder}<1 cc, V{sub 75}{sup Rectum}<1 cc, V{sub 125}{sup Urethra}<<1 cc). Results: The three nonstandard catheter patterns used 16 nonparallel, straight divergent catheters, with entry points in the perineum. Thirty plans from ten patients with prostate sizes ranging from 26 to 89 cc were optimized. All nonstandard patterns fulfilled the RTOG criteria when the clinical plan did. In some cases, the dose distribution was improved by better sparing the organs-at-risk. Conclusion: Alternative catheter patterns can provide the physician with additional ways to treat patients previously considered unsuited for brachytherapy treatment (pubic arch interference) and facilitate robotic guidance of

  5. A Hidden Markov Model for 3D Catheter Tip Tracking with 2D X-ray Catheterization Sequence and 3D Rotational Angiography.

    PubMed

    Ambrosini, Pierre; Smal, Ihor; Ruijters, Daniel; Niessen, Wiro; Moelker, Adriaan; van Walsum, Theo

    2016-11-07

    In minimal invasive image guided catheterization procedures, physicians require information of the catheter position with respect to the patient's vasculature. However, in fluoroscopic images, visualization of the vasculature requires toxic contrast agent. Static vasculature roadmapping, which can reduce the usage of iodine contrast, is hampered by the breathing motion in abdominal catheterization. In this paper, we propose a method to track the catheter tip inside the patient's 3D vessel tree using intra-operative single-plane 2D X-ray image sequences and a peri-operative 3D rotational angiography (3DRA). The method is based on a hidden Markov model (HMM) where states of the model are the possible positions of the catheter tip inside the 3D vessel tree. The transitions from state to state model the probabilities for the catheter tip to move from one position to another. The HMM is updated following the observation scores, based on the registration between the 2D catheter centerline extracted from the 2D X-ray image, and the 2D projection of 3D vessel tree centerline extracted from the 3DRA. The method is extensively evaluated on simulated and clinical datasets acquired during liver abdominal catheterization. The evaluations show a median 3D tip tracking error of 2.3 mm with optimal settings in simulated data. The registered vessels close to the tip have a median distance error of 4.7 mm with angiographic data and optimal settings. Such accuracy is sufficient to help the physicians with an up-to-date roadmapping. The method tracks in real-time the catheter tip and enables roadmapping during catheterization procedures.

  6. Preventing central venous catheter-related bloodstream infection.

    PubMed

    Wilson, Charlotte

    2015-01-13

    Nurses should be able to apply evidence-based practice in a way that is appropriate for the individual patient. This article discusses one area, the incidence of central venous catheter-related bloodstream infection in acute care, to examine the available evidence and identify ways in which this evidence can be applied to practice. Research indicates that implementing best practice at the time of insertion is a principal determinant in minimising the risk of catheter-related bloodstream infection.

  7. Catheter steering using a Magnetic Resonance Imaging system.

    PubMed

    Lalande, Viviane; Gosselin, Frederick P; Martel, Sylvain

    2010-01-01

    A catheter is successfully bent and steered by applying magnetic gradients inside a Magnetic Resonance Imaging system (MRI). One to three soft ferromagnetic spheres are attached at the distal tip of the catheter with different spacing between the spheres. Depending on the interactions between the spheres, progressive or discontinuous/jumping displacement was observed for increasing magnetic load. This phenomenon is accurately predicted by a simple theoretical dipole interaction model.

  8. Laparoscopic removal of two dislocated ventriculoperitoneal catheters: case report.

    PubMed

    Pierangeli, E; Pizzoni, C; Lospalluti, A; Gigante, N; Colamaria, A

    1999-06-01

    In a child two previously migrated abdominal catheters from ventriculoperitoneal shunts were removed from the abdominal cavity by use of laparoscopy. Avoiding the usually longitudinal laparatomy, two small incisions were necessary to insert the laparoscope (sub-umbilical incision) and grasping forceps (left iliac pit incision). Laparoscopy allowed for identification of a working ventriculoperitoneal shunt, that was correctly in place, and for removal of two old migrated catheters. The child was mobilized the same day and the post-operative course was uneventful.

  9. Catheter Migration of a Port-a-Cath System

    SciTech Connect

    Bruninx, Guy; Matte, Jean-Christophe; Wilder, Francoise van; Delcour, Christian

    1996-11-15

    A patient with axillary venous thrombosis caused by lymph node compression and the presence of a displaced catheter in the vascular lumen is presented. In this case, percutaneous interventional radiological procedures (balloon angioplasty and snare loop method) in conjunction with medical treatment were effective in limiting the post-thrombotic syndrome and restoring the proper positioning of the catheter, thereby saving the central venous access.

  10. Catheter-based transarterial therapies for hepatocellular cancer.

    PubMed

    Laroia, Sandeep T; Morales, Steven A; Laroia, Archana T

    2015-12-01

    As the prevalence of liver cancer increases, so does the demand for nonsurgical, minimally invasive alternatives to surgery, since many patients have tumors that cannot be surgically resected. Catheter-based hepatic arterial procedures may be an option in patients with primary and metastatic liver cancer. The authors describe four catheter-based hepatic arterial procedures and outline the management of potential complications during the immediate postprocedural period.

  11. Epidural Catheter Migration in a Patient with Severe Spinal Stenosis

    PubMed Central

    Anderson, Ryan

    2016-01-01

    Establishment of appropriate neuraxial catheter positioning is typically a straightforward procedural undertaking. It can, however, lead to deception of even the most experienced clinician and occur despite the most meticulous attention to detail. Written and verbal consent were obtained from the patient to prepare, discuss, and publish this case report; we describe the occurrence of what we believe was the intraoperative migration of an epidural catheter in the setting of significant tissue changes resulting from a previous spinal fusion. PMID:28097025

  12. [The management of catheter related blood stream infection].

    PubMed

    Kurai, Hanako

    2012-02-01

    Catheter-related bloodstream infection causes severe complications and high mortality. CDC revised the guideline for the prevention of intravascular catheter-related infection in 2011, and various anti-infection devices were introduced. However, the most important deterrents of infection are basic procedures such as hand-hygiene and maximal barrier precautions. I would like to describe the points involving early detection, and its medical treatment and prevention.

  13. Magnetic and robotic navigation for catheter ablation: "joystick ablation".

    PubMed

    Ernst, Sabine

    2008-10-01

    Catheter ablation has become the treatment of choice to cure various arrhythmias in the last decades. The newest advancement of this general concept is made on the navigation ability using remote-controlled ablation catheters. This review summarizes the concept of the two currently available systems, followed by a critical review of the published clinical reports for each system, respectively. Despite the limited amount of data, an attempt to compare the two systems is made.

  14. Incidence of catheter-associated bloodstream infection after introduction of minocycline and rifampin antimicrobial-coated catheters in a pediatric burn population.

    PubMed

    Weber, Joan M; Sheridan, Robert L; Fagan, Shawn; Ryan, Colleen M; Pasternack, Mark S; Tompkins, Ronald G

    2012-01-01

    The Centers for Disease Control and Prevention guidelines for prevention of intravascular catheter-related infections suggest that antimicrobial-coated catheters can decrease the risk of developing catheter-related bloodstream infection in a variety of adult patient populations. There are limited data on their efficacy in the pediatric population, particularly among children with burn injuries. A study was conducted at Shriners Hospitals for Children®, Boston, to determine whether minocycline/rifampin (MR)-coated catheters could decrease the incidence of catheter-associated bloodstream infection (CABSI) in a pediatric burn population. A historical control group included all patients with double- or triple-lumen catheters inserted in the 18-month period from January 2006 to June 2007. The study group included all patients with MR antimicrobial double- or triple-lumen catheters inserted in the subsequent 18-month period, July 2007 to December 2008. Data collected included name, age, date of burn/injury, date of admission, percent TBSA area burn injury or other diagnosis, catheter site (subclavian, internal jugular, or femoral), method of insertion (new percutaneous stick or guidewire), type of catheter (double or triple lumen), date inserted, duration of catheter placement (days), and positive blood cultures recovered while the central venous catheter was in place. CABSI was defined using the Centers for Disease Control and Prevention definition of laboratory-confirmed bloodstream infection. There were a total of 66 patients with 252 catheters (1780 catheter days) in the control group and 75 patients with 263 catheters (1633 catheter days) in the study group. Age, percent burn injury, catheter site, and method of insertion were not statistically different between the two groups. The percentage of infected catheters and the rate of infection were significantly different for the two groups, with the MR antimicrobial catheters only half as likely to become infected. In

  15. National Aerospace Plane (NASP) program

    NASA Technical Reports Server (NTRS)

    1990-01-01

    Artists concept of the X-30 aerospace plane flying through Earth's atmosphere on its way to low-Earth orbit. the experimental concept is part of the National Aero-Space Plane Program. The X-30 is planned to demonstrate the technology for airbreathing space launch and hypersonic cruise vehicles. Photograph and caption published in Winds of Change, 75th Anniversary NASA publication (page 117), by James Schultz.

  16. Misplaced central venous catheters: applied anatomy and practical management.

    PubMed

    Gibson, F; Bodenham, A

    2013-03-01

    Large numbers of central venous catheters (CVCs) are placed each year and misplacement occurs frequently. This review outlines the normal and abnormal anatomy of the central veins in relation to the placement of CVCs. An understanding of normal and variant anatomy enables identification of congenital and acquired abnormalities. Embryological variations such as a persistent left-sided superior vena cava are often diagnosed incidentally only after placement of a CVC, which is seen to take an abnormal course on X-ray. Acquired abnormalities such as stenosis or thrombosis of the central veins can be problematic and can present as a failure to pass a guidewire or catheter or complications after such attempts. Catheters can also be misplaced outside veins in a patient with otherwise normal anatomy with potentially disastrous consequences. We discuss the possible management options for these patients including the various imaging techniques used to verify correct or incorrect catheter placement and the limitations of each. If the course of a misplaced catheter can be correctly identified as not lying within a vulnerable structure then it can be safely removed. If the misplaced catheter is lying within or traversing large and incompressible arteries or veins, it should not be removed before consideration of what is likely to happen when it is removed. Advice and further imaging should be sought, typically in conjunction with interventional radiology or vascular surgery. With regard to misplaced CVCs, in the short term, a useful aide memoir is: 'if in doubt, don't take it out'.

  17. Electromagnetically tracked placement of a peripherally inserted central catheter

    NASA Astrophysics Data System (ADS)

    Sacolick, Laura; Patel, Neilesh; Tang, Jonathan; Levy, Elliot; Cleary, Kevin R.

    2004-05-01

    This paper describes a computer program to utilize electromagnetic tracking guidance during insertion of peripherally inserted central catheters. Placement of a Peripherally Inserted Central Catheter (PICC) line is a relatively simple, routine procedure in which a catheter is inserted into the veins of the lower arm and threaded up the arm to the vena cava to sit just above the heart. However, the procedure requires x-ray verification of the catheter position and is usually done under continuous fluoroscopic guidance. The computer program is designed to replace fluoroscopic guidance in this procedure and make PICC line placement a bedside procedure. This would greatly reduce the time and resources dedicated to this procedure. The physician first goes through a quick registration procedure to register the patient space with the computer screen coordinates. Once registration is completed, the program provides a continuous, real-time display of the position of the catheter tip overlaid on an x-ray image of the patient on an adjacent computer screen. Both the position and orientation of the catheter tip is shown. The display is very similar to that shown when using fluoroscopy.

  18. Obstructed catheter connection pin discovered during intrathecal baclofen pump exchange.

    PubMed

    Williams, Bryan S; Christo, Paul J

    2009-01-01

    We report a case of catheter obstruction due to complete narrowing of the lumen of a connecting pin, and catheter disconnection in a patient undergoing intrathecal Baclofen pump exchange. The patient underwent intrathecal baclofen pump implantation for treatment of lower extremity spasticity and hypertonia secondary to congenital tetraplegia. Intrathecal baclofen dose escalation occurred over the course of treatment (73 mo) from 80 to 708 mcg/d representing a 189% increase in dose. The pump had neared the manufacturer's recommended exchange interval; therefore, a pump exchange was scheduled to surgically replace the device. One week before surgery, the patient noted a distinct increase in his symptomatology and began enteral baclofen therapy. During the surgery, the pump catheter was noted to be disconnected from the pump. Upon further examination, the lumen of the connection pin positioned between the pump catheter and intrathecal catheter was completely obstructed. Postsurgically, the patient's intrathecal baclofen dose was substantially reduced from 708 to 527 mcg/d (25.6% reduction) to control hypotonicity and to reestablish an Ashworth score of 2. We discuss intrathecal baclofen therapy and a unique complication associated with a catheter connecting pin.

  19. New materials and devices for preventing catheter-related infections

    PubMed Central

    2011-01-01

    Catheters are the leading source of bloodstream infections for patients in the intensive care unit (ICU). Comprehensive unit-based programs have proven to be effective in decreasing catheter-related bloodstream infections (CR-BSIs). ICU rates of CR-BSI higher than 2 per 1,000 catheter-days are no longer acceptable. The locally adapted list of preventive measures should include skin antisepsis with an alcoholic preparation, maximal barrier precautions, a strict catheter maintenance policy, and removal of unnecessary catheters. The development of new technologies capable of further decreasing the now low CR-BSI rate is a major challenge. Recently, new materials that decrease the risk of skin-to-vein bacterial migration, such as new antiseptic dressings, were extensively tested. Antimicrobial-coated catheters can prevent CR-BSI but have a theoretical risk of selecting resistant bacteria. An antimicrobial or antiseptic lock may prevent bacterial migration from the hub to the bloodstream. This review discusses the available knowledge about these new technologies. PMID:21906266

  20. Post-procedural evaluation of catheter contact force characteristics

    NASA Astrophysics Data System (ADS)

    Koch, Martin; Brost, Alexander; Kiraly, Atilla; Strobel, Norbert; Hornegger, Joachim

    2012-03-01

    Minimally invasive catheter ablation of electric foci, performed in electrophysiology labs, is an attractive treatment option for atrial fibrillation (AF) - in particular if drug therapy is no longer effective or tolerated. There are different strategies to eliminate the electric foci inducing the arrhythmia. Independent of the particular strategy, it is essential to place transmural lesions. The impact of catheter contact force on the generated lesion quality has been investigated recently, and first results are promising. There are different approaches to measure catheter-tissue contact. Besides traditional haptic feedback, there are new technologies either relying on catheter tip-to-tissue contact force or on local impedance measurements at the tip of the catheter. In this paper, we present a novel tool for post-procedural ablation point evaluation and visualization of contact force characteristics. Our method is based on localizing ablation points set during AF ablation procedures. The 3-D point positions are stored together with lesion specific catheter contact force (CF) values recorded during the ablation. The force records are mapped to the spatial 3-D positions, where the energy has been applied. The tracked positions of the ablation points can be further used to generate a 3-D mesh model of the left atrium (LA). Since our approach facilitates visualization of different force characteristics for post-procedural evaluation and verification, it has the potential to improve outcome by highlighting areas where lesion quality may be less than desired.

  1. Cryo-balloon catheter localization in fluoroscopic images

    NASA Astrophysics Data System (ADS)

    Kurzendorfer, Tanja; Brost, Alexander; Jakob, Carolin; Mewes, Philip W.; Bourier, Felix; Koch, Martin; Kurzidim, Klaus; Hornegger, Joachim; Strobel, Norbert

    2013-03-01

    Minimally invasive catheter ablation has become the preferred treatment option for atrial fibrillation. Although the standard ablation procedure involves ablation points set by radio-frequency catheters, cryo-balloon catheters have even been reported to be more advantageous in certain cases. As electro-anatomical mapping systems do not support cryo-balloon ablation procedures, X-ray guidance is needed. However, current methods to provide support for cryo-balloon catheters in fluoroscopically guided ablation procedures rely heavily on manual user interaction. To improve this, we propose a first method for automatic cryo-balloon catheter localization in fluoroscopic images based on a blob detection algorithm. Our method is evaluated on 24 clinical images from 17 patients. The method successfully detected the cryoballoon in 22 out of 24 images, yielding a success rate of 91.6 %. The successful localization achieved an accuracy of 1.00 mm +/- 0.44 mm. Even though our methods currently fails in 8.4 % of the images available, it still offers a significant improvement over manual methods. Furthermore, detecting a landmark point along the cryo-balloon catheter can be a very important step for additional post-processing operations.

  2. Biological safety evaluation of the modified urinary catheter.

    PubMed

    Kowalczuk, Dorota; Przekora, Agata; Ginalska, Grazyna

    2015-04-01

    The purpose of this study was to evaluate in vitro safety of the novel tosufloxacin (TOS)-treated catheters with the prolonged antimicrobial activity. The test samples of silicone latex catheter were prepared by the immobilization of TOS on chitosan (CHIT)-coated catheter by means of covalent bonds and non-covalent interactions. Each step of the modification process of catheter surface was observed using ATR-Fourier transform infrared spectroscopy. In vitro cytotoxicity of the modified and unmodified catheters was assessed by direct and indirect tests in accordance with ISO standards using green monkey kidney (GMK) cell line. The MTT, lactate dehydrogenase activity (LDH), WST-8, Sulforhodamine B (SRB) test results and microscopic observation clearly indicated that unmodified silicone latex catheters decrease cell metabolic activity, act as a cytotoxic agent causing cell lysis and induce cell death through necrotic or apoptotic process. We suggest that chitosan coat with TOS immobilized limits leaching of harmful agents from silicone latex material, which significantly enhances survivability of GMK cells and therefore is quite a good protection against the cytotoxic effect of this material.

  3. Technical considerations in the use of external condom catheter systems.

    PubMed

    deHoll, J D; Williams, L A; Steers, W D; Rodeheaver, G T; Clark, M M; Edlich, R F

    1992-01-01

    Since the advent of rehabilitation engineering new advances have been made that have revolutionized condom catheter drainage systems (CCDS). An innovative CCDS has been designed that ensures unobstructed urine flow. Its condom catheter has several unique design features. It has a double row of convolutions near the catheter tip that prevent kinking and twisting so that the pathway remains open. The condom catheter features a unique inner flap that fits snugly on the glans to prevent backflow of urine on the shaft. This condom catheter is connected to a vented leg bag that eliminates the development of a partial vacuum in the connecting tube. This vacuum can create siphoning, which in turn interferes with urine flow into the leg bag. In addition, a new rechargeable battery-operated clipper has been developed that makes nick-free hair removal from the genitals exceptionally easy. This atraumatic hair removal eliminates the pubic hair that becomes trapped under the condom catheter. The clinical impact of these new advances in CCDS requires further investigation.

  4. Digital Subtraction MR Angiography Roadmapping for Magnetic Steerable Catheter Tracking

    PubMed Central

    Martin, Alastair J.; Lillaney, Prasheel; Saeed, Maythem; Losey, Aaron D.; Settecase, Fabio; Evans, Lee; Arenson, Ronald L.; Wilson, Mark W.; Hetts, Steven W.

    2014-01-01

    Purpose To develop a high temporal resolution MR imaging technique that could be employed with magnetically-assisted remote control (MARC) endovascular catheters. Materials and Methods A technique is proposed based on selective intra-arterial injections of dilute MR contrast at the beginning of a fluoroscopic MR angiography acquisition. The initial bolus of contrast is used to establish a vascular roadmap upon which MARC catheters can be tracked. The contrast to noise ratio of the achieved roadmap was assessed in phantoms and in a swine animal model. The ability of the technique to permit navigation of activated MARC catheters through arterial branch points was evaluated. Results The roadmapping mode proved effective in phantoms for tracking objects and achieved a contrast to noise ratio of 35.7 between the intra and extra-vascular space. In vivo, the intra-arterial enhancement strategy produced roadmaps with a contrast to noise ratio of 42.0. The artifact produced by MARC catheter activation provided signal enhancement patterns on the roadmap that experienced interventionalists could track through vascular structures. Conclusion A roadmapping approach with intra-arterial CE-MRA is introduced for navigating the MARC catheter. The technique mitigates the artifact produced by the MARC catheter, greatly limits the required SAR, permits regular roadmap updates due to the low contrast agent requirements, and proved effective in the in vivo setting. PMID:24797218

  5. Needle catheter duodenostomy: a technique for duodenal alimentation of birds.

    PubMed

    Goring, R L; Goldman, A; Kaufman, K J; Roberts, C; Quesenberry, K E; Kollias, G V

    1986-11-01

    A technique for duodenal alimentation (needle catheter duodenostomy) of birds was developed, using the domestic pigeon (Columba livia) as the experimental model. A needle catheter was inserted into the descending duodenum of 5 pigeons and was secured to the body wall and dorsum of each bird. A liquid diet was administered daily (in equal amounts of 0, 4, 8, 12, and 16 hours) for 14 days without adverse effects. On day 15, the catheters were removed, and the birds immediately resumed normal consumption of a pigeon ration and water diet. Although 4 of the 5 birds had minor weight loss, dietary alterations probably could be used on an individual basis to alleviate this problem. After oral alimentation was resumed, the 5 birds exceeded their initial body weight within 7 days. Four weeks after catheter removal, positive-contrast radiographic evaluations indicated that the duodenum of each pigeon appeared normal. Needle catheter duodenostomy was a viable method of alimentation in the domestic pigeon. This technique should be applicable for other avian species requiring bypass of the upper gastrointestinal tract proximal to the region of catheter insertion in the duodenum.

  6. A retrospective study of palindrome symmetrical-tip catheters for chronic hemodialysis access in China.

    PubMed

    Ye, Chaoyang; Mao, Zhiguo; Zhang, Pan; Zhang, Yuqiang; Rong, Shu; Chen, Jing; Mei, Changlin

    2015-07-01

    Hemodialysis catheters remain necessary for long-term vascular access in patients for whom arteriovenous access may be problematic or impossible. Developments in catheter design have improved long-term catheter functionality, and reduced the rate of infection and complications associated with their use. This retrospective study of 284 cases of chronic catheterization in 271 patients treated between 2009 and 2011 using Tal Palindrome™ symmetrical-tip (N = 118) or Quinton™ Permcath™ step-tip (N = 166) hemodialysis catheters evaluates the efficacy and the safety of symmetrical-tip dialysis catheters for chronic hemodialysis, compared with a step-tip catheter. Measurements of catheter performance included mean catheter dwell time, incidence of low blood flow, and rates of infection and catheter-related blood stream infection (CRBSI). The symmetrical-tip catheter had a significantly longer mean dwell time compared with the step-tip catheter; 329.4 ± 38.1 versus 273.1 ± 25.4 d (p < 0.05). In addition, the rate of occurrence of low blood flow per 1000 catheter days was lower for the symmetrical-tip compared with the step-tip catheter; 1.13 versus 6.86 (p < 0.01). The symmetrical-tip catheter was also associated with a lower incidence of complications; the rates of infection (0.28 vs. 0.78; p < 0.01) and CRBSI (0.15 vs. 0.44; p < 0.01) were lower compared with those for step-tip catheters, and catheter removal occurred less often for the symmetrical-tip catheter (8% vs. 16%; p < 0.05). The symmetrical-tip hemodialysis catheter was associated with a longer mean dwell time, lower incidence of low blood flow, and lower infection rate compared with the step-tip catheter.

  7. Catheter guided by optical coherence domain reflectometry

    DOEpatents

    Everett, Matthew; Colston, Billy W.; Da Silva, Luiz B.; Matthews, Dennis

    2002-01-01

    A guidance and viewing system based on multiplexed optical coherence domain reflectometry is incorporated into a catheter, endoscope, or other medical device to measure the location, thickness, and structure of the arterial walls or other intra-cavity regions at discrete points on the medical device during minimally invasive medical procedures. The information will be used both to guide the device through the body and to evaluate the tissue through which the device is being passed. Multiple optical fibers are situated along the circumference of the device. Light from the distal end of each fiber is directed onto the interior cavity walls via small diameter optics (such as gradient index lenses and mirrored corner cubes). Both forward viewing and side viewing fibers can be included. The light reflected or scattered from the cavity walls is then collected by the fibers and multiplexed at the proximal end to the sample arm of an optical low coherence reflectometer. The system may also be implemented in a nonmedical inspection device.

  8. Fast integrated intravascular photoacoustic/ultrasound catheter

    NASA Astrophysics Data System (ADS)

    Choi, Changhoon; Cho, Seunghee; Kim, Taehoon; Park, Sungjo; Park, Hyoeun; Kim, Jinmoo; Lee, Seunghoon; Kang, Yeonsu; Jang, Kiyuk; Kim, Chulhong

    2016-03-01

    In cardiology, a vulnerable plaque is considered to be a key subject because it is strongly related to atherosclerosis and acute myocardial infarction. Because conventional intravascular imaging devices exhibit several limitations with regard to vulnerable plaque detection, the need for an effective lipid imaging modality has been continuously suggested. Photoacoustic (PA) imaging is a medical imaging technique with a high level of ultrasound (US) resolution and strong optical contrast. In this study, we successfully developed an integrated intravascular photoacoustic/ultrasound (IV-PAUS) imaging system with a catheter diameter of 1.2 mm for lipid-rich atherosclerosis imaging. An Nd:YAG pulsed laser with an excitation wavelength of 1064 nm was utilized. IV-PAUS offers 5-mm depth penetration and axial and lateral PA imaging resolutions of 94 μm and 203 μm, respectively, as determined by imaging a 6-μm carbon fiber. We initially obtained 3-dimensional (3D) co-registered PA/US images of metal stents. Subsequently, we successfully obtained 3D coregistered PA/US ex vivo images using an iliac artery from a rabbit atherosclerosis model. Accordingly, lipid-rich plaques were sufficiently differentiated from normal tissue in the ex vivo experiment. We validated these findings histologically to confirm the lipid content.

  9. The Effect of Interdisciplinary Team Rounds on Urinary Catheter and Central Venous Catheter Days and Rates of Infection.

    PubMed

    Arora, Navneet; Patel, Killol; Engell, Christian A; LaRosa, Jennifer A

    2014-01-01

    Interdisciplinary team (IDT) rounds were initiated in the intensive care unit (ICU) in June 2010. All catheters were identified by location, duration, and indication. Catheters with no indication were removed. Data were collected retrospectively on catheter days and associated infections in a 20-month period before and after intervention with an aggregate of 19 207 ICU days before and 23 576 ICU days after institution of rounds. Results showed a statistically significant decrease in the number of indwelling urinary catheter (IUC) days (5304 vs 4541 days, P = .05) and catheter-associated urinary tract infection rates (4.71 vs 1.98 infections/1000 ICU days, P < .05). Central line days statistically increased after IDT rounds (3986 vs 4305 days, P < .05) but the catheter-related bloodstream infection rate trended down (3.5 vs 1.6 infections/1000 ICU days, P = .62). This analysis suggests that IDT rounds may have an impact on reducing the number of IUC days and associated infections.

  10. A case report on a full-thickness chest wall reconstruction with polypropylene mesh and stainless steel mesh concurrently using a transverse rectus abdominis myocutaneous flap.

    PubMed

    Yoshino, Naoyuki; Yamauchi, Shigeo; Akimoto, Masataka; Hisayoshi, Takao; Koizumi, Kiyoshi; Shimizu, Kazuo

    2006-12-01

    A full-thickness chest wall resection requires subsequent chest wall reconstruction. A chest wall resection and reconstruction was performed using a transverse rectus abdominis myocutaneous (TRAM) flap, together with polypropylene mesh (Marlex mesh) and stainless steel mesh (SSM). A 71-year-old man was diagnosed as having recurrent lung cancer in the chest wall, and underwent surgical resection. Marlex mesh was sutured to the posterior wall of the surgical defect. A portion of the SSM was adjusted to the size of the defect and cut out. Its edges were folded to make the portion into a plate. This SSM plate was placed anteriorly to the Marlex mesh and sutured to the ribs. The Marlex mesh was folded back on the SSM plate by 2 cm and fixed. After the above procedures, a left-sided TRAM flap was raised through a subcutaneous tunnel up to the defect and sutured to the region. The patient was discharged from hospital 19 days postoperatively. The wound was fine and he had no flail chest or dyspnea, and carcinomatous pain resolved.

  11. A case of central carcinoma of the mandible arising from a recurrent odontogenic keratocyst: delineation of surgical margins and reconstruction with bilateral rectus abdominis myocutaneous free flaps.

    PubMed

    Ota, Y; Karakida, K; Watanabe, D; Miyasaka, M; Tsukinoki, K

    1998-10-01

    A case of central carcinoma of the mandible arising from a recurrent odontogenic keratocyst is reported. A 38-year-old man was admitted to the Tokai University Hospital due to postoperative infection of a recurrent odontogenic keratocyst of the left mandible. He had had a cystectomy for an odontogenic keratocyst 4 years ago. The lesion revealed bony destruction of the mandible with worm-eating shaped margins with extension to the facial skin. A biopsy specimen revealed squamous cell carcinoma. The mandible was resected with facial skin and the sublingual space was dissected to preserve the lingual nerve. The oral and the facial resections were reconstructed with a titanium plate and bilateral rectus abdominis myocutaneous free flaps. The plate was removed due to infection around the margins and readjustment of the flaps was conducted 5 months after the surgery. He has not had a local relapse, metastasis, or incisional hernia for 8 months following surgery. Good occlusion has been attained by the residual mandible, and he is able to eat without any problems.

  12. [Intracardiac migration of a ventriculoatrial shunt catheter treated by endovascular transvenous retrieval].

    PubMed

    Matsubara, Noriaki; Miyachi, Shigeru; Tsukamoto, Nobuhiro

    2012-06-01

    The authors report a case of intracardiac migration of a ventriculoatrial (VA) shunt catheter and transvenous retrieval of the migrated shunt catheter. A 67-year-old male, who had previously undergone a VA shunt for hydrocephalus after subarachnoid hemorrhage, presented disorientation, memory disturbance and gait disturbance without any cardiopulmonary symptom. Head CT scan revealed ventriculomegaly that indicated hydrocephalus due to shunt malfunction. Radiogram revealed that the caudal segment of the broken atrial catheter had migrated into the heart (right ventricle). The migrated shunt catheter was retrieved by a transfemoral approach with a pigtail catheter and a snare retriever catheter, although the rostral catheter segment partially remained because of tight adhesion. The VA shunt was then reconstructed. Postoperatively, symptoms due to recurrent hydrocephalus were markedly improved and the VA shunt functioned well. Transvenous catheter retrieval was a less invasive and effective method for VA shunt catheter migration.

  13. In situ management of confirmed central venous catheter-related bacteremia.

    PubMed

    Flynn, P M; Shenep, J L; Stokes, D C; Barrett, F F

    1987-08-01

    Thirty-one patients with suspected central venous catheter-related bacteremia were evaluated with comparative quantitative cultures of central venous and peripheral blood specimens. Using criteria developed from studies in bacteremic animals, 19 patients were confirmed to have catheter-related bacteremia. Antibiotic therapy was administered through the catheter (in situ therapy) in 17 of those patients to evaluate the feasibility of treating patients with true central venous catheter-related bacteremias without catheter removal. Bacteremia was successfully eradicated in 11 of 17 patients (65%), allowing 7 patients to retain their catheter a median of 157 days. This study validates the use of comparative quantitative blood cultures in the diagnosis of catheter-related bacteremia and indicates that in situ therapy is a rational alternative to catheter removal in patients with catheter-related bacteremia.

  14. A pilot study to assess adductor canal catheter tip migration in a cadaver model.

    PubMed

    Leng, Jody C; Harrison, T Kyle; Miller, Brett; Howard, Steven K; Conroy, Myles; Udani, Ankeet; Shum, Cynthia; Mariano, Edward R

    2015-04-01

    An adductor canal catheter may facilitate early ambulation after total knee arthroplasty, but there is concern over preoperative placement since intraoperative migration of catheters may occur from surgical manipulation and result in ineffective analgesia. We hypothesized that catheter type and subcutaneous tunneling may influence tip migration for preoperatively inserted adductor canal catheters. In a male unembalmed human cadaver, 20 catheter insertion trials were divided randomly into one of four groups: flexible epidural catheter either tunneled or not tunneled; or rigid stimulating catheter either tunneled or not tunneled. Intraoperative patient manipulation was simulated by five range-of-motion exercises of the knee. Distance and length measurements were performed by a blinded regional anesthesiologist. Changes in catheter tip to nerve distance (p = 0.225) and length of catheter within the adductor canal (p = 0.467) were not different between the four groups. Two of five non-tunneled stimulating catheters (40 %) were dislodged compared to 0/5 in all other groups (p = 0.187). A cadaver model may be useful for assessing migration of regional anesthesia catheters; catheter type and subcutaneous tunneling may not affect migration of adductor canal catheters based on this preliminary study. However, future studies involving a larger sample size, actual patients, and other catheter types are warranted.

  15. Local Intravascular Drug Delivery: In Vitro Comparison of Three Catheter Systems

    SciTech Connect

    Alfke, Heiko; Wagner, Hans-Joachim; Calmer, Christian; Klose, Klaus Jochen

    1998-01-15

    Purpose: The aim of this in vitro study was to compare different catheter systems for local drug delivery with respect to the penetration depth of a biotin marker solution delivered into the vessel wall. Methods: Post-mortem carotid arteries from pigs were locally infused with a biotin solution using three different catheter systems. With all catheters (microporous balloon catheter, hydrogel-coated balloon catheter, and spiral balloon catheter) we used the same pressure of 405 kPa (4 atm) and infusion times of 60, 90, and 300 sec. After infusion the arteries were histologically prepared and stained using a biotin-specific method. With a light microscope an observer, blinded to the catheter type, scored the amount of biotin within the vessel wall, measured as staining intensity, and the penetration depth of the biotin. Results: Delivery with the hydrogel-coated balloon catheter was limited to the intima and the innermost parts of the media. The spiral balloon and microporous balloon catheter showed both a deeper penetration and a larger amount of delivered biotin compared with the hydrogel catheter, with a slightly deeper penetration using the microporous catheter. The penetration depth showed a correlation with infusion time for the spiral balloon and microporous catheters, but not for the hydrogel-coated catheter. Conclusion: Different catheter designs lead to different patterns of local drug delivery. The differences in penetration depth and amount of the substance delivered to the vessel wall should be known and might be useful for targeting specific areas within the vessel wall.

  16. Long-term Urinary Catheter Users Self-Care Practices and Problems

    PubMed Central

    Wilde, Mary; McDonald, Margaret V.; Brasch, Judith; McMahon, James M.; Fairbanks, Eileen; Shah, Shivani; Tang, Wan; Scheid, Eileen

    2013-01-01

    Aims The aims were to characterize a sample of 202 adult community-living long-term indwelling urinary catheter users, to describe self-care practices and catheter problems, and to explore relationships among demographics, catheter practices, and problems. Background Long-term urinary catheter users have not been well studied, and persons using the device indefinitely for persistent urinary retention are likely to have different patterns of catheter practices and problems. Design The study was a cross-sectional descriptive and exploratory analysis. Methods Home interviews were conducted with catheter users who provided information by self-reported recall over the previous two months. Data were analyzed by descriptive statistics and tests of association between demographics, catheter practices, and catheter problems. Results The sample was widely diverse in age (19–96 years), race, and medical diagnosis. Urethral catheters were used slightly more often (56%) than suprapubic (44%), for a mean of 6 yrs. (SD 7 yrs.). Many persons were highly disabled, with 60% having difficulty in bathing, dressing, toileting, and getting out of the bed; 19% also required assistance in eating. A high percentage of catheter problems were reported with: 43% experiencing leakage (bypassing of urine), 31% having had a urinary tract infection, 24% blockage of the catheter, 23% catheter-associated pain, and 12% accidental dislodgment of the catheter. Treatments of catheter-related problems contributed to additional health care utilization including extra nurse or clinic visits, trips to the emergency department, or hospitalization. Symptoms of catheter associated urinary tract infections were most often related to changes in the color or character of urine or generalized symptoms. Conclusions Catheter related problems contribute to excess morbidity and health care utilization and costs. Relevance to clinical practice More research is needed in how to minimize catheter associated problems

  17. Cryo-balloon catheter position planning using AFiT

    NASA Astrophysics Data System (ADS)

    Kleinoeder, Andreas; Brost, Alexander; Bourier, Felix; Koch, Martin; Kurzidim, Klaus; Hornegger, Joachim; Strobel, Norbert

    2012-02-01

    Atrial fibrillation (AFib) is the most common heart arrhythmia. In certain situations, it can result in life-threatening complications such as stroke and heart failure. For paroxsysmal AFib, pulmonary vein isolation (PVI) by catheter ablation is the recommended choice of treatment if drug therapy fails. During minimally invasive procedures, electrically active tissue around the pulmonary veins is destroyed by either applying heat or cryothermal energy to the tissue. The procedure is usually performed in electrophysiology labs under fluoroscopic guidance. Besides radio-frequency catheter ablation devices, so-called single-shot devices, e.g., the cryothermal balloon catheters, are receiving more and more interest in the electrophysiology (EP) community. Single-shot devices may be advantageous for certain cases, since they can simplify the creation of contiguous (gapless) lesion sets around the pulmonary vein which is needed to achieve PVI. In many cases, a 3-D (CT, MRI, or C-arm CT) image of a patient's left atrium is available. This data can then be used for planning purposes and for supporting catheter navigation during the procedure. Cryo-thermal balloon catheters are commercially available in two different sizes. We propose the Atrial Fibrillation Planning Tool (AFiT), which visualizes the segmented left atrium as well as multiple cryo-balloon catheters within a virtual reality, to find out how well cryo-balloons fit to the anatomy of a patient's left atrium. First evaluations have shown that AFiT helps physicians in two ways. First, they can better assess whether cryoballoon ablation or RF ablation is the treatment of choice at all. Second, they can select the proper-size cryo-balloon catheter with more confidence.

  18. Ventricular catheter entry site and not catheter tip location predicts shunt survival: a secondary analysis of 3 large pediatric hydrocephalus studies.

    PubMed

    Whitehead, William E; Riva-Cambrin, Jay; Kulkarni, Abhaya V; Wellons, John C; Rozzelle, Curtis J; Tamber, Mandeep S; Limbrick, David D; Browd, Samuel R; Naftel, Robert P; Shannon, Chevis N; Simon, Tamara D; Holubkov, Richard; Illner, Anna; Cochrane, D Douglas; Drake, James M; Luerssen, Thomas G; Oakes, W Jerry; Kestle, John R W

    2017-02-01

    OBJECTIVE Accurate placement of ventricular catheters may result in prolonged shunt survival, but the best target for the hole-bearing segment of the catheter has not been rigorously defined. The goal of the study was to define a target within the ventricle with the lowest risk of shunt failure. METHODS Five catheter placement variables (ventricular catheter tip location, ventricular catheter tip environment, relationship to choroid plexus, catheter tip holes within ventricle, and crosses midline) were defined, assessed for interobserver agreement, and evaluated for their effect on shunt survival in univariate and multivariate analyses. De-identified subjects from the Shunt Design Trial, the Endoscopic Shunt Insertion Trial, and a Hydrocephalus Clinical Research Network study on ultrasound-guided catheter placement were combined (n = 858 subjects, all first-time shunt insertions, all patients < 18 years old). The first postoperative brain imaging study was used to determine ventricular catheter placement for each of the catheter placement variables. RESULTS Ventricular catheter tip location, environment, catheter tip holes within the ventricle, and crosses midline all achieved sufficient interobserver agreement (κ > 0.60). In the univariate survival analysis, however, only ventricular catheter tip location was useful in distinguishing a target within the ventricle with a survival advantage (frontal horn; log-rank, p = 0.0015). None of the other catheter placement variables yielded a significant survival advantage unless they were compared with catheter tips completely not in the ventricle. Cox regression analysis was performed, examining ventricular catheter tip location with age, etiology, surgeon, decade of surgery, and catheter entry site (anterior vs posterior). Only age (p < 0.001) and entry site (p = 0.005) were associated with shunt survival; ventricular catheter tip location was not (p = 0.37). Anterior entry site lowered the risk of shunt failure compared

  19. The Laplace Planes of Uranus and Pluto

    NASA Technical Reports Server (NTRS)

    Dobrovolskis, Anthony R.

    1993-01-01

    Satellite orbits close to an oblate planet precess about its equatorial plane, while distant satellites precess around the plane of the planet's heliocentric orbit. In between, satellites in nearly circular orbits precess about a warped intermediate surface called the Laplace 'plane.' Herein we derive general formulas for locating the Laplace plane. Because Uranus and Pluto have high obliquities, their Laplace planes are severely warped. We present maps of these Laplace planes, of interest in telescopic searches for new satellites. The Laplace plane of the Solar System as a whole is similarly distorted, but comets in the inner Oort cloud precess too slowly to sense the Laplace plane.

  20. Explosive plane-wave lens

    DOEpatents

    Marsh, S.P.

    1988-03-08

    An explosive plane-wave air lens which enables a spherical wave form to be converted to a planar wave without the need to specially machine or shape explosive materials is described. A disc-shaped impactor having a greater thickness at its center than around its periphery is used to convert the spherical wave into a plane wave. When the wave reaches the impactor, the center of the impactor moves first because the spherical wave reaches the center of the impactor first. The wave strikes the impactor later in time as one moves radially along the impactor. Because the impactor is thinner as one moves radially outward, the velocity of the impactor is greater at the periphery than at the center. An acceptor explosive is positioned so that the impactor strikes the acceptor simultaneously. Consequently, a plane detonation wave is propagated through the acceptor explosive. 4 figs.

  1. Explosive plane-wave lens

    DOEpatents

    Marsh, Stanley P.

    1988-01-01

    An explosive plane-wave air lens which enables a spherical wave form to be converted to a planar wave without the need to specially machine or shape explosive materials is described. A disc-shaped impactor having a greater thickness at its center than around its periphery is used to convert the spherical wave into a plane wave. When the wave reaches the impactor, the center of the impactor moves first because the spherical wave reaches the center of the impactor first. The wave strikes the impactor later in time as one moves radially along the impactor. Because the impactor is thinner as one moves radially outward, the velocity of the impactor is greater at the periphery than at the center. An acceptor explosive is positioned so that the impactor strikes the acceptor simultaneously. Consequently, a plane detonation wave is propagated through the acceptor explosive.

  2. Explosive plane-wave lens

    DOEpatents

    Marsh, S.P.

    1987-03-12

    An explosive plane-wave air lens which enables a spherical wave form to be converted to a planar wave without the need to specially machine or shape explosive materials is described. A disc-shaped impactor having a greater thickness at its center than around its periphery is used to convert the spherical wave into a plane wave. When the wave reaches the impactor, the center of the impactor moves first because the spherical wave reaches the center of the impactor first. The wave strikes the impactor later in time as one moves radially along the impactor. Because the impactor is thinner as one moves radially outward, the velocity of the impactor is greater at the periphery than at the center. An acceptor explosive is positioned so that the impactor strikes the acceptor simultaneously. Consequently, a plane detonation wave is propagated through the acceptor explosive. 3 figs., 3 tabs.

  3. Thrombus on Indwelling Central Venous Catheters: The Histopathology of 'Fibrin Sheaths'

    SciTech Connect

    Suojanen, James Norman; Brophy, David Paul; Nasser, Imad

    2000-03-15

    Purpose: Central venous catheters (CVC) may fail for many reasons, though 'fibrin sheaths' blocking catheter ports are usually implicated. We examined the sheaths removed from dialysis catheters to determine their histopathology.Methods: Ten catheter strippings were performed and the removed material was studied grossly and microscopically.Results: The histologic specimens showed thrombus both with and without a proteinaceous sheath.Conclusion: Dialysis catheters fail because of thrombus formation. This can occur in either the absence or presence of a protein coating on the catheter, the so-called 'fibrin sheath.'.

  4. Evaluation of the elastic behaviour of central venous PVC, polyurethane and silicone catheters.

    PubMed

    Cervera, M; Dolz, M; Herraez, J V; Belda, R

    1989-02-01

    Eighty used and 20 new silicone, polyurethane and polyvinylchloride central venous catheters were tested to establish the Young's modulus and the bending stiffness of the catheters and their introducers. The catheters were subjected to longitudinal traction forces and their lengthening measured. Young's modulus and the geometric moment of inertia were then calculated. It is shown that polyurethane catheters show least variation in their elastic characteristics, and that silicone catheters offer least resistance to bending and do not change their elastic properties after use. All catheters were equally unlikely to cause thrombus production if this is related to excessive bending stiffness.

  5. Space-Plane Spreadsheet Program

    NASA Technical Reports Server (NTRS)

    Mackall, Dale

    1993-01-01

    Basic Hypersonic Data and Equations (HYPERDATA) spreadsheet computer program provides data gained from three analyses of performance of space plane. Equations used to perform analyses derived from Newton's second law of physics, derivation included. First analysis is parametric study of some basic factors affecting ability of space plane to reach orbit. Second includes calculation of thickness of spherical fuel tank. Third produces ratio between volume of fuel and total mass for each of various aircraft. HYPERDATA intended for use on Macintosh(R) series computers running Microsoft Excel 3.0.

  6. Double-lumen central venous catheters impregnated with chlorhexidine and silver sulfadiazine to prevent catheter colonisation in the intensive care unit setting: a prospective randomised study.

    PubMed

    Camargo, L F A; Marra, A R; Büchele, G L; Sogayar, A M C; Cal, R G R; de Sousa, J M A; Silva, E; Knobel, E; Edmond, M B

    2009-07-01

    Antimicrobial- and antiseptic-impregnated catheters are strategies recommended to prevent central venous catheter (CVC) colonisation. Few data regarding chlorhexidine/silver sulfadiazine-impregnated catheters in intensive care unit (ICU) patients have been reported. We performed a prospective, randomised study comparing the colonisation rates of chlorhexidine/silver sulfadiazine-impregnated CVCs (group 1) against standard CVCs (group 2). In order to assess catheter colonisation rates, a 4cm segment from the tips of aseptically removed catheters was cultured by the roll-plate method. In all, 109 patients were enrolled with successful catheter insertion, 51 of them in group 1 and 58 in group 2. There were no statistically significant differences between the two groups with regards to age, Sequential Organ Failure Assessment (SOFA) score, ICU admission diagnosis, infection risk, catheter insertion sites or catheter length of stay. The colonisation rates were 29.4% (15 catheters) for group 1 and 34.5% (20 catheters) for group 2 (P=0.50). Double-lumen CVCs impregnated with chlorhexidine and silver sulfadiazine were not effective in reducing the incidence of catheter colonisation in ICU patients.

  7. Hemodialysis Catheter Heat Transfer for Biofilm Prevention and Treatment

    PubMed Central

    Richardson, Ian P.; Sturtevant, Rachael; Heung, Michael; Solomon, Michael J.; Younger, John G.; VanEpps, J. Scott

    2016-01-01

    Central line-associated bloodstream infections (CLABSIs) are not easily treated and many catheters (e.g., hemodialysis catheters) are not easily replaced. Biofilms (the source of infection) on catheter surfaces are notoriously difficult to eradicate. We have recently demonstrated that modest elevations of temperature lead to increased staphylococcal susceptibility to vancomycin and significantly soften the biofilm matrix. In this study, using a combination of microbiological, computational, and experimental studies, we demonstrate the efficacy, feasibility, and safety of using heat as an adjuvant treatment for infected hemodialysis catheters. Specifically, we show that treating with heat in the presence of antibiotics led to additive killing of Staphylococcus epidermidis with similar trends seen for Staphylococcus aureus and Klebsiella pneumoniae. The magnitude of temperature elevation required is relatively modest (45-50°C) and similar to that used as an adjuvant to traditional cancer therapy. Using a custom-designed benchtop model of a hemodialysis catheter positioned with tip in the human vena cava as well as computational fluid dynamic simulations we demonstrate that these temperature elevations are likely achievable in situ with minimal increased in overall blood temperature. PMID:26501916

  8. [Placement of central venous catheters and patient safety].

    PubMed

    de Jonge, E

    2007-01-27

    Placement of a central venous catheter is one of the most common invasive procedures and is associated with septic and mechanical complications, such as bleeding and pneumothorax. Up to 30% of attempts to cannulate the central vein fail. Correct positioning of the patient can help to maximise the success rate. For placement of catheters in the subclavian vein, patients should be in the Trendelenburg position without the use of a shoulder roll to retract the shoulders. Traditionally, central venous catheters are placed using a 'blind' technique that relies on external anatomical reference marks to localise the vein. However, unnoticed anatomical variations or central venous thrombosis may contribute to cannulation failure with this technique. The use of ultrasound has been shown to increase the success rate and avoid mechanical complications when placing a catheter in the internal jugular vein. It may also increase the success rate in subclavian vein catheterisation. To increase patient safety, the use of ultrasound when placing a central venous catheter should be embraced and become the standard of care.

  9. Epidural fibrosis after permanent catheter insertion and infusion.

    PubMed

    Aldrete, J A

    1995-11-01

    Forty-six permanent epidural catheters and life-port units were implanted in 43 patients with severe, recurrent low back pain who had been considered not to be candidates for surgical intervention and in whom other therapeutic modalities had failed. Eight cases developed epidural fibrosis (EF). For analgesia, patients received either infusions with preservative-free solutions of fentanyl and bupivacaine or daily boluses of morphine and bupivacaine. Catheters remained from 75 days to 433 days. Signs of EF appeared from 21 days to 320 days after implantation. Pain at injection or resistance to injection were initial manifestations of EF, followed by poor, and eventually, nil analgesic effect. The epidural catheters were made of either polyamide, silicone, or polyurethane. Epidurograms revealed encapsulation, narrowing, and loculation of epidural space with gradually reduced spread of the contrast material. The occurrence of EF limits the permanency of implanted epidural catheters. The infusate does not cause this complication, which appears to be a foreign body reaction due to the presence of the catheter in the epidural space.

  10. Development of a balloon volume sensor for pulsating balloon catheters.

    PubMed

    Nolan, Timothy D C; Hattler, Brack G; Federspiel, William J

    2004-01-01

    Helium pulsed balloons are integral components of several cardiovascular devices, including intraaortic balloon pumps (IABP) and a novel intravenous respiratory support catheter. Effective use of these devices clinically requires full inflation and deflation of the balloon, and improper operating conditions that lead to balloon under-inflation can potentially reduce respiratory or cardiac support provided to the patient. The goal of the present study was to extend basic spirographic techniques to develop a system to dynamically measure balloon volumes suitable for use in rapidly pulsating balloon catheters. The dynamic balloon volume sensor system (DBVSS) developed here used hot wire anemometry to measure helium flow in the drive line from console to catheter and integrated the flow to determine the volume delivered in each balloon pulsation. An important component of the DBVSS was an algorithm to automatically detect and adjust flow signals and measured balloon volumes in the presence of gas composition changes that arise from helium leaks occurring in these systems. The DBVSS was capable of measuring balloon volumes within 5-10% of actual balloon volumes over a broad range of operating conditions relevant to IABP and the respiratory support catheter. This includes variations in helium concentration from 70-100%, pulsation frequencies from 120-480 beats per minute, and simulated clinical conditions of reduced balloon filling caused by constricted vessels, increased driveline, or catheter resistance.

  11. Hemodialysis Catheter Heat Transfer for Biofilm Prevention and Treatment.

    PubMed

    Richardson, Ian P; Sturtevant, Rachael; Heung, Michael; Solomon, Michael J; Younger, John G; VanEpps, J Scott

    2016-01-01

    Central line-associated bloodstream infections (CLABSIs) are not easily treated, and many catheters (e.g., hemodialysis catheters) are not easily replaced. Biofilms (the source of infection) on catheter surfaces are notoriously difficult to eradicate. We have recently demonstrated that modest elevations of temperature lead to increased staphylococcal susceptibility to vancomycin and significantly soften the biofilm matrix. In this study, using a combination of microbiological, computational, and experimental studies, we demonstrate the efficacy, feasibility, and safety of using heat as an adjuvant treatment for infected hemodialysis catheters. Specifically, we show that treating with heat in the presence of antibiotics led to additive killing of Staphylococcus epidermidis with similar trends seen for Staphylococcus aureus and Klebsiella pneumoniae. The magnitude of temperature elevation required is relatively modest (45-50°C) and similar to that used as an adjuvant to traditional cancer therapy. Using a custom-designed benchtop model of a hemodialysis catheter, positioned with tip in the human vena cava as well as computational fluid dynamic simulations, we demonstrate that these temperature elevations are likely achievable in situ with minimal increased in overall blood temperature.

  12. Heparin Leakage in Central Venous Catheters by Hemodynamic Transport

    NASA Astrophysics Data System (ADS)

    Barbour, Michael; McGah, Patrick; Gow, Kenneth; Aliseda, Alberto

    2014-11-01

    Central venous catheters (CVCs), placed in the superior vena cava for hemodialysis, are routinely filled with heparin, an anticoagulant, while not in use to maintain patency and prevent thrombus formation at the catheter tip. However, the heparin-lock procedure places the patient at risk for systemic bleeding incidences, as heparin is known to leak into the blood stream. We propose that the driving mechanism behind heparin leakage is advective-diffusive transport due to the pulsatile blood flow surrounding the catheter tip. This novel hypothesis is based on Planar Laser Induced Fluorescence (PLIF) measurements of heparin transport from a CVC placed inside an in vitro pulsatile flow loop and validated with CFD simulations. The results show an initial, fast (<10s), advection-dominated phase that rapidly depletes the concentration of heparin at the CVC tip, followed by a slow, diffusion-limited phase inside the catheter lumen, where concentration is still high, that is insufficient at replenishing the lost heparin at the tip. These results, which estimate leakage rates consistent with published in vivo data, predict that the concentration of heparin at the catheter tip is effectively zero for the majority of the interdialytic phase, rendering the heparin lock ineffective.

  13. A 4-DOF Robot for Positioning Ultrasound Imaging Catheters.

    PubMed

    Loschak, Paul M; Degirmenci, Alperen; Tenzer, Yaroslav; Howe, Robert D

    2015-08-01

    In this paper we present the design, fabrication, and testing of a robot for automatically positioning ultrasound imaging catheters. Our system will point ultrasound (US) catheters to provide real-time imaging of anatomical structures and working instruments during minimally invasive surgeries. Manually navigating US catheters is difficult and requires extensive training in order to aim the US imager at desired targets. Therefore, a four DOF robotic system was developed to automatically navigate US imaging catheters for enhanced imaging. A rotational transmission enables three DOF for pitch, yaw, and roll of the imager. This transmission is translated by the fourth DOF. An accuracy analysis was conducted to calculate the maximum allowable joint motion error. Rotational joints must be accurate to within 1.5° and the translational joint must be accurate within 1.4 mm. Motion tests were then conducted to validate the accuracy of the robot. The average resulting errors in positioning of the rotational joints were measured to be 0.28°-0.38° with average measured backlash error 0.44°. Average translational positioning and backlash errors were measured to be significantly lower than the reported accuracy of the position sensor. The resulting joint motion errors were well within the required specifications for accurate robot motion. Such effective navigation of US imaging catheters will enable better visualization in various procedures ranging from cardiac arrhythmia treatment to tumor removal in urological cases.

  14. Rat Indwelling Urinary Catheter Model of Candida albicans Biofilm Infection

    PubMed Central

    Nett, Jeniel E.; Brooks, Erin G.; Cabezas-Olcoz, Jonathan; Sanchez, Hiram; Zarnowski, Robert; Marchillo, Karen

    2014-01-01

    Indwelling urinary catheters are commonly used in the management of hospitalized patients. Candida can adhere to the device surface and propagate as a biofilm. These Candida biofilm communities differ from free-floating Candida, exhibiting high tolerance to antifungal therapy. The significance of catheter-associated candiduria is often unclear, and treatment may be problematic considering the biofilm drug-resistant phenotype. Here we describe a rodent model for the study of urinary catheter-associated Candida albicans biofilm infection that mimics this common process in patients. In the setting of a functioning, indwelling urinary catheter in a rat, Candida proliferated as a biofilm on the device surface. Characteristic biofilm architecture was observed, including adherent, filamentous cells embedded in an extracellular matrix. Similar to what occurs in human patients, animals with this infection developed candiduria and pyuria. Infection progressed to cystitis, and a biofilmlike covering was observed over the bladder surface. Furthermore, large numbers of C. albicans cells were dispersed into the urine from either the catheter or bladder wall biofilm over the infection period. We successfully utilized the model to test the efficacy of antifungals, analyze transcriptional patterns, and examine the phenotype of a genetic mutant. The model should be useful for future investigations involving the pathogenesis, diagnosis, therapy, prevention, and drug resistance of Candida biofilms in the urinary tract. PMID:25183731

  15. Efficacy of percutaneous pigtail catheters for thoracostomy at bedside

    PubMed Central

    Penupolu, Sudheer; Flores, David

    2012-01-01

    Objective Given the potential morbidity of traditional chest tube insertion, use of pigtail is desirable. The purpose of this case series is to determine the efficacy of bedside pigtail thoracostomy catheters in Adult population by using bedside ultrasound by the pulmonologists. Methods It is a retrospective case series, which describes the importance of bedside pigtail catheters placements for emergent symptomatic relief for the patients. Predicting a successful drainage, procedure is a complex and multifactorial process based on size, location, character and configuration of the abscess. Results Our experience shows that the use of standard size (7-8.5 F) pigtail catheters is usually very successful in draining of the pleural fluids. Less time consumption, lower cost and bedside technique makes it superior to conventional chest tube placement in many aspects. Conclusions Percutaneous pigtail catheters are useful in the drainage of pleural fluids. The pigtail catheters can be placed successful at bedside by the pulmonologists under ultrasound guidance with minimal complications and marked clinical improvement. The cost effectives of this procedure over the conventional chest tube placement, makes this procedure more desirable in most of the hospital settings. PMID:22754668

  16. Norfloxacin-releasing urethral catheter for long-term catheterization.

    PubMed

    Park, Jae Hyung; Cho, Yong Woo; Cho, Yong-Hyun; Choi, Joong Myung; Shin, Hee Jong; Bae, You Han; Chung, Hesson; Jeong, Seo Young; Kwon, Ick Chan

    2003-01-01

    Norfloxacin-releasing urethral catheters were prepared for the purpose of preventing urinary tract infections during long-term catheterization. The outer and inner surfaces of the catheters were coated with poly(ethylene-co-vinyl acetate) (EVA) and an amphiphilic multiblock co-polymer (PEO2kPDMS), composed of poly(ethylene oxide) and poly(dimethyl siloxane). Norfloxacin, a fluoroquinolone synthetic antibiotic, was impregnated into a coating layer. The in vitro drug release behavior was monitored for 30 days, the surface topography was investigated using scanning electron microscopy (SEM) and the antibacterial activity against different bacteria implicated in urinary tract infection was evaluated by the in vitro inhibition zone test. All the coated catheters showed continuous delivery of norfloxacin for up to 30 days owing to hydrophobic natures of norfloxacin and EVA. PEO2kPDMS incorporated in a coating layer produced a smooth and uniform surface. The coated catheters created considerable inhibition zones for 10 days against Escherichia coli. Klebsiella pneumoniae and Proteus vulgaris, indicating the continuous release of norfloxacin. Overall, it was evident that the catheters coated with EVA/PEO2kPDMS blends containing norfloxacin have a promising potential for the clinical use in patients undergoing long-term catheterization.

  17. In vitro cardiac catheter navigation via augmented reality surgical guidance

    NASA Astrophysics Data System (ADS)

    Linte, Cristian A.; Moore, John; Wiles, Andrew; Lo, Jennifer; Wedlake, Chris; Peters, Terry M.

    2009-02-01

    Catheter-driven cardiac interventions have emerged in response to the need of reducing invasiveness associated with the traditional cut-and-sew techniques. Catheter manipulation is traditionally performed under real-time fluoroscopy imaging, resulting in an overall trade-off of procedure invasiveness for radiation exposure of both the patient and clinical staff. Our approach to reducing and potentially eliminating the use of flouroscopy in the operating room entails the use of multi-modality imaging and magnetic tracking technologies, wrapped together into an augmented reality environment for enhanced intra-procedure visualization and guidance. Here we performed an in vitro study in which a catheter was guided to specific targets located on the endocardial atrial surface of a beating heart phantom. "Therapy delivery" was modeled in the context of a blinded procedure, mimicking a beating heart, intracardiac intervention. The users navigated the tip of a magnetically tracked Freezor 5 CRYOCATH catheter to the specified targets. Procedure accuracy was determined as the distance between the tracked catheter tip and the tracked surgical target at the time of contact, and it was assessed under three different guidance modalities: endoscopic, augmented reality, and ultrasound image guidance. The overall RMS targeting accuracy achieved under augmented reality guidance averaged to 1.1 mm. This guidance modality shows significant improvements in both procedure accuracy and duration over ultrasound image guidance alone, while maintianing an overall targeting accuracy comparable to that achieved under endoscopic guidance.

  18. A 4-DOF Robot for Positioning Ultrasound Imaging Catheters

    PubMed Central

    Loschak, Paul M.; Degirmenci, Alperen; Tenzer, Yaroslav; Howe, Robert D.

    2015-01-01

    In this paper we present the design, fabrication, and testing of a robot for automatically positioning ultrasound imaging catheters. Our system will point ultrasound (US) catheters to provide real-time imaging of anatomical structures and working instruments during minimally invasive surgeries. Manually navigating US catheters is difficult and requires extensive training in order to aim the US imager at desired targets. Therefore, a four DOF robotic system was developed to automatically navigate US imaging catheters for enhanced imaging. A rotational transmission enables three DOF for pitch, yaw, and roll of the imager. This transmission is translated by the fourth DOF. An accuracy analysis was conducted to calculate the maximum allowable joint motion error. Rotational joints must be accurate to within 1.5° and the translational joint must be accurate within 1.4 mm. Motion tests were then conducted to validate the accuracy of the robot. The average resulting errors in positioning of the rotational joints were measured to be 0.28°-0.38° with average measured backlash error 0.44°. Average translational positioning and backlash errors were measured to be significantly lower than the reported accuracy of the position sensor. The resulting joint motion errors were well within the required specifications for accurate robot motion. Such effective navigation of US imaging catheters will enable better visualization in various procedures ranging from cardiac arrhythmia treatment to tumor removal in urological cases. PMID:26925468

  19. [Epidemiology of catheter-related infections in intensive care unit].

    PubMed

    Merrer, J

    2005-03-01

    Catheter-related infections remain an important cause of nosocomial infection in the ICU. They include colonization of the device, exit-site infection and catheter-related bloodstream infection with or without bacteraemia. Data from clinical studies and surveillance networks should be compared cautiously due to important methodological differences and wide variations of device-utilization ratio between units or countries. In France, two regional networks (C-CLIN Paris-Nord and C-CLIN Sud-Est) produced comparable and reproducible results. Colonization represents five-six cases per 1000 catheter-days and bacteraemia represents one case per 1000 catheter-days. Incidence rates from North American studies are usually four to five times higher. Numerous risk factors have been identified. Some of them could be used to stratify patients according to risk of catheter-related infection and to allow more valid comparison between ICU's performances. Participation of French ICUs to the recent national surveillance networks (REA RAISIN and REACAT RAISIN) should be encouraged.

  20. Safety and functionality of transhepatic hemodialysis catheters in chronic hemodialysis patients

    PubMed Central

    Şanal, Bekir; Nas, Ömer Fatih; Doğan, Nurullah; Korkmaz, Mehmet; Hacıkurt, Kadir; Yıldız, Abdulmecid; Aytaç, İrem İris Kan; Hakyemez, Bahattin; Erdoğan, Cüneyt

    2016-01-01

    PURPOSE We aimed to investigate the safety and functionality of tunneled transhepatic hemodialysis catheters in chronic hemodialysis patients. METHODS Thirty-eight patients (20 women aged 56±10 years and 18 men aged 61±11 years) with transhepatic tunneled hemodialysis catheters were evaluated. The date of the first transhepatic catheterization, indications, procedure details, functional time periods of catheters, reasons for the removal or revision of catheters, catheter-related complications, and current conditions of patients were retrospectively analyzed. RESULTS A total of 69 catheters were properly placed in all patients (100% technical success) under imaging guidance during the 91-month follow-up period. The functionality of 35 catheters could not be evaluated: five catheters were removed because of noncomplication related reasons (surgical fistulas were opened in two cases [2/35, 5.7%], transplantation was performed in three cases [3/35, 8.6%]), 18 patients died while their catheters were functional (18/35, 51.4%), and 12 catheters were still functional at the time of the study (12/35, 34.3%). The functionality of catheters was evaluated the remaining 34 catheters that necessitated revision because of complications. Furthermore, only half of the catheters were functional on day 136 when evaluated using Kaplan-Meier analysis. The four main complications were thrombosis (16/34, 47%; complication rate of 0.37 days in 100 catheters), infection (8/34, 23.5%; 0.18 days in 100 catheters), migration (8/34, 23.5%; 0.18 days in 100 catheters), and kinking (2/34, 6%; 0.04 days in 100 catheters). CONCLUSION Transhepatic venous catheterization is a safe and functional alternative route in chronic hemodialysis patients without an accessible central venou route. The procedure can be performed with high technical success and low complication rates under imaging guidance. PMID:27601303

  1. Compatibility of electrolytically produced sodium hypochlorite solutions on long- term implanted dialysis catheters.

    PubMed

    Mishkin, G J

    2007-01-01

    More than 20% of the world's population use a catheter for dialysis, despite guidelines limiting their use. Although the structure and design of the catheters differ by manufacturer, the material used in central venous catheters and peritoneal dialysis catheters are the same across manufacturers. Given the long-term use of these catheters in the dialysis population, the good compatibility of the antiseptics and disinfectants used on the catheters is imperative to prevent failure and cracking of the catheter material. Tensile strengths of commercially available catheters were measured after exposure to commonly used disinfectants. The tensile strength was then compared between the catheters by analyzing the displacement vs. force (N) curves produced during the evaluation. A total of 44 catheter lumens were evaluated. The electrolytically produced sodium hypochlorite solution, Alcavis 50/ExSept Plus, was the only solution shown to be compatible with all three catheter materials resulting in a deviation of less than 10% for each of the different catheter types. Electrolytically produced sodium hypochlorite solutions were the only solutions in this study that did not alter the physical properties of any of the catheters after long-term exposure.

  2. Affine Contractions on the Plane

    ERIC Educational Resources Information Center

    Celik, D.; Ozdemir, Y.; Ureyen, M.

    2007-01-01

    Contractions play a considerable role in the theory of fractals. However, it is not easy to find contractions which are not similitudes. In this study, it is shown by counter examples that an affine transformation of the plane carrying a given triangle onto another triangle may not be a contraction even if it contracts edges, heights or medians.…

  3. An in vitro urinary tract catheter system to investigate biofilm development in catheter-associated urinary tract infections.

    PubMed

    Dohnt, Katrin; Sauer, Marie; Müller, Maren; Atallah, Karin; Weidemann, Marina; Gronemeyer, Petra; Rasch, Detlev; Tielen, Petra; Krull, Rainer

    2011-12-01

    Biofilm development in urinary tract catheters is an often underestimated problem. However, this form of infection leads to high mortality rates and causes significant costs in health care. Therefore, it is important to analyze these biofilms and establish avoiding strategies. In this study a continuous flow-through system for the cultivation of biofilms under catheter-associated urinary tract infection conditions was established and validated. The in vitro urinary tract catheter system implies the composition of urine (artificial urine medium), the mean volume of urine of adults (1 mL min(-1)), the frequently used silicone catheter (foley silicon catheter) as well as the infection with uropathogenic microorganisms like Pseudomonas aeruginosa. Three clinical isolates from urine of catheterized patients were chosen due to their ability to form biofilms, their mobility and their cell surface hydrophobicity. As reference strain P. aeruginosa PA14 has been used. Characteristic parameters as biofilm thickness, specific biofilm growth rate and substrate consumption were observed. Biofilm thicknesses varied from 105±16 μm up to 246±67 μm for the different isolates. The specific biofilm growth rate could be determined with a non invasive optical biomass sensor. This sensor allows online monitoring of the biofilm growth in the progress of the cultivation.

  4. The female experience of ISC with a silicone catheter.

    PubMed

    Logan, Karen

    2017-01-26

    Intermittent self-catheterisation (ISC) is a safe and effective treatment in the management of neuropathic bladder, voiding dysfunction and urinary incontinence in women. ISC has been shown to improve quality of life when used appropriately. It provides freedom for individuals who require bladder drainage as they can choose where and when to catheterise to empty the bladder. ISC requires minimum equipment, is a more discreet solution than an indwelling catheter and is relatively easy to teach in one patient visit. There are a range of different ISC catheters available on prescription. Many have been designed specifically for women and patient choice regarding product selection is an important consideration. This article describes a UK patient-satisfaction survey evaluating the female patient's perspective of learning ISC using a silicone intermittent catheter called HydroSil Go(™) that is manufactured by C.R. Bard, Inc.

  5. Ultrasound-guided continuous quadratus lumborum block for postoperative analgesia in a pediatric patient.

    PubMed

    Chakraborty, Arunangshu; Goswami, Jyotsna; Patro, Viplab

    2015-02-01

    Quadratus lumborum block is a recently introduced variation of transversus abdominis plane block. In this report, we describe the use of ultrasound-guided continuous quadratus lumborum block for postoperative analgesia in a 7-year-old child scheduled to undergo radical nephrectomy (left-sided) for Wilms tumor. The result was excellent postoperative analgesia and minimal requirement for rescue analgesics. The modification described may allow easier placement of a catheter for continuous infusion of local anesthetic.

  6. Catheter-related bacteremia from femoral and central internal jugular venous access.

    PubMed

    Lorente, L; Jiménez, A; García, C; Galván, R; Castedo, J; Martín, M M; Mora, M L

    2008-09-01

    The objective of this prospective observational study was to determine the influence of femoral and central internal jugular venous catheters on the incidence of catheter-related bacteremia (CRB). We included patients admitted to a 12-bed polyvalent medico-surgical intensive care unit over 4 years who received one or more femoral or central internal jugular venous catheters. We diagnosed 16 cases of CRB in 208 femoral catheters and 22 in 515 central internal jugular venous catheters. We found a higher incidence of CRB with femoral (9.52 per 1,000 catheter days) than with central internal jugular venous access (4.83 per 1,000 catheter days; risk ratio = 1.93; 95% confidence interval: 1.03-3.73; P = 0.04). Central internal jugular venous access could be considered a safer route of venous access than femoral access in minimizing the risk of central venous catheter-related bacteremia.

  7. Intravascular catheter-related infections: advances in diagnosis, prevention, and management.

    PubMed

    Raad, Issam; Hanna, Hend; Maki, Dennis

    2007-10-01

    Indwelling vascular catheters are a leading source of bloodstream infections in critically ill patients and cancer patients. Because clinical diagnostic criteria are either insensitive or non-specific, such infections are often overdiagnosed, resulting in unnecessary and wasteful removal of the catheter. Catheter-sparing diagnostic methods, such as differential quantitative blood cultures and time to positivity have emerged as reliable diagnostic techniques. Novel preventive strategies include cutaneous antisepsis, maximum sterile barrier, use of antimicrobial catheters, and antimicrobial catheter lock solution. Management of catheter-related bloodstream infections involves deciding on catheter removal, antimicrobial catheter lock solution, and the type and duration of systemic antimicrobial therapy. Such decisions depend on the identity of the organism causing the bloodstream infection, the clinical and radiographical manifestations suggesting a complicated course, the underlying condition of the host (neutropenia, thrombocytopenia), and the availability of other vascular access sites.

  8. Adjacent central venous catheters can result in immediate aspiration of infused drugs during renal replacement therapy.

    PubMed

    Kam, K Y R; Mari, J M; Wigmore, T J

    2012-02-01

    Dual-lumen haemodiafiltration catheters enable continuous renal replacement therapy in the critically ill and are often co-located with central venous catheters used to infuse drugs. The extent to which infusions are immediately aspirated by an adjacent haemodiafiltration catheter remains unknown. A bench model was constructed to evaluate this effect. A central venous catheter and a haemodiafiltration catheter were inserted into a simulated central vein and flow generated using centrifugal pumps within the simulated vein and haemodiafiltration circuit. Ink was used as a visual tracer and creatinine solution as a quantifiable tracer. Tracers were completely aspirated by the haemodiafiltration catheter unless the infusion was at least 1 cm downstream to the arterial port. No tracer was aspirated from catheters infusing at least 2 cm downstream. Orientation of side ports did not affect tracer elimination. Co-location of central venous and haemodiafiltration catheters may lead to complete aspiration of infusions into the haemodiafilter with resultant drug under-dosing.

  9. Use of the Hickman catheter as permanent vascular access for hemodialysis.

    PubMed

    Kinnaert, P; Hooghe, L; De Pauw, L; Dhaene, M; Dratwa, M; Vanherweghem, J L

    1990-01-01

    Nineteen patients in whom it was impossible to create an arteriovenous (AV) fistula were hemodialyzed with adult Hickman catheters as the sole vascular access. Catheter survival was 45% at 1 year, with eight patients requiring two or three catheters for the continuation of their treatment. The probability of a patient still being dialyzed with a Hickman catheter at 1 year was 69%. The calculated risk of developing the most frequent complications was 0.07/100 catheter days for sepsis, 0.4/100 catheter days for thrombosis, and 0.06/100 catheter days for outflow obstruction. These figures seem quite acceptable, and the use of Hickman catheters as permanent vascular access is warranted in this category of difficult patient.

  10. Nosocomial bacteremia and catheter infection by Bacillus cereus in an immunocompetent patient.

    PubMed

    Hernaiz, C; Picardo, A; Alos, J I; Gomez-Garces, J L

    2003-09-01

    We present a case of Bacillus cereus bacteremia and catheter infection in an immunocompetent patient subjected to abdominal surgery, who recovered following central catheter removal and treatment with piperacillin/tazobactam.

  11. The supraclavicular fossa ultrasound view for central venous catheter placement and catheter change over guidewire.

    PubMed

    Kim, Se-Chan; Klebach, Christian; Heinze, Ingo; Hoeft, Andreas; Baumgarten, Georg; Weber, Stefan

    2014-12-23

    The supraclavicular fossa ultrasound view can be useful for central venous catheter (CVC) placement. Venipuncture of the internal jugular veins (IJV) or subclavian veins is performed with a micro-convex ultrasound probe, using a neonatal abdominal preset with a probe frequency of 10 Mhz at a depth of 10-12 cm. Following insertion of the guidewire into the vein, the probe is shifted to the right supraclavicular fossa to obtain a view of the superior vena cava (SVC), right pulmonary artery and ascending aorta. Under real-time ultrasound view, the guidewire and its J-tip is visualized and pushed forward to the lower SVC. Insertion depth is read from guidewire marks using central venous catheter. CVC is then inserted following skin and venous dilation. The supraclavicular fossa view is most suitable for right IJV CVC insertion. If other insertion sites are chosen the right supraclavicular fossa should be within the sterile field. Scanning of the IJVs, brachiocephalic veins and SVC can reveal significant thrombosis before venipuncture. Misplaced CVCs can be corrected with a change over guidewire technique under real-time ultrasound guidance. In conjunction with a diagnostic lung ultrasound scan, this technique has a potential to replace chest radiograph for confirmation of CVC tip position and exclusion of pneumothorax. Moreover, this view is of advantage in patients with a non-p-wave cardiac rhythm were an intra-cardiac electrocardiography (ECG) is not feasible for CVC tip position confirmation. Limitations of the method are lack of availability of a micro-convex probe and the need for training.

  12. Catheter use and infection reduction in plastic surgery

    PubMed Central

    Barnes, Zach J; Mahabir, Raman C

    2013-01-01

    BACKGROUND: Catheter-associated urinary tract infections (CAUTI) are the most common hospital-associated infection and can result in increased health care costs, morbidity and even mortality. In 2009, The Scott & White Memorial Hospital/Texas A&M Health Science Center (Texas, USA) system’s CAUTI rate placed it in the upper quartile (ie, highest rate) for the country, necessitating a system-wide change. OBJECTIVE: To design and implement a guideline to reduce the incidence of CAUTI. METHODS: A multidisciplinary team was formed and completed both a root cause analysis and a review of the available literature. Consolidating the best evidence, the team formulated a best practice guideline detailing the proper indications for insertion of, improper use of and techniques to minimize infection with catheters. Included as part of this protocol was nursing and patient education, changes in identifying patients with a catheter and automatic termination orders. Three-, six- and 12-month reviews identifying additional opportunities for improvement at the end of 2010 were completed. RESULTS: In 2009, the hospital’s CAUTI rate was 1.46 per 1000 catheter days. In 2011 – the first complete year of the finalized guideline – the hospital’s CAUTI rate was 0.52 per 1000 catheter days, ranking the institution in the bottom quartile (ie, lowest rate) for the country. The surgery and plastic surgery subgroup analyses also demonstrated statistically significant reduction in both catheter use and CAUTI. CONCLUSION: The incidence of CAUTI was successfully reduced at The Texas A&M Healthcare Center. The guideline, its development and how it applies to plastic surgery patients are discussed. PMID:24431946

  13. Lumbar Catheter Placement Using Paramedian Approach Under Fluoroscopic Guidance

    PubMed Central

    Qureshi, Adnan I.; Khan, Asif A.; Malik, Ahmed A.; Afzal, Mohammad Rauf; Herial, Nabeel A.; Qureshi, Mushtaq H.; Suri, M. Fareed K.

    2016-01-01

    Background Lumbar catheter placement under fluoroscopic guidance may reduce the rate of technical failures and associated complications seen with insertion guided by manually palpable landmarks. Methods We reviewed our experience with 43 attempted lumbar catheter placements using paramedian approach under fluoroscopic guidance and ascertained rates of technical success, and clinical events. Results Among the 43 patients, 18, 1, and 1 patients were on aspirin (with dipyrimadole in 2), clopidogrel, and combination of both, respectively. Lumbar catheter placement was successful in 42 of 43 attempted placements. Floroscopic guidance was critical in three patients; one patient had severe cerebrospinal fluid (CSF) depletion (empty thecal sac phenomenon) following pituitary surgery leading to no cerebrospinal fluid return despite correct placement confirmation under fluoroscopy. Two patients had spinal needle placement at the junction between epidural and cerebrospinal fluid spaces (junctional position) leading to cerebrospinal fluid return but inability to introduce the lumbar catheter. After confirmation of position by the injection of contrast or radiographic landmarks the needle was advanced by indenting the subcutaneous tissue or reinserting at a spinal level above the first insertion. The lumbar catheter remained in position over a mean period (±standard deviation) of 4.1(±2.3) days. Improvement in hydrocephalus was seen in two patients with intracranial mass lesions. One patient developed cerebrospinal fluid leakage through the insertion track following removal of catheter and required skin suturing at the site of insertion. Conclusions We observed a high technical success rate with low rate of complications even in patients with intracranial mass lesions, those on ongoing antiplatelet medications or in whom insertion would not be possible guided by manually palpable landmarks. PMID:26958156

  14. Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction.

    PubMed

    Roldan, Carlos J; Paniagua, Linda

    2015-09-01

    Despite the level of skill of the operator and the use of ultrasound guidance, central venous catheter (CVC) placement can result in CVC malpositioning, an unintended placement of the catheter tip in an inadequate vessel. CVC malpositioning is not a complication of central line insertion; however, undiagnosed CVC malpositioning can be associated with significant morbidity and mortality. The objectives of this review were to describe factors associated with intravascular malpositioning of CVCs inserted via the neck and chest and to offer ways of preventing, identifying, and correcting such malpositioning. A literature search of PubMed, Cochrane Library, and MD Consult was performed in June 2014. By searching for "Central line malposition" and then for "Central venous catheters intravascular malposition," we found 178 articles written in English. Of those, we found that 39 were relevant to our objectives and included them in our review. According to those articles, intravascular CVC malpositioning is associated with the presence of congenital and acquired anatomical variants, catheter insertion in left thoracic venous system, inappropriate bevel orientation upon needle insertion, and patient's body habitus variants. Although plain chest radiography is the standard imaging modality for confirming catheter tip location, signs and symptoms of CVC malpositioning even in presence of normal or inconclusive conventional radiography findings should prompt the use of additional diagnostic methods to confirm or rule out CVC malpositioning. With very few exceptions, the recommendation in cases of intravascular CVC malpositioning is to remove and relocate the catheter. Knowing the mechanisms of CVC malpositioning and how to prevent, identify, and correct CVC malpositioning could decrease harm to patients with this condition.

  15. Ultrasound/fluoroscopy-assisted placement of peritoneal dialysis catheters.

    PubMed

    Maya, Ivan D

    2007-01-01

    Peritoneal dialysis (PD) catheters may be inserted blindly, surgically, and either by laparoscopic, peritoneoscopic, or fluoroscopic approach. A modified fluoroscopic technique by adding ultrasound-assistance was performed in the present study to ensure entry into the abdominal cavity under direct ultrasound visualization. From March 2005 to May 2007, ultrasound-fluoroscopic guided placement of PD catheters was attempted in 32 end-stage renal disease (ESRD) patients. Preoperative evaluation was performed on all patients prior to the procedure. After initial dissection of the subcutaneous tissue anterior to the anterior rectus sheath, the needle was inserted into the abdominal cavity under the guidance of ultrasound. The position of the epigastric artery was also examined using ultrasonography to avoid the risk of arterial injury. PD catheters were successfully placed in 31 of the 32 ESRD patients using this technique. In all of these patients, the needle could be seen entering the abdominal cavity using an ultrasound. In one patient the procedure was abandoned because of bowel puncture by the micro-puncture needle that was inadvertently advanced into a loop of bowel. This patient did not develop acute abdomen nor needed any intervention. One patient died 4 days after placement of the catheter of unrelated causes. One patient was started on acute peritoneal dialysis the same day of catheter placement without any complications. The rest of the patients started peritoneal dialysis within 2-6 weeks of catheter placement. None of the patients had bleeding related to arterial injury as ultrasound was able to visualize the epigastric artery. Our experience shows that ultrasound-fluoroscopic technique is minimally invasive and allows for accurate assessment of the entry into the abdominal cavity. This technique can avoid the risk of vascular injury altogether.

  16. The Hunter pulmonary angiography catheter for a brachiocephalic vein approach.

    PubMed

    Rosen, Galia; Kowalik, Karen J; Ganguli, Suverano; Hunter, David W

    2006-01-01

    The purpose of this work was to describe our experience in performing pulmonary angiography using the Hunter pulmonary catheter, manufactured by Cook, Inc., which is a modified 6F pigtail catheter with a "C-shaped" curve, designed for a brachiocephalic vein approach. One hundred twenty-three patients underwent pulmonary angiograms using the Hunter catheter between August 1997 and January 2002. Operator comments were gathered in 86 (70%) of the cases. The operator was, if possible, the most junior resident on the service. Thirty-nine operators participated in the survey. Efficacy, safety, and ease of use of the catheter were determined by operators' comments and ECG observations during the procedure. Corroborating clinical data were gathered from medical records. In 68 (79%) of the procedures that were commented upon, the operator described insertion into the pulmonary artery (PA) as easy; only 2 (2%) indicated difficulty in accessing the PA. In 41 (63%) of the bilateral angiograms that were commented upon, the operator described accessing the left PA from the right PA as easy; only 6 (9%) rated it as difficult and all were with an older technique in which the catheter was withdrawn to the pulmonary bifurcation without a wire or with only the soft tip of the wire in the pigtail and then rotated to the left main pulmonary artery. Thirty-one of the 41 patients who demonstrated premature ventricular contractions (PVCs) had a previous history of heart disease. Nineteen of the 39 patients who did not have PVCs had a history of heart disease (p = 0.018). The maneuverability and shape of the Hunter catheter make pulmonary angiography an easy procedure, even for operators with minimal experience and limited technical proficiency. PVCs demonstrated a statistically significant correlation with a positive patient history for cardiac disease, rather than being a universal risk.

  17. The Hunter Pulmonary Angiography Catheter for a Brachiocephalic Vein Approach

    SciTech Connect

    Rosen, Galia Kowalik, Karen J.; Ganguli, Suverano; Hunter, David W.

    2006-12-15

    The purpose of this work was to describe our experience in performing pulmonary angiography using the Hunter pulmonary catheter, manufactured by Cook, Inc., which is a modified 6F pigtail catheter with a 'C-shaped' curve, designed for a brachiocephalic vein approach. One hundred twenty-three patients underwent pulmonary angiograms using the Hunter catheter between August 1997 and January 2002. Operator comments were gathered in 86 (70%) of the cases. The operator was, if possible, the most junior resident on the service. Thirty-nine operators participated in the survey. Efficacy, safety, and ease of use of the catheter were determined by operators' comments and ECG observations during the procedure. Corroborating clinical data were gathered from medical records. In 68 (79%) of the procedures that were commented upon, the operator described insertion into the pulmonary artery (PA) as easy; only 2 (2%) indicated difficulty in accessing the PA. In 41 (63%) of the bilateral angiograms that were commented upon, the operator described accessing the left PA from the right PA as easy; only 6 (9%) rated it as difficult and all were with an older technique in which the catheter was withdrawn to the pulmonary bifurcation without a wire or with only the soft tip of the wire in the pigtail and then rotated to the left main pulmonary artery. Thirty-one of the 41 patients who demonstrated premature ventricular contractions (PVCs) had a previous history of heart disease. Nineteen of the 39 patients who did not have PVCs had a history of heart disease (p = 0.018). The maneuverability and shape of the Hunter catheter make pulmonary angiography an easy procedure, even for operators with minimal experience and limited technical proficiency. PVCs demonstrated a statistically significant correlation with a positive patient history for cardiac disease, rather than being a universal risk.

  18. Initial experience with the use of porcine acellular dermal matrix (Strattice) for abdominal wall reinforcement after transverse rectus abdominis myocutaneous flap breast reconstruction.

    PubMed

    Cicilioni, Orlando; Araujo, Gerson; Mimbs, Nancy; Cox, Matthew D

    2012-03-01

    Reestablishing anterior rectus fascial integrity remains a clinical challenge after transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. The main concerns include herniation and bulging due to abdominal weakness. Mesh-assisted closure of the fascial defect has improved bulging and herniation rates but infection, extrusion, and encapsulation are serious concerns with mesh use. Biologic tissue matrices may overcome some of these mesh-related complications. The initial experience of using Strattice for fascial closure after TRAM flap procedure is described in this article. Strattice was in-lain and sutured between the anterior and posterior layers of the rectus fascia, at the rectus muscle donor site. The abdominal wall was closed with progressive tension sutures. Postoperative complications at the donor site were assessed. A total of 16 unilateral and 9 bilateral reconstructions were performed in 25 patients. Length of hospital stay was 2 to 3 days which is shorter than with mesh repair (typically 4-5 days). During a mean follow-up period of 14.0 months, complications occurred in 7 patients (28%): seroma formation (2), minor skin separation (2), superficial skin infection (2), and superficial wound dehiscence (1). Complications were not directly related to Strattice and all, except one (superficial skin infection), were resolved without surgical intervention. In all patients, routine abdominal functions were restored 4 months postoperatively. Strattice is a safe, alternative option to synthetic mesh for fascial repair following TRAM flap breast reconstruction. When used in conjunction with progressive tension suture closure of the abdominal wall, dynamic reconstruction of the abdominal wall with resumption of abdominal function is possible with Strattice.

  19. Using central venous catheter for suprapubic catheterization in cardiac surgery.

    PubMed

    Bilehjani, Eissa; Fakhari, Solmaz

    2017-01-01

    Suprapubic catheterization is an alternative method for urinary drainage that is used when transurethral catheterization fails. Traditionally, inserted large-bore suprapubic catheters may cause fatal complications. During the past decade, we used a small central venous catheter (CVC) suprapubicly in 16 male patients for the purpose of urinary drainage, when transurethral catheterization failed. The procedure is performed in no more than 10 minutes. Success rate was 100% and this approach did not lead to any complications. In conclusion, placing a CVC for suprapubic drainage is a safe method with a high success rate and we recommend it in patients with failed transurethral catheterization after a few attempts (2-3 attempts).

  20. Cardiac tamponade caused by central venous catheter in two newborns.

    PubMed

    Monteiro, Andrey José; Canale, Leonardo Secchin; Barbosa, Rodrigo; Méier, Milton

    2008-01-01

    Cardiac tamponade secondary to the use of central venous catheter is a rare complication; however, it is potentially reversible when it is caught in time. We report two cases of cardiac tamponade that was diagnosed using a transthoracic echocardiography, followed by urgent pericardiocentesis and surgical pericardial drainage as a complication from umbilical venous catheterization. In one case, the tip of the catheter was properly placed, and in the other case, it was not. In both cases, a hyperosmolar solution was being injected. Although it may be an uncommon situation, it should be always considered as a possibility in a newborn who develops cardiogenic shock without an apparent cause.

  1. Intracranial calcified pseudocyst reaction to a shunt catheter.

    PubMed

    Yowtak, June; Hughes, Douglas; Heger, Ian; Macomson, Samuel D

    2014-02-01

    A 9-year-old boy with spina bifida, Chiari II malformation, and hydrocephalus presented with signs of increased intracranial pressure consistent with a shunt malfunction. Radiological investigations revealed an intracranial calcified lesion along the ventricular catheter. A shunt tap revealed a translucent milky white fluid. The patient underwent a ventriculostomy and, eventually, a shunt revision. Pathology findings were consistent with the formation of dystrophic calcification and a pseudocyst around the shunt catheter. Postoperatively, the patient returned to his neurological baseline. This is, to the best of the authors' knowledge, the first report of an intracranial calcified pseudocyst in a patient with normal renal function.

  2. Catheter directed interventions for acute deep vein thrombosis

    PubMed Central

    Kohlbrenner, Ryan; Kolli, Kanti P.; Lehrman, Evan; Taylor, Andrew G.; Fidelman, Nicholas

    2016-01-01

    Venous thromboembolism (VTE) is an extremely common form of vascular disease and impacts a great number of patients worldwide. Acute deep vein thrombosis (DVT) is a subset of VTE and is traditionally been treated with anticoagulation. There is good quality data which suggests the use of catheter directed interventions for the treatment of acute DVT with the aim of reducing post-thrombotic syndrome (PTS). The present review will discuss the various therapies available for acute DVT, focusing on catheter directed interventions, ranging from traditional anticoagulation to the most novel forms of aspiration thrombectomy. PMID:28123980

  3. Imaging of the complications of peripherally inserted central venous catheters.

    PubMed

    Amerasekera, S S H; Jones, C M; Patel, R; Cleasby, M J

    2009-08-01

    Peripherally inserted central catheters (PICC) are widely used to provide central venous access, often in chronically ill patients with long-term intravenous access requirements. There are a number of significant complications related to both insertion and maintenance of PICC lines, including catheter malposition, migration, venous thrombosis, and line fracture. The incidence of these complications is likely to rise as the number of patients undergoing intravenous outpatient therapy increases, with a corresponding rise in radiologist input. This paper provides an overview of the relevant peripheral and central venous anatomy, including anatomical variations, and outlines the complications of PICC lines. Imaging examples demonstrate the range of radiological findings seen in these complications.

  4. Postoperative nutritional support using needle catheter feeding jejunostomy.

    PubMed Central

    Delany, H M; Carnevale, N; Garvey, J W; Moss, G M

    1977-01-01

    Needle catheter jejunostomy was used as an adjunctive surgical procedure in 110 patients. In 19 patients (or 17%) the jejunostomy was of value for the administration of post-operative nutritional support using an elemental diet and it may serve as an alternative route for the administration of supplementing fluids and electrolytes if intestinal function is intact. The clinical experience with the catheter jejunostomy establishes it as a satisfactory technique for postoperative nutritional support in patients requiring esophageal and proximal gastric resection and repair, and gastric surgery in the elderly and debilitated. It is also useful in patients undergoing complicated biliary, pancreatic, and duodenal surgery in whom anastomotic difficulties are anticipated. PMID:407853

  5. Knotted bowel: small-bowel obstruction from coiled peritoneal shunt catheters. Report of two cases.

    PubMed

    Sanan, A; Haines, S J; Nyberg, S L; Leonard, A S

    1995-06-01

    Knotting of a peritoneal catheter around a loop of bowel is a rare occurrence, which may lead to bowel obstruction. The incomplete removal of two ventriculoperitoneal shunts resulted in two cases of iatrogenically knotted peritoneal catheters. One patient underwent a laparotomy for relief of obstruction and the other was successfully treated by uncoiling the catheter by means of a wire passed into its lumen. A plan for management of a knotted peritoneal catheter is outlined.

  6. In-111-leukocyte scintigraphy for detection of infection associated with peritoneal dialysis catheters

    SciTech Connect

    Kipper, S.L.; Steiner, R.W.; Witztum, K.F.; Basarab, R.M.; Kipper, M.S.; Halpern, S.E.; Ashburn, W.L.

    1984-05-01

    In-111-labeled leukocytes were administered to 13 patients on continuous ambulatory peritoneal dialysis in order to locate catheter-associated infections. Using a marker to indicate the catheter exit site, infections of the catheter tunnel were correctly identified prior to surgery in 4 patients with relapsing peritonitis and infections of the exit site were diagnosed in 5 out of 7 patients. The authors conclude that In-111-leukocyte scintigraphy appears to be accurate in diagnosing peritoneal infections of the dialysis catheter tunnel.

  7. Visible Evidence of Lumbar Epidural Catheter Misplacement–A Critical Incident Case Report

    PubMed Central

    Butala, Beena; Parikh, Geeta; Pargi, Rajesh

    2017-01-01

    One of the causes of failed epidurals is catheter misplacement. Though various techniques of epidural space identification have been developed, none of them is 100% successful. Here, we present a case of lumbar epidural catheter misplacement in a patient scheduled to undergo right sided open nephrectomy. Catheter was found in the surgical field coming out of psoas major muscle. PMID:28274024

  8. The Ultrasound-Only Central Venous Catheter Placement and Confirmation Procedure.

    PubMed

    Saul, Turandot; Doctor, Michael; Kaban, Nicole L; Avitabile, Nicholas C; Siadecki, Sebastian D; Lewiss, Resa E

    2015-07-01

    The placement of a central venous catheter remains an important intervention in the care of critically ill patients in the emergency department. We propose an ultrasound-first protocol for 3 aspects of central venous catheter placement above the diaphragm: dynamic procedural guidance, evaluation for pneumothorax, and confirmation of the catheter tip location.

  9. Recurrent bacteraemia by 2 different Bacillus cereus strains related to 2 distinct central venous catheters.

    PubMed

    Koch, Andrea; Arvand, Mardjan

    2005-01-01

    A 14-y-old girl with osteosarcoma developed 3 episodes of catheter-related bacteraemia by Bacillus cereus. After removal of the first and insertion of a second Hickman catheter, further episodes of B. cereus bacteraemia occurred. PFGE analysis revealed that bacteraemic episodes related to each catheter were caused by a distinct B. cereus strain.

  10. [Experimental and clinical investigations on reapplicability of resterilized intravascular catheters (author's transl)].

    PubMed

    Langmaack, H; Mendera, C; Wenz, W; Wink, K; Lehnert, H; Daschner, F

    1982-01-01

    Catheters for cardiovascular and other angiographic investigations can be resterilized by ethyl-oxide. The procedure of sterilisation has to be controled permanently. Reapplicability of catheters has become quite common because of the high price of new catheters. In spite of optimal resterilisation and permanent controll some patients still get fever attacks, because endotoxins cannot be eliminated by this method.

  11. Eight plane IPND mechanical testing.

    SciTech Connect

    Zhao, A.; Guarino, V.; Wood, K.; Nephew, T.; Ayres, D.; Lee, A.; High Energy Physics; FNAL

    2008-03-18

    A mechanical test of an 8 plane IPND mechanical prototype, which was constructed using extrusions from the testing/tryout of the 16 cell prototype extrusion die in Argonne National Laboratory, was conducted. There were 4 vertical and 4 horizontal planes in this 8 plane IPND prototype. Each vertical plane had four 16 cell extrusions, while each horizontal plane had six 16 cell extrusions. Each plane was glued together using the formulation of Devcon adhesive, Devcon 60. The vertical extrusions used in the vertical planes shares the same dimensions as the horizontal extrusions in the horizontal planes with the average web thickness of 2.1 mm and the average wall thickness of 3.1 mm. This mechanical prototype was constructed with end-seals on the both ends of the vertical extrusions. The gaps were filled with epoxy between extrusions and end-seals. The overall dimension of IPND is 154.8 by 103.1 by 21.7 inches with the weight of approximately 1200 kg, as shown in a figure. Two similar mechanical tests of 3 layer and 11 layer prototypes have been done in order to evaluate the strength of the adhesive joint between extrusions in the NOvA detector. The test showed that the IPND prototype was able to sustain under the loading of weight of itself and scintillator. Two FEA models were built to verify the measurement data from the test. The prediction from FEA slice model seems correlated reasonably well to the test result, even under a 'rough' estimated condition for the wall thickness (from an untuned die) and an unknown property of 'garage type' extrusion. A full size of FEA 3-D model also agrees very well with the test data from strain gage readings. It is worthy to point out that the stress distribution of the structure is predominantly determined by the internal pressure, while the buckling stability relies more on the loading weight from the extrusions themselves and scintillate. Results of conducted internal pressure tests, including 3- cell, 11-cell and the IPND

  12. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review

    PubMed Central

    Meddings, Jennifer; Rogers, Mary A M; Krein, Sarah L; Fakih, Mohamad G; Olmsted, Russell N; Saint, Sanjay

    2014-01-01

    Background Catheter-associated urinary tract infections (CAUTI) are costly, common and often preventable by reducing unnecessary urinary catheter (UC) use. Methods To summarise interventions to reduce UC use and CAUTIs, we updated a prior systematic review (through October 2012), and a meta-analysis regarding interventions prompting UC removal by reminders or stop orders. A narrative review summarises other CAUTI prevention strategies including aseptic insertion, catheter maintenance, antimicrobial UCs, and bladder bundle implementation. Results 30 studies were identified and summarised with interventions to prompt removal of UCs, with potential for inclusion in the meta-analyses. By meta-analysis (11 studies), the rate of CAUTI (episodes per 1000 catheter-days) was reduced by 53% (rate ratio 0.47; 95% CI 0.30 to 0.64, p<0.001) using a reminder or stop order, with five studies also including interventions to decrease initial UC placement. The pooled (nine studies) standardised mean difference (SMD) in catheterisation duration (days) was −1.06 overall (p=0.065) including a statistically significant decrease in stop-order studies (SMD −0.37; p<0.001) but not in reminder studies (SMD, −1.54; p=0.071). No significant harm from catheter removal strategies is supported. Limited research is available regarding the impact of UC insertion and maintenance technique. A recent randomised controlled trial indicates antimicrobial catheters provide no significant benefit in preventing symptomatic CAUTIs. Conclusions UC reminders and stop orders appear to reduce CAUTI rates and should be used to improve patient safety. Several evidence-based guidelines have evaluated CAUTI preventive strategies as well as emerging evidence regarding intervention bundles. Implementation strategies are important because reducing UC use involves changing well-established habits. PMID:24077850

  13. SETI in the Ecliptic Plane

    NASA Astrophysics Data System (ADS)

    Conn Henry, Richard; Kilston, S.; Shostak, S.

    2008-05-01

    The strong advantages of SETI searches in the ecliptic plane have been pointed out by Kilston, Shostak, and Henry (2008). In our poster we show one possible history of civilizations in the galaxy, from birth, through galactic colonization, up to death - and even beyond. Should this scenario be correct, the pattern suggests that the best hope for success in SETI is exploration of the possibility that there are a few extremely ancient but non-colonizing civilizations; civilizations that, aeons ago, detected the existence of Earth (oxygen, and hence life) and of its Moon (stabilizing Earth's rotation) via observations of transits of the Sun (hence, ecliptic, which is stable over millions of years [Laskar et al. 2004]), and have been beaming voluminous information in our direction ever since, in their faint hope (now realized) that a technological "receiving” species would appear. To maintain such a targeted broadcast would be extremely cheap for an advanced civilization. A search of a swath centered on our ecliptic plane should easily find such civilizations, if they exist. We hope to carry out such a search, using the Allen Telescope Array. http://henry.pha.jhu.edu/poster.SETI.pdf References: Kilston, Steven; Shostak, Seth; & Henry, Richard Conn; "Who's Looking at You, Kid?: SETI Advantages near the Ecliptic Plane," AbSciCon 2008, April 14-17, Santa Clara, CA.; Laskar, J., et al., A&A 428, 261, 2004 This work was supported by Maryland Space Grant Consortium.

  14. Complications of Permanent Hemodialysis Catheter Placement; Need for Better Pre-Implantation Algorithm?

    PubMed

    Premuzic, Vedran; Smiljanic, Ranko; Perkov, Drazen; Gavranic, Bruna Brunetta; Tomasevic, Boris; Jelakovic, Bojan

    2016-08-01

    There is a correlation between central venous cannulation and the development of central venous stenosis. Minor retrosternal vein lesions can be easily missed. Computerized tomographic (CT) venography is the diagnostic procedure of choice. The aim of this study was to examine the complications after catheter implantation in patients with prior permanent catheter placement and to evaluate present diagnostic procedures performed prior to choosing permanent access site in order to reduce possible complications after catheter placement. Complications of permanent CVC insertion in our department were analyzed between October 2011 and February 2015. We have implanted the Tesio twin catheter system and the Hickman Bard dual lumen catheter. All patients with prior permanent dialysis catheter were evaluated with color doppler, while patients with suspected central venous stenosis (CVS) or thrombosis were evaluated with phlebography or CT venography prior to catheter placement. One hundred and ninety-eight permanent dialysis catheters were placed (173 Tesio [87.4%] and 25 Hickman [12.6%]) in 163 patients. There were 125 patients (76.7%) with prior temporary catheter and 61 (48.8%) of them had more than one prior permanent catheter (1.92 catheter per person).There were 4/61 (6.5%) patients with catheter-related complications without prior phlebography and CT venography. Phlebography and CT venography were performed in 30 (24.0%) patients with suspected CVS/thrombosis and with dialysis vintage of 76.23 months (52.78-98.28). Phlebography and CT venography were more sensitive than color doppler in the detection of CVS/thrombosis in patients with prior permanent catheter placements (P < 0.001). Since this diagnostic algorithm was introduced prior to catheter placement there were no catheter insertion-related complications or dysfunctions (P < 0.001). All our procedures on patients with prior permanent catheters followed preliminary color doppler diagnostics. Nevertheless

  15. Staphylococcus-Infected Tunneled Dialysis Catheters: Is Over-the-Wire Exchange an Appropriate Management Option?

    SciTech Connect

    Langer, Jessica M.; Cohen, Raphael M.; Berns, Jeffrey S.; Chittams, Jesse; Cooper, Emily T.; Trerotola, Scott O.

    2011-12-15

    Purpose: Over-the-wire exchange of tunneled dialysis catheters is the standard of care per K/DOQI guidelines for treating catheter-related bacteremia. However, Gram-positive bacteremia, specifically with staphylococcus species, may compromise over-the-wire exchange due to certain biological properties. This study addressed the effectiveness of over-the-wire exchange of staphylococcus-infected tunneled dialysis catheters compared with non-staphylococcus-infected tunneled dialysis catheters. Methods: Patients who received over-the-wire exchange of their tunneled dialysis catheter due to documented or suspected bacteremia were identified from a QA database. Study patients (n = 61) had positive cultures for Staphylococcus aureus, Staphylococcus epidermidis, or coagulase-negative staphylococcus not otherwise specified. Control patients (n = 35) received over-the-wire exchange of their tunneled dialysis catheter due to infection with any organism besides staphylococcus. Overall catheter survival and catheter survival among staphylococcal species were assessed. Results: There was no difference in tunneled dialysis catheter survival between study and control groups (P = 0.46). Median survival time was 96 days for study catheters and 51 days for controls; survival curves were closely superimposed. There also was no difference among the three staphylococcal groups in terms of catheter survival (P = 0.31). The median time until catheter removal was 143 days for SE, 67 days for CNS, and 88 days for SA-infected catheters. Conclusions: There is no significant difference in tunneled dialysis catheter survival between over-the-wire exchange of staphylococcus-infected tunneled dialysis catheters and those infected with other organisms.

  16. Daptomycin Antibiotic Lock Therapy in a Rat Model of Staphylococcal Central Venous Catheter Biofilm Infections▿

    PubMed Central

    Van Praagh, Andrew D. G.; Li, Tongchuan; Zhang, Shuxin; Arya, Anu; Chen, Liping; Zhang, Xi-Xian; Bertolami, Shellie; Mortin, Lawrence I.

    2011-01-01

    Antibiotic lock therapy (ALT) is an adjunctive procedure to prevent or treat central venous catheter infections, ensuing catheter-related bacteremia, and catheter-related metastatic infections. Daptomycin is a cyclic lipopeptide that is rapidly bactericidal against methicillin-susceptible and -resistant Staphylococcus aureus. The efficacies of daptomycin against central venous catheter biofilms, catheter-related bacteremia, and catheter-related metastatic infections were evaluated by adapting a previously reported central venous catheter biofilm model in rats. Combined daptomycin ALT and systemic dosing resulted in the clearance of an established in vivo S. aureus central venous catheter biofilm after just two daily ALT treatments (30 min with daptomycin at 5 mg/ml) with concurrent systemic daptomycin dosing (40 mg/kg of body weight/day subcutaneously [s.c.]; equivalent exposure of 6 mg/kg/day in people). Daptomycin ALT solutions formulated in either saline or lactated Ringer's solution were equally fast in eradicating established in vivo methicillin-resistant Staphylococcus epidermidis (MRSE) central venous catheter biofilms. However, the lactated Ringer's formulation was superior to that of saline in sustaining the bacterial clearance of treated central venous catheters (83% versus 50%). In MRSE-infected central venous catheter studies, 3 days of daptomycin or vancomycin ALT (18 h at 5 mg/ml) with systemic s.c. dosing (40 mg/kg/day daptomycin or 100 mg/kg/day vancomycin) was equally effective 1 week posttherapy in maintaining cleared central venous catheters (90% [n = 10] versus 100% [n = 8]). These results suggest that daptomycin ALT, along with systemic dosing, could be an effective treatment option for the prevention or eradication of staphylococcal central venous catheter biofilm infections, thereby reducing the occurrence of catheter-related bacteremia or catheter-related metastatic infections. PMID:21709082

  17. Hemodynamics of Central Venous Catheters: experiments and simulations

    NASA Astrophysics Data System (ADS)

    Barbour, Michael; McGah, Patrick; Clark, Alicia; Ng, Chin Hei; Gow, Kenneth; Aliseda, Alberto

    2013-11-01

    Central venous catheters (CVC) are used to provide vascular access during hemodialysis in patients with end-stage kidney disease. Despite several advantages and widespread use, CVCs have a high incidence rate of clot formation during the interdialytic phase (48 hrs). In an attempt the prevent clot formation, hospitals routinely administer heparin, an anticoagulant, into the catheter after a dialysis session. It has been reported, however, that up to 40% of the heparin solution will leak into the blood stream during the interdialytic phase, placing the patient at risk for systemic bleeding incidences. The aim of this study is to determine the role that advective-diffusive transport plays in the heparin leaking process. Numerical simulations of heparin convective mass transfer have been conducted, showing that while advective losses may be significant at the tip, previous studies may be overestimating the total amount of heparin leakage. To validate the quantitative prediction from the simulations, P.L.I.F. is used to experimentally measure heparin transport from CVCs placed in an idealized Superior Vena Cava with physically accurate pulsatile flow conditions. Improved understanding of flow near the catheter tip is applied to improve catheter design and heparin locking procedures.

  18. Prevention of central venous catheter-related infection: update.

    PubMed

    Casey, Anna L; Elliott, Tom S J

    Central venous catheters (CVCs) are an essential part of modern-day healthcare, but infections associated with these devices continue to cause significant morbidity and mortality. There are many approaches for the prevention of CVC-related infection and these are outlined in national guidelines. The Department of Health Saving Lives campaign has developed a care-bundle for the prevention of CVC-related infections that focuses on the fundamental actions to be undertaken during the catheter insertion process and ongoing care. If the rate of catheter-related infection remains high despite the implementation of these infection prevention strategies, the use of novel antimicrobial technologies and practices may be considered. These include CVCs that contain antimicrobial agents, such as antiseptics or antibiotics, needleless intravenous (IV) access devices coated with silver and/or chlorhexidine, IV dressings incorporating chlorhexidine, and the use of antimicrobial catheter lock solutions, such as antibiotics, chelators or ethanol. This article outlines the different types of CVCs available, the risk of infection associated with their use and established and novel measures for prevention of these infections.

  19. [Complications of double j catheters and their endourological management].

    PubMed

    Pérez-Fentes, D

    2016-10-01

    The insertion of a double J catheter (DJ) has widespread, becoming a usual procedure and standard of care in urology. Despite its relative simplicity it is not free from intraoperative risks or problems during the weeks after the implant. Conversely, despite great advances in design of these catheters the ideal material has not been discovered yet, one that is perfectly biocompatible with urine and avoids completely the advent of complications. The range of problems associated with DJs is variable: from mild self-limited dysuria or hematuria to more complex situations with higher risk, such as catheter migration, complete calcification, breakage, obstruction and renal unit loss. The treatment of theses complications must combine maximal efficacy for their resolution with the least possible surgical aggression. Accordingly, the different options of endourological approach become very important and they are the cornerstone for the treatment of the complications associated with ureteral catheters. The objective of this review is to present the main complications derived from the insertion of a DJ, their diagnosis, prevention and treatment, focusing mainly in the different endourological techniques.

  20. Development of catheters for combined intravascular ultrasound and photoacoustic imaging

    NASA Astrophysics Data System (ADS)

    Karpiouk, Andrei B.; Wang, Bo; Emelianov, Stanislav Y.

    2009-02-01

    Coronary atherosclerosis is a complex disease accompanied by the development of plaques in the arterial wall. Since the vulnerability of the plaques depends on their composition, the appropriate treatment of the arteriosclerosis requires a reliable characterization of the plaques' geometry and content. The intravascular ultrasound (IVUS) imaging is capable of providing structural details of the plaques as well as some functional information. In turn, more functional information about the same plaques can be obtained from intravascular photoacoustic (IVPA) images since the optical properties of the plaque's components differ from that of their environment. The combined IVUS/IVPA imaging is capable of simultaneously detecting and differentiating the plaques, thus determining their vulnerability. The potential of combined IVUS/IVPA imaging has already been demonstrated in phantoms and ex-vivo experiments. However, for in-vivo or clinical imaging, an integrated IVUS/IVPA catheter is required. In this paper, we introduce two prototypes of integrated IVUS/IVPA catheters for in-vivo imaging based on a commercially available single-element IVUS imaging catheter. The light delivery systems are developed using multimode optical fibers with custom-designed distal tips. Both prototypes were tested and compared using an arterial mimicking phantom. The advantages and limitations of both designs are discussed. Overall, the results of our studies suggest that both designs of integrated IVUS/IVPA catheter have a potential for in-vivo IVPA/IVUS imaging of atherosclerotic plaques.

  1. Combined forceps and catheter extraction of an oesophageal foreign body.

    PubMed

    al-Shahi, R; O'Connell, M; Huchzermeyer, P; Moore-Gillon, V

    1997-06-01

    The extraction of impacted foreign bodies from the oesophagus is frequently performed using forceps under endoscopic guidance. We report the case of a 23-year-old prisoner who ingested a lump of cannabis resin which could not be removed from the upper oesophagus with forceps alone. We recommend the use of a Fogarty balloon catheter in conjunction with toothed forceps in such cases.

  2. Catheter ablation in patients with persistent atrial fibrillation

    PubMed Central

    Kirchhof, Paulus; Calkins, Hugh

    2017-01-01

    Catheter ablation is increasingly offered to patients who suffer from symptoms due to atrial fibrillation (AF), based on a growing body of evidence illustrating its efficacy compared with antiarrhythmic drug therapy. Approximately one-third of AF ablation procedures are currently performed in patients with persistent or long-standing persistent AF. Here, we review the available information to guide catheter ablation in these more chronic forms of AF. We identify the following principles: Our clinical ability to discriminate paroxysmal and persistent AF is limited. Pulmonary vein isolation is a reasonable and effective first approach for catheter ablation of persistent AF. Other ablation strategies are being developed and need to be properly evaluated in controlled, multicentre trials. Treatment of concomitant conditions promoting recurrent AF by life style interventions and medical therapy should be a routine adjunct to catheter ablation of persistent AF. Early rhythm control therapy has a biological rationale and trials evaluating its value are underway. There is a clear need to generate more evidence for the best approach to ablation of persistent AF beyond pulmonary vein isolation in the form of adequately powered controlled multi-centre trials. PMID:27389907

  3. Fiber photo-catheters for laser treatment of atrial fibrillation

    PubMed Central

    Peshko, Igor; Rubtsov, Vladimir; Vesselov, Leonid; Sigal, Gennady; Laks, Hillel

    2009-01-01

    A fiber photo-catheter has been developed for surgical treatment of atrial fibrillation with laser radiation. Atrial fibrillation (AF) is a heart rhythm abnormality that involves irregular and rapid heartbeats. Recent studies demonstrate the superiority of treating AF disease with optical radiation of the near infrared region. To produce long continuous transmural lesions, solid-state lasers and laser diodes, along with end-emitting fiber catheters, have been used experimentally. The absence of side-emitting flexible catheters with the ability to produce long continuous lesions limits the further development of this technology. In this research, a prototype of an optical catheter, consisting of a flexible 10-cm fiber diffuser has been used to make continuous photocoagulation lesions for effective maze procedure treatments. The system also includes: a flexible optical reflector; a series of openings for rapid self-attachment to the tissue; and an optional closed-loop irrigating chamber with circulating saline to cool the optical diffuser and irrigate the tissue. PMID:19587838

  4. An abdominal wall simulator for testing suprapubic urinary catheters.

    PubMed

    Coveney, V A; Gröver, D

    2001-08-01

    Urinary catheters (drainage tubes) are in widespread use. The most common type of long-term catheter is the Foley, which is made from natural or synthetic rubber. Foley catheters are passed into the bladder via the urethra or the suprapubic puncture channel (through the abdominal wall). A simulator for the abdominal wall has been developed to simulate aspects of the interaction between it and a suprapubic catheter. The simulator is based on a slab of ultrasoft elastomer with tensionable reinforcing polyamide filaments. The behaviour of the simulator has been compared with data published. A soft membrane (contact pressure) transducer (SMT) was used and novel instrumented 'tongs' for lateral indentation of the puncture track giving indentation stiffness. Slab materials were used with shear moduli of 0.1 and 0.021 MPa. Two filament-tensioning methods were used: by clamping to a winding mechanism and by weights. The combination of the softer slab material and tensioning by weights gave good conformity to physiological data; other combinations did not.

  5. Pneumothorax as a complication of central venous catheter insertion.

    PubMed

    Tsotsolis, Nikolaos; Tsirgogianni, Katerina; Kioumis, Ioannis; Pitsiou, Georgia; Baka, Sofia; Papaiwannou, Antonis; Karavergou, Anastasia; Rapti, Aggeliki; Trakada, Georgia; Katsikogiannis, Nikolaos; Tsakiridis, Kosmas; Karapantzos, Ilias; Karapantzou, Chrysanthi; Barbetakis, Nikos; Zissimopoulos, Athanasios; Kuhajda, Ivan; Andjelkovic, Dejan; Zarogoulidis, Konstantinos; Zarogoulidis, Paul

    2015-03-01

    The central venous catheter (CVC) is a catheter placed into a large vein in the neck [internal jugular vein (IJV)], chest (subclavian vein or axillary vein) or groin (femoral vein). There are several situations that require the insertion of a CVC mainly to administer medications or fluids, obtain blood tests (specifically the "central venous oxygen saturation"), and measure central venous pressure. CVC usually remain in place for a longer period of time than other venous access devices. There are situations according to the drug administration or length of stay of the catheter that specific systems are indicated such as; a Hickman line, a peripherally inserted central catheter (PICC) line or a Port-a-Cath may be considered because of their smaller infection risk. Sterile technique is highly important here, as a line may serve as a port of entry for pathogenic organisms, and the line itself may become infected with organisms such as Staphylococcus aureus and coagulase-negative Staphylococci. In the current review we will present the complication of pneumothorax after CVC insertion.

  6. Force Control of Flexible Catheter Robots for Beating Heart Surgery

    PubMed Central

    Kesner, Samuel B.; Howe, Robert D.

    2011-01-01

    Recent developments in cardiac catheter technology promise to allow physicians to perform most cardiac interventions without stopping the heart or opening the chest. However, current cardiac devices, including newly developed catheter robots, are unable to accurately track and interact with the fast moving cardiac tissue without applying potentially damaging forces. This paper examines the challenges of implementing force control on a flexible robotic catheter. In particular, catheter friction and backlash must be compensated when controlling tissue interaction forces. Force controller designs are introduced and evaluated experimentally in a number of configurations. The controllers are based on the inner position loop force control approach where the position trajectory is adjusted to achieve a desired force on the target. Friction and backlash compensation improved force tracking up to 86% with residual RMS errors of 0.11 N while following a prerecorded cardiac tissue trajectory with accelerations of up to 3800 mm/s2. This performance provides sufficient accuracy to enable a wide range of beating heart surgical procedures. PMID:21874164

  7. [Arterial lesions caused by the Fogarty catheter (author's transl)].

    PubMed

    Natali, J; Kieffer, E; Laurian, C; Chermet, J; Maraval, M

    1977-01-01

    The authors report 7 cases of arterial wound consecutive to the use of the Fogarty catheter: 1 rupture, 1 perforation, 2 arteriovenous fistulae. They investigate the mechanism and stress the importance of preoperative angiography to minimize the risk of unknwon anomalies. Also they indicate the ease and efficiency of the surgical correction when needed.

  8. 21 CFR 882.5150 - Intravascular occluding catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Intravascular occluding catheter. 882.5150 Section 882.5150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5150...

  9. 21 CFR 882.5150 - Intravascular occluding catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Intravascular occluding catheter. 882.5150 Section 882.5150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5150...

  10. 21 CFR 882.5150 - Intravascular occluding catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Intravascular occluding catheter. 882.5150 Section 882.5150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5150...

  11. 21 CFR 882.5150 - Intravascular occluding catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Intravascular occluding catheter. 882.5150 Section 882.5150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5150...

  12. 21 CFR 882.5150 - Intravascular occluding catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Intravascular occluding catheter. 882.5150 Section 882.5150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5150...

  13. 21 CFR 880.5210 - Intravascular catheter securement device.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Intravascular catheter securement device. 880.5210 Section 880.5210 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal...

  14. 21 CFR 880.5210 - Intravascular catheter securement device.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Intravascular catheter securement device. 880.5210 Section 880.5210 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal...

  15. 21 CFR 870.1350 - Catheter balloon repair kit.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Catheter balloon repair kit. 870.1350 Section 870.1350 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... effect the repair or replacement. (b) Classification. Class III (premarket approval). (c) Date PMA...

  16. 21 CFR 870.1350 - Catheter balloon repair kit.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Catheter balloon repair kit. 870.1350 Section 870.1350 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... effect the repair or replacement. (b) Classification. Class III (premarket approval). (c) Date PMA...

  17. Complications of flow-directed balloon-tipped catheters.

    PubMed

    Smart, F W; Husserl, F E

    1990-01-01

    Acute or short-term complications following the use of flow-directed balloon-tipped catheters are well recognized. Long-term sequelae are rarely reported. We report herein an early complication of pulmonary arterial rupture with infarction followed by the delayed development of a pulmonary arterial aneurysm.

  18. Antibiotics on urethral catheter withdrawal: a hit and miss affair.

    PubMed

    Wazait, H D; van der Meullen, J; Patel, H R H; Brown, C T; Gadgil, S; Miller, R A; Kelsey, M C; Emberton, M

    2004-12-01

    Globally, millions of patients undergo urethral catheterization every year. Our objective was to study the current use of prophylactic antibiotics on urinary catheter withdrawal. A questionnaire (N = 300) was sent to healthcare professionals involved in the management of patients with urinary catheters (consultant microbiologists, infection control nurses, consultant urologists, specialist nurses in urology, continence advisers and consultants in the care of older people). The questionnaire asked about their use of prophylactic antibiotics on the withdrawal of a urethral catheter. Sixty percent of healthcare professionals advocated the use of antibiotics for either all or selected groups of patients. The remainder did not. The use of prophylactic antibiotics varied among different groups. Of the healthcare professionals who used antibiotics, the majority cited more than one reason for their use (prevent bacteraemia, avoid an infection in a prosthesis or urinary tract infection). The course and type of antibiotic used varied. Our study has shown diversity in practice that is of concern. At present, just over one-half of patients with urinary catheters are being given antibiotics, although there is no evidence to suggest that such an intervention confers any benefit. If benefits do not exist, these patients are being exposed to the harm of antibiotics and providers are incurring costs unnecessarily. A formal trial to address this issue is urgently needed.

  19. Minimizing Hemodialysis Catheter Dysfunction: An Ounce of Prevention

    PubMed Central

    Lee, Timmy; Lok, Charmaine; Vazquez, Miguel; Moist, Louise; Maya, Ivan; Mokrzycki, Michele

    2012-01-01

    The maintenance of tunneled catheter (TC) patency is critical for the provision of adequate hemodialysis in patients who are TC-dependent. TC dysfunction results in the need for costly and inconvenient interventions, and reduced quality of life. Since the introduction of TCs in the late 1980s, heparin catheter lock has been the standard prophylactic regimen for the prevention of TC dysfunction. More recently, alternative catheter locking agents have emerged, and in some cases have shown to be superior to heparin lock with respect to improving TC patency and reducing TC-associated infections. These include citrate, tissue plasminogen activator, and a novel agent containing sodium citrate, methylene blue, methylparaben, and propylparaben. In addition, prophylaxis using oral anticoagulants/antiplatelet agents, including warfarin, aspirin, ticlodipine, as well as the use of modified heparin-coated catheters have also been studied for the prevention of TC dysfunction with variable results. The use of oral anticoagulants and/or antiplatelet agents as primary or secondary prevention of TC dysfunction must be weighed against their potential adverse effects, and should be individualized for each patient. PMID:22518310

  20. Management of non-catheter-associated complicated urinary tract infection.

    PubMed

    Dielubanza, Elodi J; Mazur, Daniel J; Schaeffer, Anthony J

    2014-03-01

    This article presents an overview of non-catheter-associated complicated urinary tract infection (UTI) from a urologic point of view. Discussion includes the evaluation and workup a complicated UTI through history, physical examination, laboratory analysis, and radiographic studies. Specific types of complicated UTI, such as urinary obstruction and renal abscess, are reviewed.